Master of Gerontological Studies, Miami University, 2017, Gerontology

Ohio has an older population who are more likely to live alone than other states. Older Ohioans are at higher risk of nursing home admission. Additionally, a recent study shows that nursing homes in Ohio have lower quality compared to the rest of the United States. Hence, improving nursing home quality in Ohio is paramount in the field of aging services. The goal of this current study was to identify factors that affect nursing home quality in Ohio using data from the 2013 Biennial Survey of Long-Term Care Facilities in Ohio for Nursing Facilities and 2013 fourth-quarter archived data from the Centers for Medicare and Medicaid Services Five-Star Rating System. Not-for-profit facilities with a low proportion of Medicaid days were more likely to be high performers in Health Inspection, Staffing, and Overall domains. Small facilities were more likely to be high performers in Staffing and Overall domains. Facilities that had no administrator turnover were more likely to be high performers in Health Inspection. Non-chain affiliated facilities performed better in the Staffing domain. Facilities with low STNA retention rates were at higher risk of receiving one- or two- star ratings in Overall. Implications for consumers, policy makers, and providers are discussed.

Committee: Jennifer Kinney (Committee Chair); Jane Straker (Committee Member); Robert Applebaum (Committee Member) Subjects: Gerontology

Master of Gerontological Studies, Miami University, 2017, Gerontology

The prevalence of Alzheimer's disease (AD) is growing in the United States. Many adults with AD will require long-term care services. Memory care units (MCUs) are a popular type of special care unit within long-term care facilities. Previous research is inconclusive regarding quality of life and quality of care outcomes for MCU residents. MCU regulations are a growing topic in Ohio and the United States. Ohio Governor John Kasich signed House Bill 470 into law effective March 21, 2017, requiring the development of MCU recommendations within six months. Using the 2005 and 2013 Ohio Biennial Survey of Long-Term Care Facilities, this study examined the number of MCUs, developed a profile of facilities with and without a MCU, and determined facility characteristics significantly associated with operating a MCU. Logistic regression analysis determined that profit status, facility size, proportion of days paid for by Medicaid, county poverty rate, and specialized activities were significantly associated with an Ohio nursing facility operating a MCU in 2013. Recommendations are presented for consumers, Ohio policy makers, and future researchers.

Committee: Jonathon Vivoda (Committee Chair); Robert Applebaum (Committee Member); Jane Straker (Committee Member) Subjects: Gerontology

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2023, Health Programs

Individuals with a mental illness is a group that is considered a vulnerable and underserved population. They face bias, discrimination, and stigma. This is not only by those in their own communities, but also by those who work in the healthcare profession. Individuals with a mental illness have become homeless, jailed, or reside in nursing homes. Much of this was due to the deinstitutionalization of the mental hospitals. Stigma is a cause for unequal treatment and/or inadequate care towards people with a mental illness. It is also believed that the younger a person is, the more diverse or empathetic that individual will be towards those who are different then him/her (Gaidhani et al., 2019). This study focused on residents diagnosed with a mental illness that reside in the nursing homes. The staff in these facilities are trained to aid those that are elderly and need assistance with basic life skills, such as dressing, bathing, eating, and mobility, but lack the ability to complete some or all of these modalities without assistance. The staff lack the knowledge and training to deal with the idiosyncrasies and behaviors of those with a mental illness (Molinari et al., 2017). This study examined if there was a difference in stigma between the different generations, working in nursing homes, towards those with a mental illness.

Committee: Gail Frankle (Committee Chair); Jesse Florang (Committee Member); Jennifer Harris (Committee Member) Subjects: Health Care Management

