Objective To examine the effects of the racial composition of residents on nursing homes’ financial and quality performance. The study examined Medicare and Medicaid certified nursing homes across the United States that submitted Medicare cost reports between the years of 1999 and 2004 (11,472 average per year). Data source Data were obtained from the Minimum Data Set (MDS), the On-Line Survey Certification and Reporting (OSCAR), Medicare Cost Reports, and the Area Resource File (ARF). Study design Panel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal findings Financial and quality performance differed between nursing homes with high proportions of Black residents and nursing homes with no or medium proportions of Black residents. Nursing homes with no Black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of Black residents. Conclusion Nursing homes’ financial viability and quality of care are influenced by the racial composition of residents. Policymakers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly Black residents.

OBJECTIVE. To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.DESIGN. Pre-post study, with a 13-month intervention period.SETTING. Four AL communities.PARTICIPANTS. All prescribers, all AL staff who communicate with prescribers, and all patients who had an infection during the baseline and intervention periods.INTERVENTION. A standardized form for AL staff, an online education course and 5 practice briefs for prescribers, and monthly quality improvement meetings with AL staff.MEASUREMENTS. Monthly inventory of all systemic antibiotic prescriptions; interviews with the prescriber, AL staff member, closest family member, and patient (when capable) regarding 85 antibiotic prescribing episodes (30 baseline, 55 intervention), with data review by an expert panel to determine prescribing appropriateness.RESULTS. The mean number of systemic antibiotic prescriptions was 3.44 per 1,000 resident-days at baseline and 3.37 during the intervention, a nonsignificant change (P = .30). Few prescribers participated in online training. AL staff use of the standardized form gradually increased during the program. The proportion of prescriptions rated as probably inappropriate was 26% at baseline and 15% during the intervention, a nonsignificant trend (P = .25). Drug selection was largely appropriate during both time periods.CONCLUSIONS. AL antibiotic prescribing rates appear to be approximately one-half those seen in nursing homes, with up to a quarter being potentially inappropriate. Interventions to improve prescribing must reach all physicians and staff and most likely will require long time periods to have the optimal effect. Infect Control Hosp Epidemiol 2014;35(S3):S62-S68Antimicrobial resistance among bacterial pathogens is an imsiderably in terms of their medical problems and functional portant and growing public health concern, 1 ' 2 and inapprostatus, 16 by inference it seems likely that antibiotic overprepriate overprescribing is believed to be a contributing factor. 3 scribing may also be a problem in AL. However, in spite of Since antibiotic prescribing rates are high in nursing homes the large and growing population served by AL, this setting (ranging from 3 to 5 prescriptions per resident annually), 4 " 9 has received virtually no attention in attempts to either deconcern has been raised about potentially inappropriate prescribe or optimize antibiotic prescribing. 8 Studying this setscribing in these settings. 1 " A few studies of attempts to reduce ting would be important both because of the number of antibiotic overprescribing in nursing homes have been pubpersons served and because its organizational structure differs lished, and these have met with mixed results. 11 " 13 considerably from that of nursing homes, making extrapoDue to changes in long-term care regulation and financing, lation of results from nursing home studies not necessarily ass...

No abstract

Objectives To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rates of antibiotic resistance. Design Cross-sectional survey. Setting Four AL communities in North Carolina. Participants AL residents who received antibiotics (n=30) from October 20, 2010 to March 31, 2011, and their primary family member, staff, and the prescribing medical provider. Measurements Semi-structured interviews conducted about prescribing included the information available at the time of prescribing and the perceptions of the quality of communication among providers, staff, residents and family members about the case. Providers were asked an open-ended question regarding how to improve the communication process related to antibiotic prescribing for AL residents. Results Among 30 cases of antibiotic prescriptions, providers often had limited information about the case and lacked familiarity with the residents, the residents’ families, and/or staff. In addition, they felt cases were less severe and less likely to need an antibiotic than did residents, families, and staff. Providers identified several ways to improve the communication process including better written documentation and staff/family presence. Conclusion In our small sample of AL communities, providers faced an array of challenges in making antibiotic prescribing decisions. Our work confirms the complex nature of antibiotic prescribing in AL communities and reveals further work is needed to determine how to improve the appropriateness of antibiotic prescribing.

Obesity rates are high among all age groups, including older adults. Obesity negatively affects health and functional ability, increasing the risk for nursing home (NH) admission. The current study examines trends over 11 years in moderate to severe obesity rates among NH residents. A generalized least squares regression model for panel data was used to test the effect of time (years) on the rates. A significant increase in rates and significant variation in rates were observed. Little research has focused on the issue of obesity in NHs. High and increasing rates and variation in rates raise questions on demand and access to NH care for obese older adults. Additional research is needed to consider factors other than time that may affect NHs' ability to admit moderate to severely obese individuals. Understanding these trends will help NHs prepare for future demand, ensure equal access, quality care, and financing of services.