Another Look 2023 Grant Awards

This winter, the Donaghue Foundation added four awards to its Another Look–Research to Improve Health for Older Adults in Long-Term Care Facilities program with an investment totaling nearly $600,000 for this year’s cycle. Since the beginning of the program in 2013, the Another Look grant program has awarded over 7.5 million dollars in funding for research that has the near-term potential to improve the health of older adults in long-term care facilities.

Norma Coe, PhD
University of Pennsylvania

Stakeholder Organization: The Green House Project

“The Effect of the Green House Model of Nursing Home Care on Patient Outcomes”

Since 2003, about 300 Green House homes have opened. These homes offer a unique approach to nursing care with single bedrooms, outdoor access, and a different staffing model involving Certified Nursing Aides taking on more tasks. Studies indicate that residents in Green House homes receive more direct care, maintain their independence longer, and have lower rates of depression and pressure ulcers than those in traditional nursing homes. They have also experienced lower COVID-19 infection and death rates. To address concerns that these outcomes are due to the types of residents served, the researchers are testing matching strategies and market definitions using data from 2011 to 2019. The project aims to determine if these strategies work well during the pandemic and will assess the impact of COVID-19 on nursing home resident characteristics. By applying propensity score methods to address selection bias, the study will compare patient outcomes between Green House and traditional nursing homes, evaluating their impact on resident well-being. The analysis will span both the pre-pandemic (2011-2019) and pandemic years (2020-2022) and consider outcomes such as physical and cognitive function, mental health, length of stay, discharge status, and 30-day readmissions for post-acute care residents. The research targets academics, nursing home administrators, and policymakers, with stakeholder engagement for effective dissemination and guidance.

Ellis Dillon, PhD
Julie Robison, PhD (pictured below)
University of Connecticut Health Center

Stakeholder Organizations: Connecticut Department of Social Services, LeadingAge Connecticut, Connecticut Association of Health Care Facilities, Connecticut Association for Health Care at Home

“Improving Hospice Use in the Connecticut Medicaid Population with Nursing Home Stays“

Extensive evidence supports hospice care’s benefits for individuals nearing the end of life and their families. However, concerns persist regarding underutilization, particularly among nursing home residents.

While hospice utilization has grown significantly, especially for Medicare beneficiaries, there remains a significant gap in the United States, with nearly a million hospice-eligible individuals annually not receiving these services. Nursing home residents, in particular, underutilize hospice care, even though it offers high-quality end-of-life care, reduces hospitalizations, and improves pain management. Additionally, racial and ethnic disparities in hospice utilization and symptom management have been observed. Recent preliminary analysis of Medicaid decedents in Connecticut has indicated lower hospice utilization and shorter enrollment among those with nursing home stays, emphasizing the need to investigate the reasons behind these disparities.

This research aims to understand the barriers and facilitators of hospice use among nursing home residents, examining various factors at the individual and nursing home levels. The findings will inform policymakers, nursing homes, hospice agencies, and researchers, helping to enhance hospice utilization and end-of-life care in this population.

Angela Perone, PhD, JD, MSW, MA
University of California, Berkeley

Stakeholder Organizations: National Consumer Voice for Quality Long-Term Care, LeadingAge California, PHI: Quality Care through Quality Jobs, California Advocates for Nursing Home Reform (CANHR), HumanGood

“The CARE Project: Addressing Conflicts between Safety and Autonomy in Nursing Homes”

Nursing homes in the United States grapple with complex regulatory issues, particularly regarding the balance between residents’ safety and autonomy rights. This can create challenges for care practitioners. The CARE Project aims to systematically investigate how nursing home workers navigate these conflicts and develop effective solutions.

The project seeks to answer the research question: How can workers best support older adults in nursing homes when their rights to safety and autonomy conflict? The study will begin with a comprehensive review of both scholarly and non-scholarly literature to explore the outcomes of various approaches, such as advocacy, resolution, and education, in addressing these conflicting rights. The project will also consider input from a stakeholder advisory committee comprising organizations and agencies involved in nursing home care.

Ultimately, the CARE Project aims to generate valuable insights and best practices for managing conflicts between residents’ safety and autonomy rights and regulations. These findings will benefit practitioners and policymakers working to enhance the quality of care for older adults in nursing homes.

Caroline Stephens, PhD, RN, GNP-BC, FGSA, FAAN
University of Utah

Stakeholder Organization: Comagine Health

“Population Science Informs Rural Nursing Home (NH) Resident & Caregiver Health Initiatives”

Nursing homes (NH) serve as primary EOL care sites for older adults with serious illnesses. Unfortunately, NH residents often face high hospitalization rates, potentially burdensome treatments, and untreated symptoms near the EOL. This situation leads to unmet care needs, family stress, and a lack of guidance in advocating for appropriate care. Experts highlight the importance of patient and family-centered care (PC) to enhance NH care quality, address unmet needs, and improve outcomes for seriously ill residents and their families. However, many eligible NH residents do not receive PC, leaving their families without the necessary support.

These unmet PC needs are amplified in states with vast rural areas, like Utah, where EOL health disparities and care access issues are more significant. Rural NH residents experience notably poorer EOL quality compared to their urban counterparts, with reasons including higher poverty rates, serious illnesses, and a lack of NH staffing and alternative care options. While rural-urban NH EOL disparities are well-documented, little is known about the diverse EOL healthcare experiences among rural NH residents. Additionally, no studies have explored how family availability affects EOL care outcomes for rural NH residents or how these outcomes impact family health.

To study this, the research team will examine 4,747 rural nursing home residents in Utah who died between 2010-2016. They aim to understand how resident characteristics and family availability influence EOL care and family health. The findings will help develop targeted interventions and policies to reduce rural EOL disparities.