PURPOSE: This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes.METHODS: A Delphi questionnaire was developed based on a review of the literature using the keywords “nursing homes,” “workforce,” and “quality of care.” A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged.RESULTS: A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea.CONCLUSION: To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.
Consensus ; Humans ; Korea ; Long-Term Care ; Methods ; Nurses ; Nursing Homes ; Nursing Process ; Nursing ; Quality of Health Care

PURPOSE: The purpose of this study was to investigate the expected family involvement of family members of elderly residents in nursing homes. METHODS: This study utilized a descriptive design with a survey research method. Data were collected using the Expect Family Involvement Questionnaire Scale, which was completed by 112 family caregivers of older adults in nursing homes in Seoul and Gyeong-gi Province. The collected data were analyzed using descriptive statistics. RESULTS: Responses to the questionnaire indicated the highest value was recorded for the item, ‘use of a room for family privacy’ with 2.41±0.43 points, followed by the item, ‘staff calling family for advice with resident problems’ with 2.38±0.38 points and ‘education about nursing home programs’ with 2.32±0.42 points. CONCLUSION: In order to promote family involvement in long-term care facilities, various approaches, interventions, and government supports with the respective of the family are required. The nursing home placement process should include understanding discuss on the importance of the role of family, and should help promote positive relationships between the elderly residents and their families. Staffs and administrators of nursing home are to consider the family as a partner rather than visitor.
Administrative Personnel ; Adult ; Aged ; Caregivers ; Humans ; Long-Term Care ; Methods ; Nursing Homes ; Nursing ; Seoul

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

BACKGROUND: Slow-motion training, an exercise marked by extremely slow movements, yields a training effect like that of a highly intense training, even when the applied load is small. This study evaluated the effects of low-intensity bodyweight training with slow movement on motor function in frail, elderly patients. METHODS: Ninety-seven elderly men and women aged 65 years or older, whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care level 1 and 2), volunteered to participate. Two facilities were used. Participants in the first facility used low-intensity bodyweight training with slow movement (the LST group, n = 65), and participants in another facility used machine training (the control group, n = 31). Exercises were conducted for 3 months, once or twice a week, depending on the required level of nursing care. Changes in motor function were examined. RESULTS: Post-exercise measurements showed significant improvements from the pre-exercise levels after 3 months, based on the results of the Timed Up and Go test (p = 0.0263) and chair-stand test (p = 0.0016) in the low-intensity exercise with slow movement and tonic force generation (LST) group. Although the ability to stand on one leg with eyes open tended to improve, no significant change was found (p = 0.0964). CONCLUSIONS: We confirmed that carrying out LST bodyweight training for 3 months led to improvements in ambulatory function and lower-limb muscle strength. In this way, it is possible that LST training performed by holding a bar or by staying seated on a chair contributes to improved motor function in elderly patients within a short time. TRIAL REGISTRATION UMIN000030853 . Registered 17 January 2018. (retrospectively registered).
Aged ; Aged, 80 and over ; Female ; Frail Elderly ; Humans ; Long-Term Care ; Male ; Motor Activity ; Movement ; Prospective Studies ; Resistance Training ; methods

PURPOSE: There has been a growing recognition that person-centered care enhances the quality of life of nursing home residents with dementia. This study was conducted to develop a person-centered dementia care online education program for direct care staff in long-term care facilities. METHODS: Delphi method with expert group was used to validate contents. We developed 61 draft items based on literature review. Twenty experts participated in consecutive three round surveys including 5-point Likert scale questions and open-ended questions. Based on experts' opinions, the content validity ratio for content validity and the coefficient of variation for stability were calculated. RESULTS: Three-round Delphi surveys and additional feedback from the expert panel established a consensus of core contents: 1) dementia (7 categories), 2) person-centered care (6 categories), 3) communication (8 categories), and 4) behavioral and psychological symptoms of dementia (6 categories). Specific sub-categories in each category were differentiated according to the job qualifications (65 sub-categories for registered nurses, 64 sub-categories for nursing aids, and 41 sub-categories for personal care workers). CONCLUSION: This delphi study identified person-centered dementia education curricula, in which the person-centered approach should be a key policy priority in Korean long-term care system. Now it is urgently needed to develop education programs utilizing online platforms that enable efficient and continuous learning for long-term care staff, which can contribute to behavior changes in the person-centered dementia care approach and improvement of care quality in long-term care facilities.
Caregivers ; Consensus ; Curriculum ; Delphi Technique ; Dementia ; Education ; Humans ; Learning ; Long-Term Care ; Methods ; Nurses ; Nursing ; Nursing Homes ; Quality of Life