Doctor of Philosophy, Miami University, 2021, Population and Social Gerontology

Nursing home aides provide the bulk of direct care in the nations' nursing homes. Despite their importance nursing homes often experience low retention rates of these critical workers. Although it would make sense that job stability would be important, relatively few studies have assessed the association between quality and retention. Seven studies of retention consistently showed quality improvements associated with higher nurse aide retention. The current study advances knowledge by modeling the retention-quality relationship, using many measures that have not been examined in previous studies. With a sample of Ohio nursing homes (n=690) from the 2017 Biennial Survey of Long-Term Care Facilities, nurse aide retention rates were grouped into four categories based on quartiles (Low: 0-48%, Medium: 49-60%, High: 61-72%, Very high: 73% and above). Dependent variables on quality were derived from the 2017 Ohio Nursing Home Resident Satisfaction Survey, 2017 Automated Survey Processing Environment, and 2017 Care Compare Archives. Structural characteristics, financial resources, staffing and management, aggregate resident characteristics, retention practices, and county characteristics were used in the analysis. High retention facilities had better resident care experience scores than low retention facilities. Compared to low retention facilities, high retention received 30% fewer total allegations, substantiated and unsubstantiated allegations, as well as fewer total complaints. Similarly, at the annual recertification survey, facilities with high nurse aide retention outperformed low retention by 25% or more: they received 1.69 fewer deficiencies and 11.44 fewer points on the deficiency score. High retention facilities also received significantly fewer deficiencies compared to the very high retention facilities. The odds of having 3-, 4-, or 5-star overall ratings and survey star ratings for high retention facilities were 2.22 and 2.42 times the odds of low retention (open full item for complete abstract)

Committee: Bob Applebaum (Committee Chair); John Bowblis (Committee Co-Chair); Jane Straker (Committee Member); Katy Abbott (Committee Member); Amy Roberts (Committee Member) Subjects: Gerontology

Master of Arts, Miami University, 2019, Speech Pathology and Audiology

For residents with communication impairments (RWCI), access to person-centered, effective communication is an integral component of quality of life (QOL) within the nursing home (NH) setting. However, limited research has been conducted regarding the status of NH staff-RWCI interactions. Through the current study, we observed NH-staff interactions with nine RWCIs during a typical day to determine the quality, quantity, and method of communication utilized by staff. We also observed barriers to effective communication within the NH setting. While nurse assistants (NA) interacted most frequently with RWCIs, a variety of NH staff types also interacted with RWCIs throughout the day. All NH staff spent minimal time interacting with RWCIs, focused on daily care topics, and mainly utilized speech even though all RWCIs displayed cognitive-linguistic deficits. Lack of staff awareness of specific RWCI abilities/limitations and the presence of hearing loss in RWCIs were barriers to effective interactions. The responsibility to interact with RWCI using a person-centered, effective communication does not fall upon one staff type, rather all NH staff can engage with RWCIs effectively. The utility of providing staff education regarding a multiple methods communication approach is discussed as a means to encourage person-centered, effective NH staff-RWCI interactions thereby improving RWCIs QOL.

Committee: Kelly Knollman-Porter Ph.D (Advisor); Donna Scarborough Ph.D (Committee Member); Jane Straker Ph.D (Committee Member) Subjects: Gerontology; Speech Therapy

Doctor of Nursing Practice , Case Western Reserve University, 2017, School of Nursing

With the high prevalence of heart failure (HF) admissions to skilled nursing facilities (SNF), the need for competent nursing staff knowledgeable in HF education principles reflected in American Heart Association and American College of Cardiology Foundation guidelines is warranted. Limited knowledge of evidence-based guidelines and basic principles of HF management has the potential to delay early symptom recognition and reporting; putting patients at risk for exacerbation and hospitalization. A pre-test, post-test design was used to assess nursing staff's knowledge of HF education principles and confidence before and after an education intervention. Initially, one hundred and fifty-three registered nurse, licensed practical nurse and certified nursing assistant participants (RN, LPN, and CNA) completed pre-intervention surveys. Seventy participants completed the study protocol. Paired sample t-tests on two HF knowledge surveys showed statistically significant differences in RN mean test scores (p=0.002 and p=0.001) after completing the educational intervention. Statistically significant differences were also noted in CNA scores after completing the educational intervention (p=0.010 and p<0.0005). No statistically significant differences were noted in LPN mean test scores (p= 0.295 and p=0.0630) after completing the educational intervention. Paired-sample t-tests also evaluated the effect of education on RN, LPN and CNA confidence scores. Confidence to care for HF patients increased significantly for all nursing staff after the education (RN, p= 0.001; LPN and CNA, p< 0.0005). Findings of this scholarly project indicate an evidence-based education intervention can increase nursing staff's knowledge and confidence to monitor and manage HF patients in skilled nursing facilities.

