Structured Abstract
Objectives
To create data driven typologies of licensed nurse staffing and health services in residential care/assisted living (RC/AL).
Design
Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services, and the extent to which these clusters were related.
Setting
RC/AL communities in the United States.
Participants
A convenience sample of administrators and health care supervisors from 89 RC/AL communities in 22 states.
Measurement
RC/AL characteristics, licensed nurse staffing (total number of hours worked by registered nurses [RNs] and licensed practical nurses [LPNs]), number of hours worked by contract nurses, and availability of 47 services.
Results
Analysis revealed four licensed nurse staffing clusters defined by total number of hours and the type of nurse providing the hours (RN, LPN, or a mix of both). They ranged from no/minimal RN and LPN hours to high nursing hours with a mix of RNs and LPNs. The 47 services clustered into five clusters including Basic Services, Technically Complex Services, Assessments, Wound Care and Therapies, Testing and Specialty Services, and Gastrostomy and IV Medications. The availability of services was related to the presence of nurses (both RNs and LPNs) except for the Gastrostomy and IV Medications services, which were not readily available.
Conclusion
The amount and skill mix of licensed nurse staffing varies in RC/AL and is related to the types of services available. These findings may have implications for resident care and outcomes. Future work in this area, including extension to include non-nurse direct care workers, is needed.
OBJECTIVES
To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings.
DESIGN
Cross-sectional descriptive study.
SETTING
AL communities in 27 states.
PARTICIPANTS
One hundred sixty-five physicians and administrators of 125 AL settings in which they had patients.
MEASUREMENTS
Interviews and questionnaires containing open- and close-ended questions regarding demographics, care arrangements, attitudes, and behaviors in managing medical problems.
RESULTS
Most respondents were certified in internal medicine (46%) or family medicine (47%); 32% were certified in geriatrics and 30% in medical directorship. In this select sample, 48% visited the AL setting once a year or less, and 19% visited once a week or more. Mean physician confidence in AL staff was 3.3 (somewhat confident), with greater confidence associated with smaller AL community size, nursing presence, and the physician being the medical director. Qualitative analyses identified differences between settings including lack of vital sign assessment in the home setting, concern about the ability of AL staff to assess and monitor problems, and greater administrative and regulatory requirements in AL than in the other settings.
CONCLUSION
Providing medical care for AL residents presents unique challenges and opportunities for physicians. Nursing presence and physician oversight and familiarity and communicating with AL staff who are highly familiar with a given resident and can monitor care may facilitate care.
Hardship and illness in participants' lives frame their diabetes experience and notions of well-being. Providers need to be aware of the social, economic, and political lenses shaping diabetes self-management and subjective well-being.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.