PURPOSE: This was a methodological study to develop a valid and reliable health assessment tool for middle-aged adults in long-term care settings (HATMAL). METHODS: At the first stage of this study, initial 56-items HATMAL were derived via literature review, survey for needs assessment, and focus group interviews with experts. At the second stage, 54 items HATMAL were finalized via content validity test with 5 experts and a pilot study with 30 nurses. At the third stage, validity and reliability tests were conducted with 100 middle-aged patients in a long-term care hospital. Data were analyzed by factor analysis using SPSS 18.0 program. RESULTS: Exploratory factor analysis resulted in 3 factors; functional assessment, symptom assessment, and comfort assessment. These 3 factors explained 83.8% of total variance and construct validity was confirmed. Test-retest reliability was .67 for appetite changes, .76 for regulating for behavior problems, and 1.0 for other items. CONCLUSION: Results indicate that HATMAL is valid and reliable to assess the health for middle-aged patients in long-term care settings. This study would contribute to provide more effective personalized treatment and care for middle-aged patients in long-term care settings considering their own characteristics.
Adult* ; Appetite ; Focus Groups ; Humans ; Long-Term Care* ; Methods ; Middle Aged ; Needs Assessment ; Pilot Projects ; Reproducibility of Results ; Symptom Assessment

PURPOSE: This study was done to develop and test the validity and reliability of the Korean version of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-K) in assessing pain of elders with dementia living in long-term care facilities. METHODS: The PACSLAC-K was developed through forward-backward translation techniques. Survey data were collected from 307 elders with dementia living in 5 long-term care facilities in Korea. Data were analyzed using descriptive statistics, Pearson correlation, Spearman's rho, paired t-test, ROC (receiver operation characteristic) curve with the SPSS/WIN (20.0) program. RESULTS: The PACSLAC-K showed high internal consistency (.90), inter-rater reliability (.86), intra-rater reliability (.93), and high concurrent validity (.74) in paired t-test with PAINAD. Discriminant validity also showed a significant difference compared with no pain. The PACSLAC-K showed a sensitivity of .93, specificity of .88, and Area Under the Curve of .95 in the ROC curve. CONCLUSION: The findings of this study demonstrate that PACSLAC-K is useful in assessing pain for elders with dementia living in long-term care facilities.
Aged ; Aged, 80 and over ; Area Under Curve ; Checklist ; Dementia/*physiopathology ; Female ; Geriatric Assessment/*methods ; Humans ; Long-Term Care/*methods ; Male ; *Pain Measurement ; Questionnaires ; ROC Curve ; Republic of Korea

OBJECTIVES: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in South Korea. METHOD: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in Korea. RESULTS: There are three types of home care nursing in Korea. Public health center provides home visit nursing to vulnerable population by registered nurses for free, based on community health act in public health center. As of 2017, 1,261,208 people were enrolled in the visiting health program of public health center. Health behavior and disease management has been improved and showed having cost-benefit effect among the enrolled people in visiting health program. Visiting nursing care in long-term care services is provided by registered nurses or nurse aid, based on long-term care act. The cost is paid as the unit price according to service time. 1,095,764 older people used long-term care services in 2017, only 0.2% of total cost used for home visiting nursing. Even though the number of user of home visiting nursing, it was reported that users spent less medical cost and hospitalized shorter. Hospital-based home care nursing is provided to patients and their families under the prescription of a doctor by family nurse specialists who are employed by medical institute based on medical law. Four hundred sixty family nurse specialists worked for hospital-based home care nursing and hospital-based home care services accounted for 0.038% of total medical expenses in 2017. CONCLUSION: Even though home visit nursing care services are different in aspect of legal basis, personnel, running institutes, and cost basis, home visit nursing care showed cost-benefit effect and good health outcomes. In order to advance home visit nursing care, the integrated home visiting care, improvement of working condition, and revision of legal basis should be considered.
Academies and Institutes ; Disease Management ; Health Behavior ; Home Care Services ; Home Care Services, Hospital-Based ; House Calls ; Humans ; Jurisprudence ; Korea ; Long-Term Care ; Methods ; Nurses ; Nursing Care ; Nursing ; Prescriptions ; Public Health ; Running ; Specialization ; Vulnerable Populations

PURPOSE: The purpose of this study was to investigate if pain mediates or moderates the relationship between cognitive impairment and aggressive behaviors in nursing home residents with dementia based on the Need-driven Dementia-compromised Behavior model. METHODS: This was a secondary analysis of the Minimum Data Set assessment data on long-term care from the state of Florida during calendar year 2009. The data used in this study was the first comprehensive assessment data from residents with dementia (N = 56,577) in Medicare-certified or Medicaid-certified nursing homes. Path analysis using a series of hierarchical regression analyses and two-way analysis of variance was used to evaluate the mediating and moderating effect of pain on the relationship between the level of cognitive impairment and aggression. RESULTS: Results indicated that pain did not mediate the relationship between cognition and aggressive behaviors, but there was evidence of a significant moderating effect of pain only for residents with severe cognitive impairment. Only among the residents with severe cognitive impairment, those with pain had significantly more frequent aggressive behaviors than those without pain. CONCLUSION: A change in the frequency of aggressive behaviors in severely cognitively impaired residents should signal the possibility that the person is experiencing pain. Accurate but simple pain assessment in this population including these behavioral changes should be developed further, and pain should be well controlled to reduce these problematic behaviors.
Aged ; Aged, 80 and over ; *Aggression ; Cognition Disorders/*complications/psychology ; Dementia/*complications/psychology ; Female ; Florida ; Humans ; Long-Term Care ; Male ; Nursing Homes ; Pain/*complications/psychology ; Pain Measurement/methods ; Self Report ; *Social Behavior