Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

Dys, Sarah; Smith, Lindsey; Tunalilar, Ozcan; Carder, Paula

doi:10.1177/2333721420979840

Cited by 14 publications

(12 citation statements)

References 135 publications

(172 reference statements)

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“…Residents of long-term care homes commonly receive monthly capitated primary care through consistent primary care providers under contract by the home, but no similar model exists in retirement homes, nor is there a regulatory requirement for on-site or on-call physicians in Ontario or elsewhere. 44 Our findings suggest that the implementation and expansion of similar medical models of care in retirement homes may be an important intervention to promote continuity of care and reduce rates of hospital-based care among this population.…”

Section: Discussionmentioning

confidence: 78%

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Manis

Poss

Jones

et al. 2022

CMAJ

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Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes.

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Section: Discussionmentioning

confidence: 78%

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Manis

Poss

Jones

et al. 2022

CMAJ

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“…42,43 Yet most AL communities in the U.S. do not provide medical or skilled nursing services. 44 Further, the majority (83.3%) of AL staff are unlicensed personnel (e.g., personal care aides) and only 16% are licensed personnel (e.g., registered nurses [6.1% and licensed practical nurses [9.9%]). 2 The need for more skilled post-acute care among AL residents after hospital discharge may not be met on site 19 and necessitates additional support.…”

Section: Discussionmentioning

confidence: 99%

Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities

Wang

Mao

McGarry

et al. 2022

J American Geriatrics Society

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Background Despite the rapid growth of assisted living (AL) and frequent hospitalizations among AL residents, little is known about their patterns of post‐acute care transitions and outcomes. This study examined the post‐acute care transitions among AL residents and their association with outcomes in the first 30 and 60 days after hospital discharge. Methods This study used data from 2018 national Medicare enrollment and claims datasets, the Minimum Data Set (MDS), and Medicare Provider Analysis and Review (MedPAR) of 104,497 unique Medicare beneficiaries residing in ALs in the U.S. Post‐acute care referrals, based on hospital discharge status, to skilled nursing facilities (SNF), home with home health care (HHC), home without HHC, and other settings. Outcomes included 30‐day and 60‐day hospital readmissions, emergency department (ED) visits, long‐stay care nursing home placement, and mortality. Multinomial logistic regression analysis and logistic regression analysis were conducted. Results The most common post‐acute care referral was to SNF (40%), followed by home without HHC (28%), home with HHC (17%), and others (15%). Compared to discharge home without HHC, discharge to SNF was associated with a lower likelihood of ED visits (Odds Ratio = 0.597, p < 0.01) and hospital readmissions (OR = 0.856, p < 0.001), and higher likelihood of long‐stay nursing home placement (OR = 11.224, p < 0.01) and mortality (OR = 2.025, p < 0.01). Discharge home with HHC was associated with a higher likelihood of hospital readmissions (OR = 1.148, p < 0.01) and a lower likelihood of long‐stay nursing home placement (OR = 0.737, p < 0.05) than discharge home without HHC. The results were similar within the first 30 days as well as 60 days after hospital discharge. Conclusions AL residents who are discharged to different post‐acute care settings tend to differ in 30‐day and 60‐day outcomes. At hospital discharge, clinicians and discharge planners should be provided information about the exact type and availability of services at AL to make the most appropriate discharge referrals for AL residents.

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“…The literature reports additional factors influencing nurse-physician communication in primary care and assisted living, from nurses' or interprofessional perspectives, which we did not find, including territorialism, lack of time on part of the physician, difficulty reaching each other, not working with the same electronic records and unclear team goals. 7,9,[14][15][16][17][18]28 Limitations and strengths…”

Section: Discussionmentioning

confidence: 99%

Nurse-physician Communication around Identifying Palliative Care Needs in Nursing Home Residents

Steen

Jongen

Dekker

et al. 2021

Preprint

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Objective: To assess experiences of medical practitioners who are on the staff of nursing homes with communication with nursing staff about identifying emerging and changing (palliative) care needs of residents of nursing homes in the Netherlands. Design: Qualitative interview study. Setting and Participants: Fifteen physicians and two nurse practitioners employed by eight care organizations in the western urbanized region of the Netherlands. Methods: We conducted individual semi-structured interviews in 2018 informed by a topic list that was based on a qualitative dataset about facilitators to palliative care in dementia reported by elderly care physicians. The interviews were recorded, transcribed verbatim and analysed with Atlas.ti. We used both deductive and inductive coding adding refined codes related to communication. Results: All interviewees expressed appreciation for nursing staff on whom they relied to communicate palliative care needs, yet they reported a variety of communication challenges around important changes in the condition of the residents which were covered by two themes. (1) Teamwork was facilitated or impeded by team size and structure, quality of relationships and clarity in hierarchical relationships. (2) Continuity of information was affected by (in)effective routes of consultation and (lack of) detail in communicating observations. Conclusions and Implications: Also in the case of on-staff physicians, functioning of the multidisciplinary team and accurate sharing of observed changes in the condition of nursing home residents are crucial for physicians to be able to address palliative care needs. The expressions of the physicians of how they would favor nursing staff to communicate can inspire interprofessional training, such as reporting objective observations and phrasing a clear request for help while avoiding overly demanding appeals.

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Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

Cited by 14 publications

References 135 publications

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities

Nurse-physician Communication around Identifying Palliative Care Needs in Nursing Home Residents

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