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BackgroundObjectiveMethodsResultsConclusionsDisproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers.The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic.A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis.Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time.Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic. [ABSTRACT FROM AUTHOR]

An increase in respiratory rate (RR) can be an early indicator of clinical deterioration, yet it remains an often-neglected vital sign. The most common way of measuring RR is by manually counting chest-wall movements, a time-consuming and error-prone process. Staffing and funding shortages, particularly in post-acute and long-term care, mean these RR measurements are often infrequent, potentially leading to missed diagnoses and preventable readmissions. Here we present a case series from skilled nursing facilities, highlighting how continuous respiratory monitoring using a contactless remote patient monitoring (RPM) system can support clinicians in initiating timely interventions, potentially reducing preventable hospitalizations, mortality, and associated financial implications.

In its current state the German healthcare system will not be able to adequately care for a growing proportion of older patients with a decreasing healthcare work force. This is particularly so in the postacute care of severely ill patients. In a second of two parts we discuss the perspectives and options at hand. A major conclusion is that substantial gains could be obtained by regulatory adjustments that better align acute care and rehabilitative measures. [ABSTRACT FROM AUTHOR]

Background: The extent to which a positive delirium screening and new diagnosis of Alzheimer's disease or related dementias (ADRD) increases the risk for re-hospitalization, long-term nursing home placement, and death remains unknown. Objective: To compare long-term outcomes among newly admitted skilled nursing facility (SNF) patients with delirium, incident ADRD, and both conditions. Design, Setting, and Participants: A retrospective cohort study of Medicare beneficiaries who entered a SNF from hospital with a minimum 14-day stay (n = 100,832) from 2015 to 2016. Main Measures: Return to home, hospital readmission, admission to a long-term care facility, or death. Key Results: Patients with delirium were as likely to be discharged home as patients diagnosed with ADRD (HR: 0.63, 95% CI: 0.59, 0.67; HR: 0.65, 95% CI: 0.64, 0.67). Patients with both delirium and ADRD were less likely to be discharged home (HR: 0.49, 95% CI: 0.47, 0.52) and showed increased risk of death (HR: 1.30, 95% CI: 1.17, 1.45). Patients with ADRD, regardless of delirium screening status, had increased risk for long-term nursing home care transfer (HR: 1.66, 95% CI: 1.63, 1.70; HR: 1.76, 95% CI: 1.69, 1.82). Patients with delirium and no ADRD showed increased risk of transfer to long-term nursing home care (HR: 1.25, 95% CI: 1.18, 1.33). The rate of deaths was higher among patients who screened positive for delirium without ADRD compared to the no delirium and no ADRD groups (HR: 2.35, 95% CI: 2.11, 2.61). Conclusion: A positive delirium screening increased risk of death and transfer to long-term care in the first 100 days after admission regardless of incident ADRD diagnosis. Patients with delirium and/or ADRD also are less likely to be discharged home. Our study builds on the evidence base that delirium is important to address in older adults as it is associated with negative outcomes. [ABSTRACT FROM AUTHOR]

The article presents a study which identified the educational content encountered by students while in the nursing home to inform curricular design and to assess the effectiveness of this hands on skilled nursing facility (SNF) experience based on positive perception from students and rich endorsement from written feedback. Topics include coding categories based on faculty consensus, challenges in initiating and maintaining the SNF visits, and primary threat to preserving this experience.