Committee: Deborah Lindell (Committee Chair); Corrine Jurgens (Committee Member); Mary Dolansky (Committee Member) Subjects: Education; Nursing

Master of Gerontological Studies, Miami University, 2006, Gerontology

The purpose of this critical inquiry is to explore the cultural norms, socio-political history and legislative actions that helped to shape American and Ohio nursing homes as they are now. Culturally, how was it that we arrived at the harsh conditions existing in the almshouses of the 19th and early 20th centuries – the ancestors of our nursing homes - and how is it that some of those problems have carried over to nursing facilities today? Politically, what have been the forces that have shaped nursing home policy over the past eight centuries as well as during the past eight decades or so? How have Social Security, Medicaid, Medicare and other government programs for the poor, elderly and disabled affected the nursing home industry and its funding and regulations? Our ongoing general acceptance of what many consider to be minimal standards for the care of our elders will be viewed here through the major legislative events in the history of public welfare and nursing homes as they evolved in England, America and in Ohio.

Committee: Robert Applebaum (Advisor) Subjects: Sociology, Public and Social Welfare

Master of Science, The Ohio State University, 1961, Graduate School

Committee: Not Provided (Other) Subjects:

DNP, Kent State University, 2024, College of Nursing

The management of dementia is a difficult task in all healthcare settings. Behavioral and psychological symptoms of dementia (BPSD) affect 90% of individuals with dementia. One-third of older individuals living with dementia are regularly prescribed antipsychotic medications to handle dementia-related behaviors. For six decades the FDA has been aware that antipsychotics were being used in nursing homes to sedate residents for BPSD, without dementia being an approved diagnosis. The serious side effects and increased risk of death have led to changes in nursing home policy and regulation. The Centers for Medicare and Medicaid (CMS) teamed up with Federal and State agencies and proposed dementia care planning that involves assessing BPSD and utilizing non-pharmacologic interventions. The primary objective of this project is to determine if educating staff in non-pharmacological management of BPSD will reduce antipsychotic medication use. Method This evidence-based quality improvement (QI) project is based on Lewin's Change Theory of unfreezing, moving, and refreezing. Using the PDSA method to move the process forward, a team was established, and a plan of action was developed to reduce the administration of antipsychotics by educating staff in non-pharmacological interventions. Sixteen nursing staff (n-16) were trained over four days in nonpharmacologic dementia care management. A pre-and-post-assessment questionnaire was conducted. Twenty-two resident participant's medications were reviewed by the Psychiatric Mental Health Nurse Practitioner (PMHNP), and gradual drug reductions (GDRs) were ordered. GDRs are a CMS compliance requirement for nursing homes conducted as standard practice based on the pharmacist recommendations and an important recommendation by CMS in antipsychotic reduction are conducted and documented by the consulting PMHNP. Nursing responses to patients with GDRs who presented with behaviors and antipsychotic dose reduction (open full item for complete abstract)

Committee: Kimberly Cleveland PhD, JD, RN, C-MBC, C-MPC (Committee Chair); Pamela, Stephenson PhD, RN (Committee Member); Andrea Warner Stidham PhD, RN (Committee Member) Subjects: Aging; Behavioral Psychology; Behaviorial Sciences; Cognitive Psychology; Health; Health Care; Health Education; Medical Ethics; Medicine; Mental Health; Nursing; Personal Relationships; Personality Psychology; Pharmaceuticals; Pharmacology; Psychology; Psychotherapy

Bachelor of Arts (BA), Ohio University, 2019, Sociology

Studies have shown that building relationships is important for maintaining and improving health, but there have not been many narrative accounts of how new relationships are developed in elder care facilities. The purpose of this qualitative study is to obtain a better understanding of how adults living in nursing facilities maintain emotionally close relationships with family and friends and develop new relationships with other residents. Results will look at strategies for receiving social support and building meaningful relationships. The stories I have collected present the real faces of the aging population, and demonstrate the many opportunities we have to grow meaningful relationships in elder care facilities. By understanding these relationships, we can foster more successful relationships in and out of skilled nursing facilities, which might lead to better outcomes in health and well-being for the growing elderly population.

