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This study aimed to identify the barriers to a timely discharge from short-term care in Veterans Health Administration (VHA) Community Living Centers (CLCs). Ninety-nine interviews were conducted with CLC staff in leadership and direct-care positions in eight varied CLCs. Major themes identified through qualitative analysis as barriers to a timely discharge were a lack of patients' financial resources, low social support, and reluctance of some veterans and staff to view a timely veteran discharge as their goal. Staff also perceived that barriers were much more difficult to overcome in regions where community-based long-term services and supports were limited or nonexistent. Because VHA has lagged behind Medicaid more generally in terms of investment in these types of services, additional strategies are warranted to achieve the important policy goal of deinstitutionalizing VHA care and returning veterans to their homes in the community. [ABSTRACT FROM AUTHOR]

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students’ professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students’ professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students’ professional development. [ABSTRACT FROM PUBLISHER]

Health care transitions are often dangerous for older patients. Interviews with older adults about their health care moves in Rhode Island (RI) were conducted to develop an Internal Medicine (IM) curriculum designed to provide IM interns with insights about the impact of transitions on patients. This paper describes some ways patients talk about their transitional experiences. Following pilot interviews, 10 nursing home residents were interviewed about their care transitions, conversations with physicians, and advice to doctors beginning their careers. The interviews were analyzed to identify themes. Patients described multiple moves, often did not know what to expect, appreciated help from a family member and desired effective communications with physicians. Learning about patient experiences may help new physicians appreciate the experiences of transitions on patients. [ABSTRACT FROM AUTHOR]

To understand the process of instituting culture change (CC) practices in nursing homes (NHs). NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail. Results: The themes include: (a) Reasons for implementing CC practices vary; (b) NH approaches to implementing CC practices are diverse; (c) NHs consider resident mix in deciding to implement practices; (d) NHAs note benefits and few costs to implementing CC practices; (e) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; (f) Education and communication efforts are vital ways to institute change; and (g) NHA and other staff leadership is key to implementing changes. Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations. [ABSTRACT FROM PUBLISHER]

The article presents a study which examines the impact of electronic health records (EHR) to the physician's behavior, physician-patient interactions, and responses of patients during EHR implementation. The study uses the triangulation design and visual analog scales (VAS) on the analysis. The results show that patient trust in the physician and the security of the therapeutic relationship showed to override most patients' concerns while physicians and medical staff improved work efficiencies.

An introduction is presented in which the author offers information on several topics discussed in the issue including the long-term care, physicians giving medical care for older adults, and managing transitions of patients from hospitals to nursing home with effective care.

In this article, the author highlights the importance of nursing homes within the long-term health care system in the U.S. He informs about physician Stanley M. Aronson, who was associated with nursing home, and his contribution in the U.S. health care industry. It further presents statement of Bill Thomas, creator of the reform effort called the Eden Alternative, concerning how hospital and a poorhouse came together to produce the nursing home.

Health care transitions are often dangerous for older patients. Interviews with older adults about their health care moves in Rhode Island (RI) were conducted to develop an Internal Medicine (IM) curriculum designed to provide IM interns with insights about the impact of transitions on patients. This paper describes some ways patients talk about their transitional experiences. Following pilot interviews, 10 nursing home residents were interviewed about their care transitions, conversations with physicians, and advice to doctors beginning their careers. The interviews were analyzed to identify themes. Patients described multiple moves, often did not know what to expect, appreciated help from a family member and desired effective communications with physicians. Learning about patient experiences may help new physicians appreciate the experiences of transitions on patients.