Need for discharge to intermediate care (DCIC) can increase length of stay and be a source of stress to patients. Estimating risk of DCIC would allow earlier involvement of case managers, improve length of stay and patient satisfaction by setting realistic expectations. The aim was to use National Surgical Quality Improvement Program dataset to develop a prediction model for DCIC after undergoing liver metastasectomy. Data were obtained from National Surgical Quality Improvement Program 2011-2018 covering liver metastasectomy. Recursive partitioning narrowed potential predictors and identified thresholds for categorization of continuous variables. Logistic regression identified a predictive model, internally validated by using 200 bootstrap samples with replacement. A risk score was derived using Framingham Study methodology by dividing all regression coefficients by the smallest model coefficient. Receiver operating characteristic analysis identified the score that maximized sensitivity/specificity, defining low/high risk. Finally, recursive partitioning identified categories low/medium/high. The most parsimonious model predicting DCIC area under the curve (, 0.722, 95%CI: 0.705-0.739) identified five independent predictors including age >60, procedure type, hypertension requiring medication, albumin <3.5 mg/dL and hematocrit <30%. Internal validation resulted in expected bias-corrected area under the curve of 0.717, 95% CI: 0.698-0.732. The maximum score was 17.9 and 5.8 maximized sensitivity (sn) and specificity (sp) [sn = 81%, sp = 51%) predicting DCIC. Stratified into three groups, a score ≥9.5 identified highest risk (12.8%), ≥4.3 medium (6.1%) and <4.3 lowest risk (1.5%). Determining risk of DCIC benefits shared decision making and patient care. This evidence may enhance discharge planning after liver metastasectomy expediting the process. Age >60 contributed the most weight to the score, but the use of additional variables in three groups allowed further discrimination between patients. [ABSTRACT FROM AUTHOR]

Objectives: Group mental health interventions are difficult to implement into rehabilitation facilities, but no one has studied the specific barriers. This mixed-methods project systematically examined the implementation of a mental health (MH) group intervention in a VA community living center (CLC) for residents on subacute rehabilitation units, using the Promoting Action on Research Implementation in Health Services (PARIHS) implementation framework. Methods: We implemented a group MH intervention, tracking team referrals, attendance rates, and reasons for declining to participate. We conducted qualitative interviews with attendees. Results: Individual barriers to attendance included acute illness (n = 67, 20%), attitudes toward MH (n = 50; 15%), and perceived busyness (n = 19; 6%). Facility barriers included competing appointments (n = 69; 21%). Interviews demonstrated challenges to implementation, including stigma toward mental health (Theme: Challenges and Supports to Implementation). Attendees found the group relatable, and noted that both positive and negative group dynamics contributed to their experience (Themes: Content Relevance and Group Dynamics). Conclusions: The results provide insight into implementing a group MH treatment into the CLC setting, with implications for the MH care of older adults residing in CLCs. Clinical Implications: 1) Group leaders should consider matching attendees for ability levels (physical or cognitive). 2) At the facility level, leaders may take steps to address stigma toward MH by adopting approaches (e.g., music) or framing MH issues (e.g., use of language) in a way that is approachable. 3) Modifiable barriers at the individual and facility level could be addressed to encourage ease of implementation. [ABSTRACT FROM AUTHOR]

To examine the risk of contracting SARS-CoV-2 during a post-acute skilled nursing facility (SNF) stay and the associated risk of death. Cohort study using Minimum Data Set and electronic health record data from a large multistate long-term care provider. Primary outcomes included testing positive for SARS-CoV-2 during the post-acute SNF stay, and death among those who tested positive. The sample included all new admissions to the provider's 286 SNFs between January 1 and December 31, 2020. Patients known to be infected with SARS-CoV-2 at the time of admission were excluded. SARS-CoV-2 infection and mortality rates were measured in time intervals by month of admission. A parametric survival model with SNF random effects was used to measure the association of patient demographic factors, clinical characteristics, and month of admission, with testing positive for SARS-CoV-2. The sample included 45,094 post-acute SNF admissions. Overall, 5.7% of patients tested positive for SARS-CoV-2 within 100 days of admission, with 1.0% testing positive within 1-14 days, 1.4% within 15-30 days, and 3.4% within 31-100 days. Of all newly admitted patients, 0.8% contracted SARS-CoV-2 and died, whereas 6.7% died without known infection. Infection rates and subsequent risk of death were highest for patients admitted during the first and third US pandemic waves. Patients with greater cognitive and functional impairment had a 1.45 to 1.92 times higher risk of contracting SARS-CoV-2 than patients with less impairment. The absolute risk of SARS-CoV-2 infection and death during a post-acute SNF admission was 0.8%. Those who did contract SARS-CoV-2 during their SNF stay had nearly double the rate of death as those who were not infected. Findings from this study provide context for people requiring post-acute care, and their support systems, in navigating decisions around SNF admission during the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