Committee: Berkeley Franz (Advisor) Subjects: Aging; Gerontology; Sociology

Master of Science, University of Toledo, 2017, Occupational Health (Industrial Hygiene)

An Abstract of Characterization and Perceptions of Noise in Nursing Homes by Stacie R. Dubin Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Masters of Science Degree in Occupational Health The University of Toledo December 2017 Medical staff has been shown to be exposed to noise and noise influence on work performance may affect patient care (Bharathan et al., 2007). Although research on noise has been conducted in hospitals, less has examined the nursing home environment and little attention has been given to noise and its impact on older adults. A relatively large number of nursing home residents and workers are potentially at risk to the effects of noise. Noise levels were measured at four nursing homes in Northwest Ohio to determine whether noise levels exceeded the EPA's recommendation of noise levels in hospital environments. In addition, a survey was distributed to determine the perception of noise levels by healthcare employees in a nursing home and the effects on their physiological and psychological health. Noise levels were measured over three days at each Facility for 24-hours at one-minute intervals. Five occupied locations were sampled at each Facility: Nurses Station, Community Space, Resident Room, Dining Room, and Other. An Unoccupied Room was also sampled for comparison purposes. Noise levels were examined by day (7 a.m. to 10 p.m.) and night (10 a.m. to 7 a.m.). The in-person survey was a descriptive design and subjects were employees from the four nursing homes at least 18 years of age. Results of Analysis of Variance (ANOVA) demonstrated significant differences in noise levels by Facility (p<0.001) and Sampling Location (p<0.001). In general, the highest noise levels were seen in the Resident Room and Other space. The mean Leq daytime and nighttime levels were similar except in the Community Space and Nurses Station which decreased at night. All mean Leqs were below ACGIH occupati (open full item for complete abstract)

Committee: April Ames (Committee Chair); Victoria Steiner (Committee Member) Subjects: Health Sciences; Occupational Health

Master of Science in Occupational Health, University of Toledo, 2017, Occupational Health (Industrial Hygiene)

Indoor air quality (IAQ) is considered one of the top five environmental risks to the public's health. Older adults are more vulnerable to health complications associated with indoor air contaminants because of their decreased immune system and age-associated health problems, as well as the fact that they spend up to 95 percent of their time indoors. Area air sampling was conducted in the nursing home section of four long term care facilities, three days at each facility (12 days total). Particle concentrations (PM2.5, PM10, Total Particulate matter (TPM), Ultrafine Particles (UFP), temperature, and humidity were measured. Two minute samples were collected during seven Sampling Sessions. Up to nine indoor locations were sampled, representing the various occupied spaces in each nursing home, along with an outside location for comparison. Results of Analysis of Variance (ANOVA) by Facility demonstrated significant differences (p<0.001) in PM concentrations and UFP counts. One Facility had higher particulate concentrations at all Sampling Locations which may include contributions from geographic location, vehicular traffic, or resident clustering. ANOVA by Sampling Location demonstrated significant differences (p<0.001) in PM concentrations and UFP counts. In general, the highest UFP and PM concentrations were seen in the kitchen, satellite kitchen, and hair salon, especially at times when the staff and residents were active in these rooms. Significant differences were seen in UFP counts (Facilities 1 and 3) and PM2.5 (Facility 2) by Sampling Session. The highest concentrations were found for the Sampling Sessions in the mid-morning and mid-afternoon which were during peak times of activity for the residents. Although maximum temperature measurements exceeded ASHRAE winter guidelines, this may be appropriate for older residents who prefer a warmer temperature. While most median particle values were below ASHRAE guidelines, maximum values did exceed occasionally (open full item for complete abstract)

Committee: April Ames PhD, CIH (Committee Chair); Victoria Steiner PhD (Committee Member); Akbar-Khanzadeh Farhang PhD, CIH (Committee Member); Sheryl Milz PhD, CIH (Committee Member) Subjects: Aging; Alternative Medicine; Engineering; Environmental Engineering; Environmental Health; Environmental Science; Environmental Studies; Gerontology; Health; Health Care Management; Health Sciences; Medicine; Occupational Health; Occupational Safety; Public Health; Welfare

Master of Arts, Miami University, 2015, Economics

Regulatory inspections are an important tool utilized in many industries to assure safety and quality. This study examines the impact that the composition of a regulatory team can have on inspection violations. Using data from the nursing home industry, we find that larger teams with less diversity in terms of areas of expertise tend to issue larger numbers of violations, and that larger inspection teams are also more likely to assign violations of a higher severity level than smaller teams. Along with the overall team effects, we find that effects can vary according to the expertise of the inspectors and, in several cases, find evidence that inspectors are more likely to find violations relating to their area of expertise. Understanding the importance of team composition is important for public policy makers in order to ensure adequate and consistent regulation across the board.

