Investigating adverse events in long-term care facilities:a systematized review

Objective:This systematized review aimed to synthesize the results of empirical studies focused on the types and factors of adverse events(AEs)that contribute to them in long-term care(LTC)settings.Methods:The search was conducted in Pro Quest,Scopus,and Pub Med in January 2021 and resulted in 1057 records.The content analysis method was used in the data analysis.Results:In all,35 studies were identified as relevant for the review.The analysis revealed 133 different types of AEs and 60 factors that contributed to them.Conclusions:In LTC,various AEs occur,most of which are preventable,while many factors that influence their occurrence could be significantly modifiable.Through an effective analysis of AEs in LTC,it is possible to minimize their occurrence and,at the same time,minimize their negative impact on all par ties concerned.

Dignity and its related factors among older adults in long-term care facilities:A cross-sectional study

Objectives:This study aimed to explore the dignity and related factors among older adults in long-term care facilities.Methods:Cross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities.Dignity among older adults was measured using the Dignity Scale,and its potential correlates were explored using multiple linear regressions.Results:Results showed that the total score of the Dignity Scale is 151.95±11.75.From high to low,the different factors of dignity among older adults in long-term care facilities were as follows:caring factors(4.83±0.33),social factors(4.73±0.41),psychological factors(4.66±0.71),value factors(4.56±0.53),autonomous factors(4.50±0.57),and physical factors(4.38±0.55).A higher score of the Dignity Scale was associated with higher economic status,fewer chronic diseases,less medication,better daily living ability and long-time lived in cities.Conclusion:Older adults with low economic status,more chronic diseases,and poor daily living ability,taking more medications,or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.

Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Contemporary Designs for Long-Term Care (LTC) Facilities

In addition to experiencing shortage in LTC workforce, some existing facilities are unable to provide quality service, since they were designed and built decades ago. Thus, the renovation of outdated LTC facilities is currently an unavoidable issue. In this paper, some contemporary practices are presented related to renovating old LTC facilities to improve the quality of service. The most important concept is the person-centered design. Some other elements include the importance of natural lighting for residents, proper practices of flooring and picking doors, some details in home-like design, new guidelines for resident rooms’ design, and other miscellaneous issues. Furthermore, the latest Americans with Disabilities Act (ADA) compliance protocols are reviewed, and some crucial elements are discussed to ensure the renovations will make the facilities compliant with the current standards.

Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Safety and Quality of Care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical Care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

Evaluation of Care Quality Related to Dietary Intake and Swallowing Functions of Residents at Long-Term Facilities in Japan

This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care facilities. We investigated outcome indicators, such as changes in dietary intake and swallowing function levels of residents, and clarified which structural and process indicators were associated with the outcome indicators. This was a retrospective study, analyzing information on healthcare services from 1067 long-term care facilities during the fiscal year 2012, sampled from among those registered with the Welfare, Health and Medical Care Information Network of the Welfare and Medical Service Agency in Japan. Five outcome indicators were identified. Next, we examined the relationships between the outcome indicators and structural or process indicators using a multivariate linear regression model, adjusting for facility type. The findings showed how the five outcome indicators were used in long-term care facilities over a period of one year and determined the independent predictors of these outcome indicators. The amplification of dietary function 1 was associated with “assessment of oral functions using a feeding and swallowing assessment checklist every three months”, “holding care conferences related to ingestion and swallowing every three months”, and “maintaining a 1:2 ratio for meal-time assistants to residents”. To improve the quality of care, it is necessary to increase the number of staff (e.g., to provide meal assistance to residents) and to understand changes in the residents’ status through accurate assessment and monitoring.

Quality indicators for the care of older adults with disabilities in longterm care facilities based on Maslow’s hierarchy of needs

Purpose:This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities(LTCFs)based on Maslow’s hierarchy of needs.Methods:The draft of the quality indicators was drawn up based on a literature review and research group discussion.The quality indicators were finalized by two rounds of expert consultation(involving 15 experts)using the Delphi method.The Analytic Hierarchy Process was applied to calculate the indicators’weight.Results:The response rates of the two rounds of consultation were 100%and 93%,and the expert authority coefficients were 0.86 and 0.87.After two rounds of consultation,the expert opinion coordination coefficients of the first-,second-and third-level indicators were 0.42,0.25,and 0.96,respectively(P<0.05),and the variation coefficient was0.25.The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level,19 second-level,and 107 third-level indicators.Conclusion:The quality indicators for the care of older adults with disabilities in LTCFs are reliable,scientific,comprehensive,and practical and specify the content of person-centered care needs.This can provide a reference for evaluating and improving care quality in LTCFs.

Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Potential Legal Issues and Care Implications during Care-Prevention Gymnastic Exercises for the Elderly Using Pepper in Long Term Health Care Facilities

In Japan, the shortage of personnel is a problem in long-term care nursing and rehabilitative care prevention. Nevertheless, Japan has taken measures to compensate for these shortages by promoting medical and nursing care activities using robotic technologies, and employing human resources from overseas. The purpose of this study was to determine potential legal issues and subsequent implications for care during prevention gymnastic exercises for the elderly using Pepper in long-term health facilities. The application program of Care-Prevention Gymnastics Exercises for Pepper (Pepper with CPGE) was made by the Xing Company Japan. Currently, care workers become intermediaries for the safe use of Pepper with CPGE. However, it was realized that some legal issues may arise if Pepper with CPGE alone will carry out these preventive care programs for the elderly without the presence of care workers as intermediaries. In this situation, using Pepper with CPGE alone to conduct care prevention gymnastics will require safety measures to prevent these possible practice issues and anticipate implications for care. In this regard, determining detailed target levels of rehabilitation exercise demands and environmental setting safety become essential factors. The use of humanoid robots in healthcare is expected to influence more practice protocols in contemporary and futurist rehabilitative human care. The identification of possible safety issues in performance and environmental situations, and implications for care are critical to ensure safe and valuable rehabilitative health care practices for the elderly population.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis （TB）. The TB prevention and treatment staff in health care facilities are responsible for the identification, diagnosis, treatment, supervision, and management of TB patients .

Vitamin D and Number of Falls in a Long-Term Care Facility

Falls represent a significant contribution to the morbidity and mortality of the elderly population. Because vitamin D is important in bone physiology, the use of vitamin D to restore deficient bone and ameliorate the effects of bone fractures due to falls has become a common practice in recent years. Following introduction of widespread use, reports began to emerge that vitamin D not only aided in repair of fall-induced bone fractures, but that it also reduced the occurrence of falls. Vitamin D now has become a routine intervention as a fall-prevention measure. Early analyses found evidence of prevention efficacy (reduced falls), but recent analyses are more equivocal. We retrospectively examined the records of 350 patients in a long-term care facility in which vitamin D administration and the number of falls were recorded as part of a comprehensive database of care. We found a dramatic rise in vitamin D use over the period covered (2006 – 2011) and a corresponding dramatic decrease in the number of falls. However, the number of falls continued to decline after 2008, despite a plateau in number of patients on vitamin D, particularly females. It appears that other factors contribute to the overall decline.

Quality of Intrapartum Care: Direct Observations in Selected Health Facilities in Zambia

Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. Aim: The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. Methodology: Guided by a descriptive cross sectional design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. Results: One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. Conclusion: Low numbers of midwives, inadequate supplies and equipment were major obstacles to following national and international agreed standards for providing optimal care during intrapartum period. Recommendations: There is need for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.

Experiences of Children’s Care Received at Windhoek Residential Child Care Facilities, Namibia

The caring is a very important aspect for every child’s well-being and development. A child should be cared for by biological parents or extended family members when possible. In the absence of these two possibilities, other options are in place such as Residential Child Care Facilities (RCCFs). However, RCCFs are generally regarded as last resorts, as it is noted that they have a negative impact on the well-being of the children. Caregivers in RCCFs should ensure that these children are being adequately cared for as they substitute their biological or extended families. It is also a child’s rights to be provided love, care and support coupled with a sense of belonging, recognition and independence. However, children without or inadequate parental care are likely to be vulnerable from all forms of violence. The aim of this qualitative, exploratory, descriptive, contextual and phenomenological study was to explore and describe the children’s experiences regarding the care received at the Residential Child Care Facilities and to provide recommendations regarding research findings. Data were collected through one on one in-depth interviews and Tech method was used to analyze data. The results of the study show that children in RCCFs have experienced both positive and negative care. The care is experienced through relationships with staff in the facilities, provision of their basic needs, knowledge of their cultural identity and their adult future preparation once they leave the facilities. Thus, it is recommended that a conducive environment that contributes to the quality of care for children in RCCFs be established, taking into consideration human resources capacity, policy guidelines and standards in place while providing care to those children.