An increase in respiratory rate (RR) can be an early indicator of clinical deterioration, yet it remains an often-neglected vital sign. The most common way of measuring RR is by manually counting chest-wall movements, a time-consuming and error-prone process. Staffing and funding shortages, particularly in post-acute and long-term care, mean these RR measurements are often infrequent, potentially leading to missed diagnoses and preventable readmissions. Here we present a case series from skilled nursing facilities, highlighting how continuous respiratory monitoring using a contactless remote patient monitoring (RPM) system can support clinicians in initiating timely interventions, potentially reducing preventable hospitalizations, mortality, and associated financial implications. [ABSTRACT FROM AUTHOR]

Objectives: Analyze the information-seeking practices and identify the information and education needs of nurses in a war veterans nursing home. Develop an online toolkit for use at the nurses' stations to meet nurses' health information needs. Methods: Investigators employed mixed methods to determine the health information needs of the participating nurses at the skilled nursing facility using an online questionnaire and in-person observations. Resulting data was compared to determine how nurses' self-reported data corresponded with investigator observations. Results: Twenty-seven out of a total of thirty-five nurses responded to the online questionnaire. The study principal investigator also observed a total of twelve nurses working across all shifts. The online questionnaire asked nurses to identify when they need health information for an acute clinical scenario. Nurses self-reported feeling most confident in assessing falls and pain, followed by medication adherence and skin integrity. Issues most frequently encountered during observation of nurses were falls, interventions surrounding cognitive ability or dementia, and use of antibiotics. Nurses reported and were observed to consult colleagues most frequently, followed by drug handbooks and relying on nursing experience. Conclusion: Nurses in skilled nursing facilities will benefit from ready online access to current drug handbooks as well as information resources surrounding commonly encountered clinical issues and stated needs. An outcome of this project is an online toolkit site using a LibGuide created specifically for this purpose. Researchers purchased laptop computers that were installed at each of the nurses' stations to provide ready access to the toolkit site. [ABSTRACT FROM AUTHOR]

Objectives: Analyze the information-seeking practices and identify the information and education needs of nurses in a war veterans nursing home. Develop an online toolkit for use at the nurses’ stations to meet nurses’ health information needs. Methods: Investigators employed mixed methods to determine the health information needs of the participating nurses at the skilled nursing facility using an online questionnaire and in-person observations. Resulting data was compared to determine how nurses’ self-reported data corresponded with investigator observations. Results: Twenty-seven out of a total of thirty-five nurses responded to the online questionnaire. The study principal investigator also observed a total of twelve nurses working across all shifts. The online questionnaire asked nurses to identify when they need health information for an acute clinical scenario. Nurses self-reported feeling most confident in assessing falls and pain, followed by medication adherence and skin integrity. Issues most frequently encountered during observation of nurses were falls, interventions surrounding cognitive ability or dementia, and use of antibiotics. Nurses reported and were observed to consult colleagues most frequently, followed by drug handbooks and relying on nursing experience. Conclusion: Nurses in skilled nursing facilities will benefit from ready online access to current drug handbooks as well as information resources surrounding commonly encountered clinical issues and stated needs. An outcome of this project is an online toolkit site using a LibGuide created specifically for this purpose. Researchers purchased laptop computers that were installed at each of the nurses’ stations to provide ready access to the toolkit site.

