Nursing Home Residents With Dementia: Association Between Place of Death and Patient Safety Culture

Author:

Orth Jessica1ORCID,Li Yue1,Simning Adam12,Zimmerman Sheryl3,Temkin-Greener Helena1

Affiliation:

1. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA

2. Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York, USA

3. The Cecil G. Sheps Center for Health Services Research and The Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, USA

Abstract

Abstract Background and Objectives Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. We examined associations between these variables and place of death (NH/hospital) among residents with dementia. Research Design and Methods Cross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death. Results Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements. Discussion and Implications Promoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.

Funder

National Institutes of Health

Agency for Healthcare Research and Quality

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Gerontology,General Medicine

Reference59 articles.

1. Do safety culture scores in nursing homes depend on job role and ownership? Results from a national survey;Banaszak-Holl;Journal of the American Geriatrics Society,2017

2. Patient safety culture: A review of the nursing home literature and recommendations for practice;Bonner;The Annals of Long-Term Care,2008

3. Staffing ratios and quality: An analysis of minimum direct care staffing requirements for nursing homes;Bowblis;Health Services Research,2011

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