Changes in resident mix in nursing homes: cognitive and sensory data from a (redesigned) sampling plan

In planning and implementing a study, we unintentionally and serendipitously obtained data about changes in resident mix over a 2.8-yr. period. We screened residents of a 184-bed nursing home for cognition and sensorium in October 1984 to assess sampling feasibility for a grant proposal in preparation. At that time, 65.2% of the residents met the sampling criteria. However, in July/August 1987, after award of funding, only 5.4% of residents of the same nursing home met the cognitive and sensory criteria. We were forced to recruit from an additional six nursing homes, in which only 9.3% of residents met the sampling criteria.     

Health and Care Related Risk Factors for Suicide Among Nursing Home Residents: A Data Linkage Study

This study aimed to examine associations between health status and care needs of nursing home residents and risk of death from suicide compared to other causes through a retrospective data linkage cohort study examining nursing home resident deaths in Australia between 2000 and 2013. Data linkage was performed between aged care assessment tools—Resident Classification System and Aged Care Funding Instrument—and the National Coronial Information System. A competing risks survival analysis was performed to determine the association between care assessment variables (activities of daily living (ADL), behavior, and complex health care) and the risk of death from suicide and any other cause. Of the 146 nursing home residents who died from suicide, 130 (89%) were matched to their assessment data, with comparable information available for 95 residents (65%). Residents who required high levels of care with ADL, physical health care, and cognitive and behavioral issues had a higher risk of dying from all other causes, yet lower risk of dying from suicide. The study findings demonstrate the feasibility and value of linking these two data sets; highlight a need for improved data collection processes; and support a person‐centered care approach for prevention of suicide among nursing home residents.     

Using indices of happiness to examine the influence of environmental enhancements for nursing home residents with Alzheimer's disease

The present study extends the growing behavioral literature on indices of happiness for persons with developmental disabilities to the geriatric population. Data on indices of emotional affect (i.e., happiness) were collected prior to, during, and after each resident was exposed to environmental enhancement activities of various durations. Results showed that every activity improved each resident's level of happiness when compared to pre- and postactivity levels. These outcomes suggest that indexing affect may be as useful for nursing home residents as it has been for individuals with developmental disabilities.     

A Death in the Family: Report of a Single-Session Trauma Group for Nursing Home Residents and Staff

This article describes a single-session trauma-debriefing group conducted at a nursing home following the death of a resident on an outing. The group had as its core an existing weekly therapy group in the facility, with the addition of affected staff, family, and other residents who were on the outing. The treatment illustrates four principles relevant to counseling and psychotherapy in nursing homes: 1) recognition of death; 2) treatment in and of the milieu; 3) flexibility and structure; and 4) dealing with countertransference. Along the way, we see how the residents are capable of giving, and not merely receiving.     

Social interaction patterns of geriatric home and community residents

Thirty elderly nursing home residents and ten community residing older adults were observed in group settings. Their behavior was assessed for dependent personal maintenance, independent personal maintenance, and appropriate and inappropriate behaviors. Responses by staff and peers to these behaviors were classified as positive, negative, or ignore. The frequency of occurrence of these behaviors as well as the relationship of resident to peer or staff behaviors were analyzed. Results indicate that community-residing elders' behaviors differ from nursing home residents' in quantity rather than quality of interactions. There was a lower frequency of behaviors in the nursing home residents. Though older adults respond differentially to various behaviors of other nursing home residents, staff responses were consistent regardless of residents' behavior. These results suggest that geriatric home residents' behavior can be characterized as withdrawn rather than dependent.     

Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.     

Evaluations by staff, residents, and community seniors of patronizing speech in the nursing home: impact of passive, assertive, or humorous responses

Two studies tested the impact of alternative communication in accommodation strategies. Nursing home staff and residents (and community-residing seniors in Study 2) rated nurse-resident conversational scenarios in which a resident responded passively, directly assertively, or humorously (indirectly assertively) to a patronizing nurse. The nurse then either maintained a patronizing manner or accommodated with a more respectful speech style. Even though all groups devalued the nurse who maintained a patronizing speech style, nursing home residents predictably showed the most acceptance. The directly assertive response by the resident elicited more devaluation of the nonaccommodating nurse than did either passive or humorous responses, but also the least favorable ratings of the resident. Ratings of the humorous response in Study 2 suggested that humor could be a good compromise response style for allowing the receiver of patronizing speech to express opposition to a request, yet still maintain an appearance of competence and politeness.     