Objective: The aims of this study were to examine the efficacy among various vitamin D supplementation regimens on serum 25-hydroxyvitamin D (25(OH)D) concentrations and determine the minimal dose rate required to achieve sufficient serum concentrations (≥75 nmol/l) among older adults in long-term care (LTC).Design: A 1-year medical history was abstracted from medical records, and a one-time blood draw to measure serum 25(OH)D concentrations was obtained. Individuals were stratified into vitamin D-supplemented and non-supplemented groups. The supplemented group was further categorised into four treatment forms: single-ingredient vitamin D2or3, multivitamin, Ca with vitamin D or combination of the three, and by daily prescribed doses: 0-9·9, 10-19·9, 20-49·9, 50-99·9 and >100 μg/d.Setting: Five LTC communities in Austin, Texas.Participants: One hundred seventy-three older (≥65 years) adults.Results: Of the participants, 62% received a vitamin D supplement and 55% had insufficient (≤75 nmol/l) 25(OH)D serum concentrations. Individuals receiving single-ingredient vitamin D2or3 supplementation received the highest daily vitamin D mean dose (72·5 μg/d), while combination of forms was the most frequent treatment (44%) with the highest mean serum concentration (108 nmol/l). All supplementation doses were successful at reaching sufficient serum concentrations, except those<20 μg/d. Using a prediction model, it was observed that 0·025 μg/d of vitamin D supplementation resulted in a 0·008 nmol/l increase in serum 25(OH)D concentrations.Conclusions: Based on the predictive equation, results suggest that supplementation of 37·5 μg/d of vitamin D2or3 or combination of vitamin D is most likely to achieve sufficient serum 25(OH)D concentrations in older adults in LTC. [ABSTRACT FROM AUTHOR]

Michael Mileski,1 Kimberly Lee,1 Curtis Bourquard,1 Belinda Cavazos,1 Kristopher Dusek,1 Kristopher Kimbrough,1 Linda Sweeney,1 Rebecca McClay2 1School of Health Administration, Texas State University, San Marcos, TX, USA; 2School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, WV, USACorrespondence: Michael MileskiSchool of Health Administration, Texas State University, 601 University Drive, Encino Hall—250, San Marcos, TX 78666, USATel +1 (512) 245-3556Email mileski@txstate.eduPurpose: The main objective of this study was to investigate abuse of residents with either dementia or Alzheimer’s disease in long-term care settings, to identify facilitators and barriers surrounding implementation of systems to prevent such occurrences, and to draw conclusions on combating the issue of abuse.Patients and methods: A systematic review was conducted using the Medline, CINAHL, and Academic Search Ultimate databases. With the use of key terms via Boolean search, 30 articles were obtained which were determined to be germane to research objectives. The review was conducted and structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: Residents with dementia or Alzheimer’s disease are at greater risk of abuse. The growing population could increase this problem exponentially. The most common facilitators were the introduction of policies/programs in the facility, education, and working conditions. The most cited barriers were poor training, lack of research, and working conditions in the long-term care setting.Conclusion: The examples given would be useful in minimizing the potential for abuse in the long-term care setting. Leadership can take an active role in the prevention of abuse of the elderly through their actions, education of employees, and changes in the work environment.Keywords: exploitation, nursing facility, skilled nursing, nursing home

Michael Mileski,1 Matthew Brooks,1 Alison Kirsch,1 Fengmei Lee,2 Amanda LeVieux,1 Alexandra Ruiz3 1School of Health Administration, Texas State University, San Marcos, TX 78666, USA; 2Department of Sociology, Long Term Care Administration, Texas State University, San Marcos, TX 78666, USA; 3School of Social Work, Texas State University, San Marcos, TX 78666, USA Objectives: The objective of this study was to investigate the applicability and effectiveness of the use of music in providing for positive physical and mental outcomes in nursing facilities.Problem: Lack of quality of life (QOL) has been a significant issue within nursing facilities. With the rise in census due to Baby Boomers, it has become imperative to find ways to increase overall QOL.Methods: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate to collect data regarding the use of music to provide for positive physical and mental outcomes in nursing facilities.Results: The most common facilitator mentioned was increased socialization or communication (18%), followed by reduced depression (12%), improved physical health (11%), and reduced agitation or behavior problems (9%). The most common barriers were as follows: cannot isolate effects of music (26%), cost prohibitive (11%), difficult to implement (11%), and no significant improvements in QOL or well-being (11%).Conclusion: The use of music showed positive outcomes for residents in nursing facilities and should be considered for implementation as part of the normal culture within such facilities. Keywords: music, music therapy, nursing facilities, skilled nursing, outcomes

