Practically Speaking
Fall 2020

Another Look: Research to Improve Health for Older Adults in Long Term Care Facilities

Donaghue recently awarded over $1.2 million for eight research studies from the Another Look: Research to Improve Health for Older Adults in Long Term Care Facilities program. Since 2013, the program has awarded $5.4 million in funding for research to improve the health of older adults living in long term care facilities.

The Impact of Person-Centered Care on Nursing Home Quality
Katherine Abbott, PhD
Miami University, Scripps Gerontology Center

Stakeholder organization: American Health Care Association/National Center for Assisted Living The Preferences for Everyday Living Inventory (PELI) is a tool that providers can use to learn about an individual’s preferences and integrate that information into their personalized care plans. In 2015, the Ohio Department of Medicaid mandated that all Medicaid certified nursing homes use the PELI to enhance person-centered care. This mandate provides the opportunity to answer three key questions: Is use of the PELI a predictor of resident and family satisfaction; a predictor of clinical (e.g., pressure ulcers, falls) and care process outcomes (e.g., physical restraints, antipsychotic medication use); and is it a predictor of quality ratings (e.g., overall star rating, health inspection rating, staffing rating, quality rating, number of complaints).

Transfer Trauma in Nursing Home Long-Term Care Residents
Chiang-Hua Chang, PhD and Ana Montoya, MD
University of Michigan, Division of Geriatric & Palliative Medicine

Stakeholder organization: Michigan Department of Health and Human Services The COVID-19 pandemic has increased the urgency of addressing transfer trauma, the negative impact of transferring nursing home residents between different facilities, as the creation of regional hubs may have increased transfers between facilities. Therefore, the research question for this study is whether there are adverse consequences of facility transfers that can be measured and monitored prospectively to prevent transfer trauma in the future. To answer this question, this study will use the Minimum Data Set data linked to Medicare data to identify transfers and to assess negative outcomes among nursing home long-term residents and to determine the impact of COVID-19 on these outcomes.

The Impact of COVID-19 in Nursing Homes
Verena R. Cimarolli, PhD
Leading Age, LTSS Center @UMass Boston

Stakeholder Organization: Wellspring Lutheran Services, WeCare Connect™ Nursing homes are currently facing an unprecedented crisis due to the rapid spread of COVID-19. Not only are nursing home residents and patients at risk for infection and death, but Certified Nursing Assistants (CNAs) who are on the frontlines providing hands-on care are also at risk for infection and death. The overall purpose of this 18-month cross-sectional study is to investigate the impact of COVID-19 on CNAs and nursing home residents and patients when taking into account employers’ efforts to train and prepare CNAs for their work during COVID-19.

Communication Among Family and Formal Caregivers
Francesca Falzarano, PhD
Joan & Sanford I. Weill Medical College of Cornell University

Stakeholder organization: LeadingAge LTSS Center @UMass Boston Considerable research has shown that better family-staff communication is associated with better resident quality of life and quality of care. However, it is unclear how this relationship generalizes to residents and family caregivers in assisted living facilities. Thus, this study will analyze data from a subsample of both nursing homes and assisted living facilities and their family caregivers to examine family caregivers’ perceptions of aspects of communication (e.g., frequency, availability, helpfulness) with formal care providers and their influence on resident outcomes (e.g., health and psychosocial functioning).

End-of-Life Care in Assisted Living Communities
Helena Temkin-Greener, PhD, MPH
University of Rochester

Stakeholder organization: American Health Care Association and National Center for Assisted Living While assisted living residents wish to age in place, many experience frequent transitions across care settings at the end of life. To date, there have been no national-level studies of variations in end-of-life burdensome transitions in assisted living, and of their relationship with assisted living and state-level factors. This study will focus on the following research questions: 1) How frequent are burdensome EOL care transitions among assisted living residents and how do they vary across communities, counties and states? 2) What assisted living-level factors are associated with these transitions? 3) Is there an association between state assisted living regulations and EOL care transitions? 4) Is there an association between assisted living-level factors and state-level regulatory stringency and COVID-19 case prevalence and deaths among assisted living residents in selected states?

Examining Disparities in Outcomes for Duals in Assisted Living
Kali Thomas, PhD
Brown University

Stakeholder organization: National Association for Regulatory Administration Assisted living, a popular long-term care option for older adults needing personal care assistance, is increasingly serving a vulnerable population of low-income older adults dually-enrolled in Medicare and Medicaid. However, little is known about the needs of this population, the quality of care they are receiving, and how this varies across states and assisted living providers. This project will examine how state policies and provider behavior drive disparities in the health outcomes of dually eligible assisted living residents.

Neighborhood Socioeconomic Disadvantage and Nursing Home Outcomes
Jasmine Travers, PhD and Jason Falvey, PhD
New York University, Rory Meyers College of Nursing

Stakeholder organization: Leading Age There is growing evidence that neighborhood-level factors, such as poverty, public transportation infrastructure, and housing quality, may influence both the quality and quantity of healthcare delivered to older adults. These factors are especially relevant for nursing home residents, for whom even small declines in health status could result in hospitalization or death. Their preliminary work suggests that nursing homes are disproportionately located in socioeconomically disadvantaged neighborhoods and may have worse infrastructure and more difficulty attracting and retaining staff. These relationships may contribute to health inequities. The goal of our study is to evaluate nursing home resident outcomes across degrees of neighborhood socioeconomic disadvantage.

Multiple Views of Quality in Long Term Care
Diana L. White, PhD
Portland State University, Institute on Aging

Stakeholder organization: Department of Human Resources, Aging and People with Disabilities Division Scholars increasingly view quality of life and quality of care as concepts that are mutually related, multidimensional, perspective-dependent, and context-dependent. A holistic approach to measuring quality is important because incongruent views by different actors have negative implications for service delivery and receipt. The project will use qualitative and quantitative secondary data to develop and test a measure of person-centered care from the perspective of residents. In addition to resident interviews, data were collected from administrators, direct care staff, nurses, and others. Additionally, administrative and regulatory data about participating organizations were collected.