Factors Influencing Level of Stress During the Nursing Home Decision Process

This investigation examined whether characteristics of elders and their caregivers and facets of the nursing home decision-making context were associated with recalled levels of stress during nursing home decision-making. Employing a conceptual framework based upon the literature on caregiver stress and nursing home decision-making, we considered a number of factors that might influence sponsors' stress as decisions were being made about nursing home placements. We examined data from telephone interviews with a sample of 142 sponsors (responsible parties) of first-time, recently admitted nursing home residents. Higher levels of reported stress were directly associated with more factors triggering the decision to admit, higher levels of competing demands, and limited time. Employment was indirectly related to higher stress through its impact on demands. Hospitalization and being the spouse or an adult child of the resident were indirectly related to stress because they were associated with limited available time. The results offer some insights into the types of individuals who may be vulnerable to higher levels of stress and the kinds of interventions that might avert high stress in the nursing home decision process.     

Direct assessment of quality of care in a geriatric nursing home

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.     

Further observational data on the behavioral and social world of institutions for the aged

This study is an extension of previous observational work on the social ecology of dependence and independence in the institutionalized elderly. Observations of everyday, naturally occurring interactions between elderly residents of two different long-term institutions and their social partners were extended such that, aside from the identification of type of behavior, the dyadic form and continuity of each behavior was specified. The following were among the major results: (a) Previously found interaction patterns between elderly residents and their social partners, replicated in both a nursing home and a home for the chronically ill, supported the notion of discrepant social ecologies for dependent versus independent behaviors of residents: (b) specification of each behavioral act as to its dyadic form underscored the fact that the interactions were controlled largely by social partners and not by the elderly residents; (c) coding continuity or discontinuity of behavior suggested that independent behaviors were maintained by chaining; and (d) elderly residents in the home for the chronically ill evinced, as expected, more dependence-related behaviors.     

Depressed nursing home residents' activity participation and affect as a function of staff engagement

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8 to 45 weeks, 5 minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity; however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.     

Location in negotiation: Is there a home field advantage?

Although location is considered to play an important role in negotiation potentially favoring one side over the other, little research has examined whether negotiating on one’s home field indeed confers an advantage to the resident party. We tested this possibility by experimentally manipulating participants’ occupancy status (resident versus neutral versus visitor). Across three studies, we find that residents of an office space outperform the visiting party in a distributive negotiation. In addition, our results suggest that this performance discrepancy between residents and visitors may be due to both a resident advantage (residents outperforming a neutral party) and a visitor disadvantage (visitors performing worse than a neutral party). Finally, our findings reveal that confidence partially mediates the effects of occupancy status on negotiation performance and demonstrate that an intervention designed to boost visitor confidence can help overcome the home field advantage. Implications of these results for theory and practice are discussed.     

Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.     

Longitudinal reliability of the Life Satisfaction Index (Short Form) with nursing home residents: a cautionary note.

We administered the Life Satisfaction Index (Short Form) 18 times over a 39-wk. period to an initial sample of 76 old, frail, multiply impaired, and depressed nursing home residents participating in a longitudinal quasi-experimental study of the effects of cognitive group interventions on cognition and depression. As no changes over time were observed on the outcome variable of life satisfaction, the stability of the instrument's internal consistency could be examined. Kuder-Richardson KR-20 coefficients ranged from .11 to .60, with a mean of .42 (SD = .11). We conclude that caution should be used when applying this instrument to measure life satisfaction in frail nursing home residents.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

An investigation of the effects of dog visits on depression,mood, and social interaction in elderly individuals living in a nursing home

The present study investigated the effects of weekly dog visits on depression scores, mood, and social interaction in elderly individuals living in a nursing home. Five elderly residents participated in baseline assessments for 4–8 weeks and then received weekly dog visits for 6 weeks. Assessments, consisting of weekly observations of social interaction and paper and pencil measures of mood and depression, continued during the dog visits. The effect of dog visits was evaluated in a multiple baseline across participants design. Dog visits did not improve depression scores, mood (with the exception of one resident), or social interaction (with the exception of one resident). Residents did interact with the dog during the visits, however, and reported that they enjoyed the visits. These results show that dog visits do not always have therapeutic effects and suggest the need for further research in the area before the beneficial effects of dog visits can be substantiated. Copyright © 2008 John Wiley & Sons, Ltd.     