Rural seniors face many barriers to care, but faith community nurses (FCNs) could be a cost-effective partner in promoting wellness and managing chronic and post-acute care needs. In an exploratory study of faith community nursing in a rural area, the prevalence of such programs was assessed and information regarding characteristics, activities, and supports for and barriers to such programs were identified. Results suggest that seniors comprise a large proportion of FCNs' clientele, and those interactions often include home visits. FCNs are knowledgeable about community resources, serve as advocates, and promote education about advance directives and death and dying. This paper suggests faith community nursing programs, in mutually beneficial partnership with long-term care providers, can offer an additional layer of support to meet rural seniors' health and long-term care needs within a fragmented, and sometimes difficult to access health care system. [ABSTRACT FROM AUTHOR]

Background and Purpose: Increasing activity has been shown to improve outcomes in patients receiving post–acute rehabilitation, but little is known about the activity duration and intensity that are actually occurring throughout the rehabilitative stay for older adults in skilled nursing facilities. The purpose of this study was to quantify duration and intensity of movement in older adults receiving rehabilitation in a skilled nursing facility, using 4-limb actigraphy. Methods: Observational study of 92 older adults admitted for rehabilitation services at 2 skilled nursing facilities. All participants wore actigraph accelerometers (wGT3X+) on bilateral wrists and ankles for 24 hours, inclusive of 1 session each of physical and occupational therapy. Using actigraphy data, we calculated (a) movement duration (time the dominant or noninvolved upper or lower limb was active) and (b) movement intensity (sum of activity counts per minute for the dominant or noninvolved upper or lower limb). Results: Over the 24-hour period, the lower limb moved a total median [interquartile range] of 01:10 (hours:minutes) [01:01] and the upper limb moved a total average (SD) of 04:45 (02:00). When participants did move, it was at low intensities with 61 [87] and 610 [623] activity counts per minute for lower limb out-of-therapy time and during physical therapy, respectively. For the upper limb, activity counts per minute were 689 (388) for out-of-therapy movement and 1359 (695) during physical therapy. However, neither the lower or upper limb reached a moderate-intensity level (2690-6166 counts per minute). Discussion: Older adults receiving rehabilitation in 2 skilled nursing facilities had low movement duration and movement intensity both in and out of therapy. Conclusion: Rehabilitation interventions for older adults should target and increase movement duration and intensity, during and after skilled nursing facility care. [ABSTRACT FROM AUTHOR]

OBJECTIVE To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) outbreaks in skilled nursing facilities (SNFs). DESIGN Cross‐sectional study linking county SARS‐CoV‐2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post‐acute and long‐term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non‐Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS For Genesis and non‐Genesis SNFs: any outbreak (one or more residents testing positive for SARS‐CoV‐2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non‐Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6–57.7 percentage point; P =.008) difference in the probability of an outbreak for Genesis and non‐Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4–20.8 cases; P =.003) for Genesis SNFs. A 10‐bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6–1.2 percentage point; P <.001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five‐Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS‐CoV‐2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167–2173, 2020. See related Special Article by Ouslander et al. in this issue. [ABSTRACT FROM AUTHOR]

This article describes our recommendation fo r adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations fo r adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporatelevel policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted fo r SNFs to improve their discharges. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Although preventable, healthcare‐associated infections (HAIs) are commonly observed in post‐acute care settings for at‐risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post‐acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. DESIGN: We used 2013‐2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections). PARTICIPANTS: A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older. MEASUREMENTS: Our outcome was a 30‐day preexisting, or "linked," HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care ("home"). RESULTS: Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P <.001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = −1.29 to −1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity. CONCLUSIONS: SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370–378, 2020 [ABSTRACT FROM AUTHOR]

