Predictors of Advance Directives in Institutionalized Elderly This study used a cross-sectional design to interview 133 cognitively alert residents from 13 nursing facilities to examine the predictors of Advance Directives (ADs). A logistic regression examined the effect of Locus of Control (LOC) in predicting the presence of ADs, after controlling for residents' background characteristics and organizational factors. The findings suggested that LOC was not significant. Rather, two background characteristics, religious affiliation and knowledge of ADs, predicted having ADs. More specifically, Jews and Catholics compared to Protestants, and those with more knowledge of ADs had implemented ADs. From a practice perspective, educational programs geared at examining differences in religious affiliation and knowledge of the subject are likely to impact residents' implementation of ADs. As a note of caution, the findings from the study need to be tested with larger, more generalizable samples. Read more
Prevalence and Problems in the Use of Satisfaction Surveys Results from Research on Ohio Nursing Homes The purpose of this chapter is to investigate the extent to which consumer satisfaction surveys are being conducted in skilled nursing facilities in the state of Ohio, the nature of the survey process and outcomes, and reported problems with satisfaction surveys. To date, research has not examined these issues, hence there is a lack of empirical information to gauge the prevalence and effectiveness of the consumer satisfaction survey process and outcomes from the perspective of facility staff. This study helps to fill the gap in the research literature by providing information on satisfaction surveys, based on interviews with management staff from a random sample of nursing homes throughout the state that are certified by the Ohio Department of Health as licensed providers. Read more
Predictors of Institutionalization for Persons with Alzheimer’s Disease and the Impact on Family Caregivers This study examines the factors which differentiate family caregivers who placed (n = 284) versus continued to provide in-home care (n = 642) to relatives with dementia over a 2-year period. Caregiver variables (i.e., income, kin relations, depression, burden, physical health, and social support) and care receiver variables (i.e., level of functional impairment and age) were entered into a logistic regression analysis predicting subsequent placement versus continuing care at home. Results indicate that compared to continuing care subjects, caregivers most likely to place their family member were more depressed, caring for impaired relatives with more problem behaviors (e.g., wandering, inappropriate behavior) and receiving respite assistance. After placement, caregivers were found to be more burdened and to have declined slightly in their levels of subjective physical health. Findings suggest that interventions for family caregivers before and after placement may be beneficial in alleviating the negative effects of this stressful transition. Read more
Restraint Removal and Changes in Social Response Among Nursing Home Residents This study investigated whether removing physical restraints from previously restrained nursing home residents would change their social response. A quasi-experimental design was used to obtain data from 93 previously restrained subjects who became restraint-free (experimental group) and from 93 randomly selected never-restrained subjects (nonequivalent control group) in seven nursing homes. A repeated measures analysis of covariance (ANCOVA) controlling for group differences in cognitive status and physical activities of daily living (PADL) was used to examine changes in social response at pretest, posttest, and follow-up. Findings suggested that restraint removal had no effect on changing social response over time. Even after attempting to control for differences between groups, social response was significantly related to subjects’ cognitive abilities and PADL status. The control group was better functioning in both areas, and this affected their ability to respond socially at a much higher level throughout the study than the experimental group. Read more
The Effect of Activity Involvement and Social Relationships on Boredom Among Nursing Home Residents This study investigated the types of activities that nursing home residents participate in, and whether participation in group activities and quality of residents' social networks could explain reports of boredom. Results indicated that residents enjoyed both solitary activities (watching TV, reading) as well as group activities like parties, social programs, playing cards and other games. Further, boredom was not related to participation in group activities but rather to depression, negative interactions with social network members and, perhaps, with a lack of friendships with other residents. Findings indicate that the personal and mental health needs of residents should be given major consideration while designing group activities for residents. Read more
Nursing Assistants Caring for Dementia Residents in Nursing Homes Most research on nursing home care has focused on its problems and shortcomings, with few positive reports concerning resident care. The current study investigates a neglected aspect of nursing home research. family members' positive perceptions of the care nursing assistants provide to residents with dementia. Content analysis of cross-sectional data from 133 family member interviews from five nursing homes revealed four positive themes: • Family members' appreciation for how difficult it is to care for persons with dementia and understanding constraints imposed by understaffing, heavy workloads, and low wages; • Care provided by nursing assistants that exceeds expectations; • Positive expressions between nursing assistants and residents and residents' family members; and • Identification of a kin-like relationship between residents and nursing assistants. Read more
Institutionalization A Continuation of Family Care It is often assumed that with institutionalization comes an end to family caregiving. The goal of this study is to show that family caregiving continues even after institutionalization of the care recipient. The data come from 81 families who institutionalized their elders. The findings indicate that families remain involved in the care of the elder after institutionalization, although to a lesser degree and in different ways. Involvement in personal care tasks is reduced, not terminated; involvement in the specialized needs of the elder, such as their financial and legal concerns, continues, along with the new role of advocacy. The effects of caregiving are still felt by the primary caregiver, as are the effects of institutionalizing the care recipient. Read more
A Stepwise Approach to Reducing Physical Restraints in Nursing Homes This article describes a step-by-step process for implementing restraint reduction programs in seven skilled nursing facilities. Important steps involved in the project included gaining the commitment of top management to the project, such as administrators and medical directors; educating staff on restraint reduction philosophy and techniques; forming multidisciplinary committees; and establishing a formal implementation plan. The varying success rates of the program depended on the level of commitment to the project by top management, the level of staff morale and motivation, the ability to customize the program to suit the culture of the facility; and the efforts of direct-care staff to develop innovative alternatives. The project demonstrated that frail, elderly people in nursing homes need not be physically restrained to receive effective care and that alternatives can include more dignified options. Read more
Changes in Attitudes Toward Restraints Among Nursing Home Staff and Residents’ Families Following Restraint Reduction Changes in attitudes toward using physical restraints, and the benefits of restraint elimination were examined by interviewing 161 staff and 153 family members of residents in four Long Term care facilities before and after formal restraint reduction programs were instituted. The four sites were divided into two groups: one group was composed of two sites that had initiated restraint reduction prior to this study, while the other group initiated restraint reduction as a result of this study. Both groups experienced statistically significant declines in restraint prevalence rates from pre- to posttest. Although both staff and families cited fewer reasons for using restraints from pre- to posttest, staff along with families of previously restrained residents, did not perceive increased benefits to residents or their relatives following restraint reduction. Restraint reduction, therefore, could lead to an acceptance of nursing practices that emphasize dignity even without an accompanying perception of improvement in relatives' or residents' daily lives. Read more
