Context Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care. Objective To describe, from the staff perspective, positive/negative experiences related to caring for dying residents. Methods Qualitative analysis using survey data from staff working in 52 Indiana nursing homes. Results A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31–50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord. Conclusion Findings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.

BackgroundThe objective of this study was to better understand the experiences of family members in the nursing home to hospital transfer decision making process.Semi-structured interviews were conducted with 20 family members who had recently been involved in a nursing home to hospital transfer decision.ResultsFamily members perceived themselves to play an advocacy role in their resident’s care and interview themes clustered within three over-arching categories: Family perception of the nursing home’s capacity to provide medical care: Resident and family choices; and issues at ‘hand-off’ and the hospital. Multiple sub-themes were also identified.ConclusionsFindings from this study contribute to knowledge surrounding the nursing home transfer decision by illuminating the experiences of family members in the transfer decision process.

These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes.

Background Reach Out and Read promotes early literacy and school readiness by incorporating book delivery and anticipatory guidance into well-child visits. There is a need to train future healthcare providers in the knowledge and skills to communicate with parents/caregivers about early childhood literacy. We developed and evaluated a curriculum to improve learners’ knowledge, attitudes, and skills towards the incorporation of parent-provider literacy communication into well-child visits. Methods Family medicine residents ( n = 30), physician assistant students ( n = 36), and medical students ( n = 28) participated in a curriculum consisting of service learning, online didactic training, objective structured clinical exams (OSCEs) and a debriefing session. Standardized patients (SPs; 6 months to 5 years) and standardized patient caregivers were recruited and trained. Learners were evaluated on their abilities to offer books to patients, provide anticipatory guidance, and demonstrate parent-provider communication skills. Knowledge, attitudes, and satisfaction were collected pre- and post-curriculum. Results Significant increases in total knowledge were observed after completing curriculum activities ( p < 0.001). All attitudes improved after training ( p < 0.05). All learners (100%) recommended that caregivers talk back and forth with their 6‑ to 12-month-old babies and make eye contact. Few (18.2%) learners recommended playing games like ‘peek-a-boo’ while reading. When caregivers evaluated learners’ basic parent-provider communication skills, all reported that the learners treated them with respect and used plain language. Discussion Our curriculum extends beyond previous studies by measuring recommended books, anticipatory guidance, and communication skills using paediatric SPs and standardized patient caregivers. Curriculum activities can be tailored to best promote parent-provider literacy communication training in other programs. Electronic supplementary material The online version of this article (10.1007/s40037-019-0503-8) contains supplementary material, which is available to authorized users.

OBJECTIVES To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. DESIGN Retrospective cohort study using hospice patient electronic medical record data. SETTING Large, national hospice provider PARTICIPANTS Data from 32,605 hospice patients who received routine hospice care from 2009–2014 were analyzed. MEASUREMENTS Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a one week period and pairwise comparisons were used to detect differences in care provided between the three settings. RESULTS Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home vs. nursing home vs. assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than two weeks and up to 20% had stays greater than six months. CONCLUSION There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care.

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The objectives of this report are to determine the association between performance-based measures of physical function with caregiver reports of physical function in older adults with Alzheimer’s disease (AD) and to examine whether those associations vary by the level of patients’ cognitive functioning. Subjects included 180 patient-caregiver dyads who are enrolled in a clinical trial testing the impact of an occupational therapy intervention plus guideline-level care to delay functional decline among older adults with Alzheimer’s disease. The primary caregiver-reported measure is the Alzheimer’s Disease Cooperative Study Group Activities of Daily Living Inventory (ADCS-ADL). Performance-based measures include the Short Physical Performance Battery (SPPB) and the Short Portable Sarcopenia Measure (SPSM). Analysis of covariance (ANCOVA) models were used to determine the associations of each physical performance measure with ADCS-ADL, adjusting for cognition function and other covariates. We found significant correlations between caregiver-reports and observed performance-based measures across all levels of cognitive function, with patients in the lowest cognitive group showing the highest correlation. These findings support the use of proxy reports to assess physical function among older adults with AD.

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