Targets: We examined the efficacy of working memory exercises (WME), applied concurrently with rehabilitation services provided in skilled nursing facilities, for improving activities of daily living (ADLs) among older skilled nursing facilities residents with cognitive impairment. Intervention Description: Participants (N = 63) were randomized to the WME or treatment-as-usual control group. The WME was a 3-week, 9-session course (30 minutes each) of a rehabilitation program for therapists in post-acute settings. Mechanisms of Action: Working memory exercises aim to improve ADLs by targeting attention and working memory, based on the link between executive function and everyday functional skills. By developing cognitive communication skills and strengthening strategies for learning and memory, WME may give patients an added boost to traditional ADLs remediation therapies. Outcomes: Working memory exercises participants' ADL performance increased by 1.59 points on average (95% confidence interval = 0.69-2.49, P < .001) on the Katz Index of ADL scale compared with a 0.05 decrease for the control group (95% confidence interval = -1.09 to 0.99, P = .92). A greater proportion of WME participants than controls progressed from ADL dependent to independent for continence, dressing, feeding, functional transfers, and toileting. Simultaneously targeting cognitive and functional skills was associated with greater improvements in ADLs than targeting functional deficits alone. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effect of a multicomponent rehabilitation protocol on functional outcomes in a post-acute care facility. Eleven older, medically complex patients (80.3 ± 7.3 yrs) completed a multicomponent rehabilitation protocol during a stay at a post-acute care facility. Gait speed, Berg Balance scores, and sit-to-stand velocity were examined upon admission and discharge. Bayesian paired sample t -tests were used to determine changes from PRE to POST and linear regression analyses were used to determine the influence of length of stay. Gait speed increased by 0.26 m/s (49% increase) from PRE (0.65 ± 0.38 m/s) to POST (0.90 ± 0.42 m/s) exercise intervention (p = 0.013). Berg Balance Scores significantly increased by 26% from PRE (38.27 ± 8.33) to POST (45.73 ± 3.32) exercise intervention (p = 0.009). A 45% increase in STS velocity from PRE (0.37 ± 0.14 m/s) to POST (0.51 ± 0.13 m/s; p ≤ 0.001) was observed following the multicomponent rehabilitation protocol. Length of stay did not influence improvements in gait speed, Berg Balance Scores, nor Sit-to-stand velocity (p = 0.176–0.811). The multicomponent rehabilitation protocol with movement velocity biofeedback is feasible in a post-acute care facility in medically complex older patients and demonstrates improvements in clinical mobility and balance outcomes. • Post-acute care facilities may underdose rehabilitation services • Velocity-based training in a post-acute care setting resulted in clinically meaningful changes • A multi-component rehabilitation protocol may improve physical gains in post-acute care [ABSTRACT FROM AUTHOR]

Current research indicates that total joint arthroplasty patients who are discharged to skilled nursing facilities (SNFs) have higher complication rates as compared to home. Many factors like age, sex, race, Medicare status, and past medical history have been shown to influence discharge destination. The present study sought to gather patient-indicated reasons for SNF discharge and identify potentially modifiable factors influencing the decision. Primary total joint arthroplasty patients were asked to complete surveys at their presurgical and 2-week postsurgical follow-up appointments. The surveys included home access and social support questions as well as patient-reported outcome measures: Patient-Reported Outcomes Measurement and Information System, Risk Assessment and Prediction Tool, Knee injury and Osteoarthritis Outcome Score for Joint Replacement, or Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement. Of 765 patients who met inclusion criteria, 3.9% were discharged to an SNF and these were more frequently post-THA, women, older, Black, and persons living alone. Regression analyses indicated that lower Risk Assessment and Prediction Tool score, higher age, no caregiver presence, and Black race were significantly associated with SNF discharge. Patients discharged to an SNF most commonly reported social concerns rather than medical or home access concerns as the main factor for SNF discharge. While age and sex are nonmodifiable factors, the availability of a caregiver and social support represents an important modifiable factor in regard to discharge destination. Dedicated attention during the preoperative planning period may help augment social support and avoid unnecessary discharges to SNFs. [ABSTRACT FROM AUTHOR]

Michael Mileski, Joseph Baar Topinka, Kimberly Lee, Matthew Brooks, Christopher McNeil, Jenna Jackson School of Health Administration, Texas State University, San Marcos, TX, USA Objectives: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. Keywords: readmissions, skilled nursing, quality improvement, hospital, finance, Medicare, transfers

Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training. [ABSTRACT FROM AUTHOR]