Discharge documents are the main means of communication between healthcare settings, and their transmission from hospital to skilled nursing facility (SNF) is essential to assure high-quality care transitions, provide optimal patient care, and...
Many older adults do not plan for their LTSS needs. When older adults experience a health crisis (e.g. hospitalization, worsening dementia), family members must often react to the crisis. With PCORI funding, we developed PlanYourLifespan.org (PYL...
Pneumonia is the most common cause of hospitalization for nursing home residents. When deciding whether to treat a resident in the nursing home or transfer to a hospital, it is important to consider risks of hospitalization, including significant...
Most behaviour assessment tools used in long-term care (LTC) involve retrospective reports. These assessments are prone to errors in recall and provide little opportunity to identify the context of behaviours. Furthermore, these assessments are...
Up to 38% of individuals with advanced dementia experience clinical depression. Although studies demonstrate lower rates of clinical depression as dementia advances, this may be attributed to the difficulty of assessment at this stage. Clinical...
Home healthcare is post-acute care services provided to homebound patients in home settings, serving mostly older adults. It is important to ensure and improve home healthcare quality everywhere in the United States. This study leveraged data...
The burden of polypharmacy has become an increasing challenge in long-term care (LTC). Multiple medications prescribed may increase the risk of adverse drug events, such as falls and hospital transfers, especially for frail older adults with...
Interdisciplinary (ID) care plan meetings are a key component of nursing home care in 2019. Initially established as a didactic technique for teaching graduate nurses in the 1930s, the care plan has gone through many iterations to make it what it is...
Transitions across healthcare settings lead to unintentional errors, rehospitalizations, and mortality, and a key reason is poor communication between care settings. We developed a weekly telehealth videoconference to facilitate a virtual care...
Symptoms of delirium are common in the post-acute care setting, particularly in patients who have dementia or are approaching the end of life. When behavioral measures fail to adequately manage symptoms, there are few alternative options...