Relationships between steps taken in selecting a nursing home and consumers' satisfaction.

Analysis of data related to selection of a nursing home by 411 families of nursing home residents led to the conclusion that steps selected and taken by consumers in the selection of a home were associated with their subsequent satisfaction with the home. Satisfaction was greater (a) for families in agreement about the home selected and (b) for families who investigated all homes in an area before selecting one. Less satisfied were families (a) who were forced to make an immediate decision about placement following illness of a patient, (b) who felt they lacked sufficient time to investigate homes, and (c) who chose the first home with space available.     

Measuring Daytime Drowsiness in Nursing Home Residents: The MSLT-NH

A standardized method of assessing daytime drowsiness in frail nursing home residents has not been previously available. We present here the development and test characteristics of an instrument to measure daytime drowsiness in nursing home residents with cognitive and functional impairment, the Multiple Sleep Latency Test-Nursing Home (MSLT-NH). In a standardized manner, the resident is tested three times in one day (at 9 a.m., 11 a.m., and 1 p.m.) to measure the amount of time until the subject falls asleep. The average sleep latency (minutes to fall asleep) is the measure of interest. We tested the MSLT-NH in 95 residents from six community nursing homes in the Los Angeles area (82% of subjects were female; 81% were white, mean age was 86.6 years and mean score on the Mini-Mental State Examination [MMSE] was 9.4). Interrater reliability of the MSLT-NH was quite good (correlations between raters ranged from 0.98 to 0.99; all p values were <.0001). Validity was assessed by comparing MSLT-NH results to simultaneous wrist activity estimation of sleep, and by comparing MSLT-NH findings to results from nighttime sleep estimation by wrist actigraphy the night prior to MSLT-NH. The percent agreement between MSLT-NH and wrist actigraph ranged from 77% to 79% MSLT-NH results were significantly associated with peak duration of nighttime sleep episodes the night prior to testing. The MSLT-NH was also quite acceptable for use in the NH setting. In conclusion, we have developed a promising measure of daytime drowsiness in NH residents. Further testing will help establish whether this test is a clinically useful measure of daytime drowsiness from medications or other conditions in the NH setting.     

Community-Engaged Neighborhood Revitalization and Empowerment: Busy Streets Theory in Action

Busy streets theory predicts that engaging residents in physical revitalization of neighborhoods will facilitate community empowerment through the development of sense of community, social cohesion, collective efficacy, social capital, and behavioral action. Establishing safe environments fosters positive street activity, which reinforces neighborhood social relationships. A community-engaged approach to crime prevention through environmental design (CE-CPTED) is one promising approach to creating busy streets because it engages residents in collaborative interactions to promote safer environments. Yet, few researchers have studied how CE-CPTED may be associated with busy streets. We interviewed 18 residents and stakeholders implementing CE-CPTED in Flint, Michigan. We studied three neighborhoods with different levels of resident control over CE-CPTED. Participants described how CE-CPTED implementation affected their neighborhood. Participants from all three neighborhoods reported that CE-CPTED was associated with positive street activity, sense of community, and collective efficacy. Participants from neighborhoods with higher resident control of CE-CPTED reported more social capital and behavioral action than those from neighborhoods with less resident control. Our findings support busy streets theory: Community engagement in neighborhood improvement enhanced community empowerment. CE-CPTED that combines physical revitalization with resident engagement and control creates a potent synergy for promoting safe and healthy neighborhoods.     

Heal the Hurt Child by Hertha Riese

Abstract

The mental health needs of the long–term nursing home resident receive little attention. It is especially difficult for the more cognitively intact resident to obtain psychological help. An integrated group psychotherapy model that incorporates developmental, cognitive–behavioral, and psychodynamic approaches is described, based on the author’s clinical experience in developing and co–leading four groups in three long–term care facilities over a period of ten years. The technical and countertransference challenges of working with this unique population and in this format are described, along with clinical material to illustrate common themes. The success of the groups in improving the morale, sense of community, and quality of life for group members is demonstrated.