Every day for the next twenty years, more than 10,000 people in the United States will turn 65. With life expectancies increasing as well, many of these Americans will eventually require ...round-the-clock attention-and we have only begun to prepare for the challenge of caring for them. InLabors of Love, Jason Rodriquez examines the world of the fast-growing elder care industry, providing a nuanced and balanced portrait of the day-to-day lives of the people and organizations that devote their time to supporting America's aging population.
Through extensive ethnographic research, interviews with staff and management, and analysis of internal documents, Rodriquez explores the inner workings of two different nursing homes-one for-profit and one non-profit-to understand the connections among the administrative regulations, the professional requirements, and the type of care provided in both types of facilities. He reveals a variety of challenges that nursing home care workers face day to day: battles over the budget; the administrative hurdles of Medicaid and Medicare; the employees' struggle to balance financial stability and compassionate care for residents. Yet, Rodriquez argues, nursing home workers give meaning and dignity to their work by building emotional attachments to residents and their care. An unprecedented study,Labors of Lovebrings new insight into the underlying structures of a crucial and expanding sector of the American health care system.
Correction to: BMC Health Services Research (2024) 24:374 https://doi.org/10.1186/s12913-024-10879-3 In this article, Table 5 was published as a duplicate of Table 4 due to a typesetting mistake. ...National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway Marit Stordal Bakken 4. Oddvar Førland1 Show authors BMC Health Services Research volume 24, Article number: 667 (2024) Cite this article 112 Accesses Metrics details The Original Article was published on 26 March 2024 Correction to: BMC Health Services Research (2024) 24:374 https://doi.org/10.1186/s12913-024-10879-3 In this article, Table 5 was published as a duplicate of Table 4 due to a typesetting mistake.
The pandemic of viral infection with the severe acute respiratory syndrome coronavirus‐2 that causes COVID‐19 disease has put the nursing home industry in crisis. The combination of a vulnerable ...population that manifests nonspecific and atypical presentations of COVID‐19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID‐19 among nursing home residents have created a “perfect storm” in our countryʼs nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal. J Am Geriatr Soc 68:2153–2162, 2020.
This Special Article comments on the article by White et al. in this issue.
If we continue, we grow old, and this is how it could be for us, writes Renée Rose Shield in her candid and sympathetic account of life in one American nursing home. Drawing on anthropological ...methods and theory to illuminate institutional life, she probes the sources of the profound sense of unease she found at the place she calls The Franklin Nursing Home. For fourteen months Shield participated in life at a nursing home in the northeastern United States. She got to know many of the people associated with the home—doctors, nurses, custodians, kitchen workers, administrators, social workers, visiting relatives, and above all, the residents, who emerge in this book as the individuals they are. Sections in which the residents speak poignantly in their own voices are woven throughout her richly detailed observations of everyday routines and events. We see them using guile and humor to get by, struggling to approach the end of their lives with a measure of autonomy and dignity, and we meet an often conscientious and caring staff constrained by conflicting professional perspectives and by the bureaucratic structure in which they work.There are no villains here. Rather, Shield explains how conditions in the nursing home create a difficult and uncomfortable liminality—the transition from an accustomed role to a new one-for the residents. In characterizing nursing-home existence, she goes beyond Erving Goffman's classic definition of the total institution to show how residents pass from adulthood to death without the comfort of ritual or community support common in rites of passage. In addition to the isolation created by this solitary passage, she finds restrictions on reciprocity—the old people are always recipients whose need and obligation to repay are seen as unnecessary and difficult to satisfy. The system encourages their passivity, which deepens their dependency and helps to explain why they are often perceived as children. Offering concrete suggestions for improving the quality of nursing-home life, Uneasy Endings will find a broad audience among those who work with the aged.
Objective
To compare staffing levels and deficiencies of the 10 largest U.S. for‐profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after ...purchase by four private equity (PE) companies.
Data Sources
Facilities for the largest for‐profit chains were identified through Internet searches and company reports and matched with federal secondary data for 2003–2008 for each ownership group.
Study Design
Descriptive statistics and generalized estimation equation panel regression models examined staffing and deficiencies by ownership groups in the 2003–2008 period, controlling for facility characteristics, resident acuity, and market factors with state fixed effects.
Principal Findings
The top 10 for‐profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for‐profit facilities also had lower staffing and higher deficiencies than government facilities. The chains purchased by PE companies showed little change in staffing levels, but the number of deficiencies and serious deficiencies increased in some postpurchase years compared with the prepurchase period.
Conclusions
There is a need for greater study of large for‐profit chains as well as those chains purchased by PE companies.
BACKGROUND/OBJECTIVES
To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with ...2019 coronavirus disease (COVID‐19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents.
DESIGN
Cross‐sectional analysis on Connecticut nursing home (n = 215) COVID‐19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two‐part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death).
SETTING
All Connecticut nursing homes (n = 215).
PARTICIPANTS
None.
INTERVENTION
None.
MEASUREMENTS
Numbers of COVID‐19 confirmed cases and deaths among residents.
RESULTS
The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20‐minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio IRR = .78; 95% confidence interval CI = .68–.89; P < .001); compared with one‐ to three‐star facilities, four‐ or five‐star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78–.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02–1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03–1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20‐minute increase in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR = .74; 95% CI = I .55–1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths.
CONCLUSION
Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.
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