Committee: John Bowblis (Advisor); Charles Moul (Committee Member); Greg Niemesh (Committee Member) Subjects: Economics; Health Care

Master of Gerontological Studies, Miami University, 2015, Gerontology

Respect to residents and their choices has been established as a fundamental right of nursing home residents. Despite the importance of this basic right, little is known about perceived respect in nursing homes and the factors associated with it. The purpose of this cross-sectional study was to examine perceived respect and its possible correlates across Ohio nursing homes. On average, nursing homes in Ohio had relatively high respect scores. After adjusting for a range of facility factors, I found facility size, facility location, resident participation in care planning and Center for Medicare and Medicaid star ratings in the staffing domain to be associated with perceived respect. Our understanding of how these factors affect respect among the resident population in Ohio nursing homes would benefit from a more nuanced examination of each subdomain of respect. Although additional research is needed, this study identified several potential next steps for policymakers seeking to ensure that residents are treated with respect.

Committee: Sara J. McLaughlin PhD (Committee Chair); Robert A. Applebaum PhD (Committee Member); Jane K. Straker PhD (Committee Member) Subjects: Aging; Gerontology

Master of Gerontological Studies, Miami University, 2014, Gerontology

Underutilization of mental health services in nursing homes is a major issue. Reasons for this phenomenon are varied and include misdiagnosis, lack of available mental health services, lack of trained professionals, and limited financial resources. Using the 2011 Biennial Survey of Long-Term Care Facilities in Ohio, this study examines how lack of access, payment, and resident reluctance to seek mental health services are perceived as barriers by nursing facility administrators. In addition, it examines how different facility factors affect these barriers. Location of facilities, facility size, and availability of mental health services were all significantly associated with barriers. Rural nursing facilities reported higher barriers compared with urban locations. Single facility organizations were less likely to report payment and access as barriers. Facilities that offer mental health services were less likely to report access and resident reluctance to receive services, but reported that reimbursement was a consistent barrier.

Committee: Robert Applebaum Ph.D. (Committee Chair); Sara McLaughlin Ph.D. (Committee Member); Jane Straker Ph.D. (Committee Member) Subjects: Gerontology

Master of Gerontological Studies, Miami University, 2014, Gerontology

More than a million immigrants from the former Soviet Union are currently living in the United States. Many of those immigrants arrived to the United States in older age. While previous studies were focused on the Russian immigrants' utilization of healthcare services in the United States, almost no studies examined the older Russian-speaking immigrants' hardships in the Soviet Union. A thematic analysis approach was used to analyze interviews conducted with 16 immigrant women from a Mid-Atlantic region, who moved to the US after the collapse of the Soviet Union. Seven identified themes were broken down by two major categories: childhood and adulthood in the Soviet Union and older age in the United States. The findings suggest that views of long-term care, intergenerational support, and socio-economic status are deeply rooted in the cultural and societal expectations of the country of origin.

Committee: Kate de Medeiros (Committee Chair) Subjects: Gerontology

PhD, University of Cincinnati, 2013, Medicine: Occupational Safety and Ergonomics

There has been a plethora of research investigating the adverse health effects of shift work and to a lesser extent musculoskeletal disorders (MSDs). The health care industry, specifically nurses and nurse aides, is probably the most integrated profession with shift work. The high prevalence of the low back pain and injuries among nursing aides indicates the need of investigation on the physical and psychosoical demands for shiftwork. The objective of the current study was to determine the physical and psychosocial work demands for long-term nursing aides for different shifts (Day, Evening and Night) and shift lengths (8-hour versus 12-hour) and adverse musculoskeletal outcomes. Fifty four female nursing aides who were permanent employee of five nursing homes in Cincinnati metropolitan area completed a psychosocial questionnaire developed from the Quality of worklife, Job Content and Dundee State Stress questionnaires. The nursing aides were also observed with a specially developed REBA checklist that quantified the postural demands. In addition, 2 nursing aides from each shift were monitored to quantifying the amount of time sitting, standing, and walking, as well as energy expenditure. Finally the nursing aides completed body discomfort symptom survey. One-way ANOVA, Kruskal-Wallis, and Fisher Exact Tests was used to identify significant differences among shifts. The results indicated more severe postures for shoulders and elbows in night shifts and for neck in 8-hour day shift. Walking steps and energy expenditure on day shift were significantly greater than on night shift and posed a significant amount of activity. Hourly energy expenditure on 8-hour shift was greater than 12-hour shift. The 8-hour shifts (especially evening and night) ranked lower when compared to the 12-hour shift for psychosocial factors: relationship with the coworkers and supervisor and had family interference with work, The 8-hour day shift nursing aides reported more hand-wrist p (open full item for complete abstract)