Assessment of Active Case Search of COVID-19 in Healthcare Facilities during the Third Wave of the Pandemic in Ekiti State, Nigeria

Early case detection and isolation of patients infected with highly infectious diseases through active case search (ACS) are important for early commencement of treatment and control of the disease within a population. This study aimed to assess the ACS of COVID-19 in healthcare facilities during the third wave of the pandemic in Ekiti State, Nigeria. This cross-sectional study was conducted in all healthcare facilities in Ekiti State. All cadres of local government primary healthcare workers were trained to carry out the ACS using semi-structured interviewer-administered questionnaire uploaded on android phone software open data kit (ODK). ACS was conducted between June and September (epidemiological week 23 to 36), 2021 and the collected data were analyzed using IBM SPSS version 23.0. P-value < 0.05 was taken as significant. The number of ACS visits for COVID-19 increases with epidemiological week progression, but the highest was in week 32 (9.9%). Cases of suspected COVID-19 in the healthcare facilities in the last one week were reported in more than half (58%) of the visits and 57.8% of those reported, documented between 1 - 4 cases. Also, out of those that were reported, 42% of them missed (not line listed) at least one suspected case of COVID-19. The private health facilities missed more cases of COVID-19 (54.3%) than other categories of health facilities (p < 0.001). The health educators and local government immunization officers (LIO) than other cadre of healthcare workers found most missed cases (57.1% and 51.4% respectively) in their visits (p < 0.001). The health educator as well as the LIO detected the highest proportion of missed suspected cases which shows that disease surveillance officers alone may not be adequate for ACS, there is a need to involve other local government team member.

Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state,Nigeria

Objective:This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria.Materials and Methods:A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study.Participants(104)were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study,respectively.The three-phase delay model directed the study.A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants.Quantitative instrument was tested for reliability,while the qualitative instrument went through the rigors of qualitative data.Results:Findings revealed low level of referral and counter-referral practices as only 19(18.27%)and 30(28.85%),respectively,of care providers referred patients above 10 times in a year.The study also revealed inadequate human and material resources for referrals and counter-referrals.The mean on barriers to referral was 2.90,which was above the cutoff of mean of 2.50,which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies.Conclusions:Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers.Therefore,provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies.There is also a need for teamwork and synergy among all stakeholders in the referral chain.

Method to Evaluate the Location of Aged Care Facilitiesin Urban Areas Focusing on the Equity in Terms ofUsers’Accessibility

The present study developed and tested a method to evaluate the location of aged care facilities from the viewpoint of whether they are equitably located for users,using the improved Median Share Ratio(MSR).By evaluating the current location of aged care facilities,it is possible to extract the districts which are short of facilities.The evaluation method was applied to Chofu and Kiyose Cities in Tokyo Metropolis,Japan,and the evaluation result of weighting and that of not weighting by elderly population were compared and discussed.Consequently,adopting the evaluation method with weighting by elderly population,it is possible to adequately examine the districts where new aged care facilities should be constructed.From this evidence,it is significant to evaluate the location of aged care facilities,using the improved MSR with weighting by elderly population in the study.

Patients’ Preferences of Healthcare Facilities for Quality Healthcare Services in Akwa Ibom State: A Game Theory Approach

The purpose of this work is to apply Game theory approach to determine patients’ preferences of healthcare facilities for quality healthcare in Akwa Ibom State. Cross-sectional descriptive study and purposive sampling technique were adopted in order to collect the relevant data. Factors influencing patients’ preferences of health care facilities between public and private hospitals in Akwa Ibom State were assessed using a set of questionnaires which were distributed to 9976 patients in University of Uyo Teaching Hospital, Uyo, Akwa Ibom State. A two-person zero sum game theory approach was applied. Perception of quality healthcare services received by respondent’s preferred facilities between public and private hospitals was examined. Also the reasons for patients’ persistence of their preferred facilities were evaluated using questionnaire. The optimal strategy and the value of the game were determined using the factors influencing patients’ preferences of healthcare facilities, and analysed with two-person-zero-sum game. Facility that gives their clients the best satisfaction was identified. The data collected through questionnaire were analysed using the rules of dominance in a two-person-zero-sum game and TORA statistical software was employed. The result shows that the value of the game, v = 330 which implies that the game is favourable to public hospital. The result also showed that patients preferred public hospitals due to costs of services with probability one (1), while private hospitals attributed their preferences to attitude of healthcare providers with probability one (1).