Organizational Characteristics of Assisted Living Communities With Policies Supportive of Admitting and Retaining Residents in Need of End-of-Life Care.
Organizational Characteristics of Assisted Living Communities With Policies Supportive of Admitting and Retaining Residents in Need of End-of-Life Care.
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DOI：
10.1177/1049909120968254
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Belanger E
中科院分区：
文献类型：
--
作者：
Travis LJ;Thomas KS;Clark MA;Belanger E
允许居民就地死亡的住宿护理/辅助生活社区（RC/AL）数量迅速增加。本研究的目的是检查 RC/AL 社区的组织特征，这些特征与支持接纳和留住需要临终 (EOL) 护理的居民的设施级政策相关。我们使用了 2010 年全国住宅护理设施调查的横截面数据。组织特征包括结构因素、人员配置水平和其他相关设施级政策。我们检查了描述性统计数据、二项式和多元多项式回归模型，以确定 1) 接纳和保留，或 2) 仅保留的可能性，与 3) 既不接纳也不保留需要 EOL 护理的 AL 居民相比。大多数寄宿护理机构 73.7%（n = 22,642）表示在 EOL 时接纳并留住了居民。然而，熟练护理水平普遍较低，其中 60.9% 的 RC/AL 社区报告没有注册护士，包括临终关怀工作人员。在多变量、多项回归模型中，熟练护理、个人护理助理的实际接触时间以及允许豁免自我疏散规则的政策等组织特征与 RC/AL 社区接纳/保留需要 EOL 护理的居民的可能性增加相关。尽管熟练护理水平总体较低，但一项全国代表性调查显示，大多数 RC/AL 社区接纳并留住需要 EOL 护理的居民。人员配备和自我疏散政策豁免似乎是 RC/AL 社区提供这些服务的核心特征。
There has been a rapid increase in the number of residential care/assisted living communities (RC/AL) that allow residents to die in place. The objective of this study was to examine the organizational characteristics of RC/AL communities that are associated with facility-level policies supportive of admitting and retaining residents in need of end-of-life (EOL) care. We used cross-sectional data from the 2010 National Survey of Residential Care Facilities. Organizational characteristics included structural factors, staffing levels, and other relevant facility-level policies. We examined descriptive statistics, binomial and multivariable multinomial regression models to determine the likelihood of 1) admitting and retaining, or 2) only retaining, as compared to 3) neither admitting nor retaining AL residents in need of EOL care. A majority of residential care facilities 73.7% (n = 22,642) reported admitting and retaining residents at EOL. Yet, levels of skilled nursing care were generally low with 60.9% of these RC/AL communities reporting that registered nurses were not available, including hospice staff. In multivariable, multinomial regression models, organizational characteristics such as skilled nursing, hands-on contact hours from personal care aides, and policies allowing exemptions to self-evacuation rules were associated with increased likelihood of RC/AL communities admitting/retaining residents in need of EOL care. Despite overall low levels of skilled nursing care, a nationally representative survey revealed that a majority of RC/AL communities admit and retain residents in need of EOL care. Staffing and exemptions from self-evacuation policies appear to be central characteristics associated with the provision of these services in RC/AL communities.
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DOI：
10.1016/j.jamda.2019.09.013
发表时间：
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10.1001/jama.2018.8981
发表时间：
2018-07-17
期刊：
JAMA
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