Committee: Kermit Davis Ph.D. (Committee Chair); Nancy Daraiseh PhD (Committee Member); Linda Sue Davis Ph.D. (Committee Member); Paul Succop Ph.D. (Committee Member) Subjects: Occupational Safety

MA, University of Cincinnati, 2003, Allied Health Sciences : Communication Sciences and Disorders

The purpose of this study was to find out how hearing aids are cared for in nursing homes by examining the condition of the hearing aids, resident satisfaction with the hearing aids, healthcare provider attitudes about hearing aid maintenance, and amount of knowledge on the part of both the residents and healthcare providers about how to maintain proper function of hearing aids. Thirty-four non-demented nursing home residents who owned at least one hearing aid and 17 healthcare providers that worked closely with the residents were asked specific questions related to hearing healthcare. The overall results indicated that the majority of nursing home residents and staff do not possess adequate knowledge about maintaining hearing aids to keep them properly functioning. Implications of this finding are discussed. It is recommended that a hearing aid reference guide created specifically for healthcare providers become available for use when faced with a hearing aid issue.

Committee: DR. ROBERT KEITH (Advisor) Subjects:

Doctor of Philosophy, The Ohio State University, 2003, Music

The purpose of this study was to investigate and analyze the status of the use of music in Medicare and Medicaid-certified nursing homes in the State of Ohio. Areas of concern included qualifications of personnel planning activities; sources of ideas for planning; available materials and equipment; frequency and duration of activities; types of activities, trips or performances; intergenerational and community activities; and purposes for including music activities. To obtain this information a questionnaire was sent by U.S. Mail to the activity directors of all Medicare and Medicaid-certified nursing homes in the State of Ohio. Networking, books, and volunteer expertise were the most frequent sources of ideas. Music instruments reported were pianos, rhythm band and small percussion. Electronic equipment and media were cassette tapes, videotapes, compact discs (CDs), and karaoke machines. More large nursing homes reported owning computers than did small homes. Activities occurred between daily and 3-5 times per week and lasted between 30-60 minutes. One third of all facilities reported having outsiders perform weekly. Listening to recorded music, singing, and listening to live performed music were the most frequent activities. These were offered on site with very few trips. While children performed at the majority of facilities, there were few reported intergenerational activities. Homes that employed professional musicians and music therapists reported more than average intergenerational activities. Church and volunteers were the most frequent community groups providing music. Gospel was the most popular genre with slight regional variations. Music therapy sessions involved groups and individuals, relaxation techniques, reminiscence, and sensory stimulation. Success of activities was measured by participation in facilities of all sizes, areas, and certification. Pleasure was the number one purpose for engaging residents in music activities, followed by social inter (open full item for complete abstract)

Committee: Patricia Flowers (Advisor) Subjects:

Bachelor of Science, Miami University, 2011, College of Arts and Sciences - Statistics

Minimum quality standards are enforced to guarantee consumers a certain level of quality. Minimum direct care staffing (MDCS) standards are minimum quality standard used in nursing homes. This study uses a difference-in-difference approach to analyze how implementing MDCS standards affects nurse staffing levels and composition. The results suggest that when faced with a binding staffing constraint, nursing homes increase staffing, but when the constraint is non-binding, some facilities will reduce staffing level. The results of this paper have implications for initiating new minimum quality standards in the nursing home industry.

Committee: John Bowblis PhD (Advisor); John Bailer PhD (Committee Member); Michael Curme PhD (Committee Member) Subjects: Economics