Latarsha Chisholm

Background: Providing high-quality advance care planning conversations for nursing home residents living with Alzheimer’s Disease and Related Dementias is a persistent challenge, but implementation of advance care planning interventions remains limited. Objective: This study explored barriers and enablers to implementing the Goals of Care video with nursing home staff and identified strategies to implement the video intervention. Methods: Nursing home administrators identified staff members involved in ACP discussions with residents and families. A research team member contacted these individuals by email or telephone. Fourteen staff members across six Florida nursing homes participated in in-person or virtual semi-structured interviews. A summative content analysis quantified the frequency of each CFIR construct coded as an enabler or barrier, with frequencies calculated at the nursing home level. Results: The primary enabler was the alignment of the Goals of Care video with nursing homes’ organizational mission. The most identified barrier was the video’s perceived length. Strategies to improve implementation included adapting materials, assessing readiness, and addressing site-specific challenges. Conclusions: Tailoring the Goals of Care video to the organizational context is essential. Addressing barriers, such as video concerns, while leveraging existing enablers can strengthen adoption and support more consistent advance care planning practices.

Background/Objectives: Nursing staff turnover can adversely affect nursing home (NH) performance. To address staffing shortages, NHs are increasingly turning to agency nursing staff as a solution. This study examined the relationship between the use of agency nursing staff and turnover rates among NH permanent nursing staff. Methods: This retrospective, observational study used secondary data from several sources, including the Payroll-Based Journal, the Care Compare: Five Star Quality Rating System, and Area Health Resource Files (n: =35,200, years: 2021–2023). The dependent variable was turnover rates among registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). The independent variable was the classification of NHs based on their level of agency nursing staff utilization. Facilities were classified as “high utilizers” (the top 25% in agency nursing staff use) and “low utilizers” (the remaining 75%). This classification was informed by prior research indicating that the impact of agency nursing staff on NH performance is most pronounced at higher levels of utilization. A two-way fixed-effects regression model (facility and year) was used, with appropriate control variables. Results: NHs identified as high utilizers had significantly higher turnover rates among permanent RNs (7%) and CNAs (1.9%) compared to facilities that had low utilization of agency nurses (p < 0.001). No significant association was found between agency LPN utilization and LPN turnover. Conclusions: Greater reliance on agency nursing staff was associated with increased turnover, with the strongest effect observed for RNs. NH administrators should consider strategies to balance agency staff utilization with efforts to retain permanent staff, emphasizing long-term workforce stability.

The Journal of Long-Term Care is an international, multi- and inter-disciplinary, peer-reviewed, online journal established as a focus for advancing the research evidence base for all aspects of long-term care for adults. Its range includes empirical papers and theoretical discussions relevant to policy and practice, methodological papers about improving methods in social care research, and perspectives papers commenting on significant issues for the sector. The editorial board welcomes submissions of high quality, original articles that fit with the Journal’s remit. We will consider articles that are also relevant to the care of children and younger people where there is clear relevance for adult care (e.g. concerning issues of families or transitions into adult care).There is no fee for submitting or publishing articles. All articles are published online as open access on the journal’s website to encourage maximum impact for all work.

Sixty-seven percent of dementia patients die in nursing homes (NHs), where end-of-life care is often suboptimal, and hospice not accessed in a timely manner. The eligibility criteria for the Medicare Hospice Benefit (< 6 months prognosis) poses challenges for patients with Alzheimer’s disease and related dementias given the variable disease progressions that characterize most dementias. This study describes current NH processes used to identify dementia residents to refer to hospice, and stakeholders’ input into the design of a standardized process for clinical decision-making, using the Mitchell Index, a dementia mortality prediction tool. Individual interviews and focus groups were conducted with NH administrators, medical directors, directors of nursing, MDS coordinators, and social workers (N=11). Participants completed an online survey including facility (e.g., size, profit status) and individual demographics (e.g., years of experience), then participated in an interview that involved a brief presentation of the proposed standardized process using the Mitchell Index. Qualitative data analysis followed a deductive approach, guided by constructs from the Consolidated Framework for Implementation Research (CFIR). Preliminary analyses indicate providers believe the Mitchell Index can be successfully adapted for NH use. Participants stated the tool added something to current processes (CFIR relative advantage), would be easy to use (CFIR complexity), and pointed to external influences (i.e., regulations; CFIR domain 2: outer setting) which would be important to consult in later stages of intervention development. Overall, nursing home stakeholders endorse the potential for a standardized process using the Mitchell Index to be acceptable and feasible in high-Medicaid nursing homes.

U.S. population growth is greatest amongst the oldest-old who are most likely to need temporary or permanent reliance on formal or informal care-giving. With co-survival of older spouses, and greater longevity, informal care-giving is increasingly provided by older adults for other older adults. Little is known about the positive and negative care-giving experiences of older informal caregivers. This observational study examines the relationship between the care-giving situation and the positive and negative perceptions of care-giving in caregivers age 65 and older. A survey of 108 older informal caregivers utilizes well-validated instruments to measure perceptions of two positive (positive self image, positive life) and two negative (stress, uncertainty) experiences due to care-giving. Regressions statistically assess the relationship between care-giving situations and these positive and negative perceptions. We find that while some care-giving situations, such as higher amounts of unpaid support, are related to positive care-giving experiences, others, such as care-giving a recipient with a greater number of ADL deficits, having more care-giving responsibilities, and having increased hours of work due to care-giving, are related to more negative experiences. Some situations, such as lower income and greater involvement in care-giving, are related to both positive and negative perceptions. Higher levels of emotional support were related to mixed positive and less negative perceptions of care-giving. Result indicate that healthcare system and community support is needed to provide opportunities for unpaid support and assistance with caregivers of recipients with a high number of ADL deficits and caregivers who have more care-giving responsibilities.