Nicholas Castle

University of Pittsburgh | Pitt · Department of Health Policy & Management

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are...

Objectives: This study compared the PSC perceptions of foreign and domestic born and trained nurses working in urban NHs in 5 states to analyze how nurses' PSC perceptions corresponded to their personal and professional characteristics. Methods: We distributed 3539 surveys to registered nurses and licensed practical/vocational nurses employed in...

While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Med...

Objectives: To examine the association between CNS medication burden and serious falls in those with a recent fall history. Design: Nested-case control study; cases matched to four controls by age, gender, and date. Setting: US nursing homes. Participants: 5,556 residents age ≥65 with a recent fall history admitted to a nursing home between...

Objective: To assess the importance and performance of consultant pharmacist services delivered before and after an intervention to detect and manage adverse drug events among nursing facility residents. Design: Before and after intervention survey of physicians participating in a randomized, controlled trial. Setting: Four nonprofit, academic...

Nursing homes are becoming increasingly complex clinical environments because of rising resident acuity and expansion of postacute services within a context of historically poor quality performance. Discrete quality markers have been linked to director of nursing (DON) leadership behaviors. However, the impact of DON leadership across all measured...

The psychometric properties of The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Nursing Home survey: Discharged Resident Instrument (NHCAHPS-D) are examined. A random sample of 550 nursing homes was selected from across the United States and 365 agreed to participate (participation rate = 66%). From 7,020 surveys sent to dischar...

Background: Few studies have compared the risk of recurrent falls across various antidepressant agents—using detailed dosage and duration data—among community-dwelling older adults, including those who have a history of a fall/fracture. Objective: To examine the association of antidepressant use with recurrent falls, including among those with a hi...

Potentially avoidable hospitalizations (PAHs) of skilled nursing facility (SNF) patients are common and costly. Telemedicine represents a unique approach to manage and potentially reduce PAHs in SNFs, having been used in a variety of settings to improve coordination of care and enhance access to providers. Nonetheless, broad implementation and use...

Influenza vaccination remains the cornerstone of influenza prevention, yet national goals for nursing home residents and staff vaccination have not been met. Few studies have examined associations between facility and resident characteristics; employee processes, such as staff vaccination policies; and resident influenza vaccination. In this nation...

This entry provides an account of the use of physical and chemical restraint in long-term care. Physical restraints are described and a historical account of their significant reduction (from a more than a 44% use rate to less than 5%) is given. Chemical restraints (i.e., antipsychotic drugs) are described and recent events and initiatives aimed at...

Although it is generally accepted that anticholinergic use may lead to a fall, results from studies assessing the association between anticholinergic use and falls are mixed. In addition, direct evidence of an association between use of anticholinergic medications and recurrent falls among community-dwelling elders is not available. To assess the a...

Objectives The objectives of this study were to (1) obtain a national perspective of the current state of nursing home (NH) infection prevention and control (IPC) programs and (2) examine differences in IPC program characteristics for NHs that had and had not received an infection control deficiency citation. Design A national cross-sectional surv...

This research examined resident and facility-specific factors associated with a diagnosis of a urinary tract infection (UTI) in the nursing home setting. Minimum Data Set and Online Survey, Certification and Reporting system data were used to identify all nursing home residents in the United States on April 1, 2006, who did not have a UTI (n = 1,13...

The purpose of this article is to describe differences in nursing home quality outcomes among nurses who are foreign born and foreign educated, nurses who are foreign born and U.S. educated, and nurses who are U.S. born and U.S. educated.This cross-sectional study took place in 91 nursing homes across the United States. Full- and part-time licensed...

As nursing homes turn abroad to fill vacancies, the diverse linguistic backgrounds of nurse hires are creating new challenges in comprehensibility between nurses, providers, and residents. Accents are a natural part of spoken language that may present difficulty even when the parties involved are speaking the same language. We surveyed 1,629 nurses...

More than one-third of community-dwelling older adults fall each year. Falling is classified as a geriatric syndrome which has multiple contributing factors and an interaction between chronic predisposing diseases and impairments and acute precipitating insults. One potentially modifiable risk factor is medication use. While previous research has b...

Introduction: The purpose of this research was to determine whether service-enriched housing (i.e., the Staying at Home [SAH] program) in publicly subsidized buildings for low-income older adults influenced resident outcomes. Method: Eleven elderly high-rise buildings were used. Seven buildings had the SAH program and four did not. Information w...

Many caregivers continue to provide care and support to their care recipients after institutional placement. A two-group randomized controlled trial was carried out to test the efficacy of a psychosocial intervention for informal caregivers whose care recipients resided in a long-term care facility. The intervention was delivered during the 6 month...

The research presented here provides some descriptive information of nursing home pay for performance (P4P) initiatives and an examination of the opinions of Nursing Home Administrators (NHAs) about P4P. Opinions on three common elements of P4P were examined: the incentive format, program format, and quality format. Information came from a mail sur...

We present redox estimates and the preliminary results of petrologic experiments on the Tissint meteorite, and discuss their implications for martian magmatism.

Hand hygiene (HH) is recognized as an effective way to decrease transmission of infections. Little research has been conducted surrounding HH in nursing homes (NHs). In this research, deficiency citations representing potential problems with HH practices by staff as identified in the certification process conducted at almost all US NHs were examine...

In this analysis, the association of nurse aide absenteeism with quality is examined. Absenteeism is the failure of nurse aides to report for work when they are scheduled to work. Data used in this investigation came from survey responses from 3,941 nursing homes; Nursing Home Compare; the Online System for Survey, Certification and Administrative...

Background Health care-associated infections are the leading cause of morbidity and mortality in US nursing homes (NHs). The objective of the research is to assess the impact of Maryland NH infection preventionists (IPs) on NH quality measures. Methods Two hundred thirty-four NHs were queried through mailed survey. These survey data were then link...

Long-term care administrators (administrators) can influence the care nursing home residents receive. However, little research has examined what factors of administrators are associated with how they influence care. In this research, the association between administrators' education and quality of nursing home care is examined. In addition, the ass...

Information from nurse aides describing their opinions of hand hygiene practices in nursing homes including perceived barriers to hand hygiene is presented. The information comes from a questionnaire developed for this investigation, with items addressing compliance, facility guidelines and protocols, training, hand washing facilities and materials...

Purpose of the Study: We examined how organizational culture in nursing homes affects staff turnover, because culture is a first step to creating satisfactory work environments. Nursing home administrators were asked in 2009 to report on facility culture and staff turnover. We received responses from 419 of 1,056 administrators contacted. Responden...

There are four core themes developed in Patient-Centred Health Care which deal with critical issues, models, theories and frameworks (both theoretical and empirical) that expound understandings of patient centred care and the processes, practices and behaviours supporting its attainment: 1. Conceptions and cultures of patient-centred care 2. Coo...

Prescription drug misuse among older adults includes inappropriate and harmful use of these drugs. In this study, prescription drug misuse in assisted living settings as reported by direct care workers (DCWs) was examined. Data came from DCWs in 45 assisted living settings located in Pennsylvania. A total of 944 DCWs completed a questionnaire on th...

Zoned pyroxenes in unbrecciated eucrites NWA 7035 and NWA 7193 allow tracing of HED parent magmatic history. Results are consistent with noncogenetic origin of eucrites.

Survey of Tissint oxide compositions and initial results of oxy-thermobarometry. Results are similar to other olivine-phyric shergottites and may indicate oxidization during closed system crystallization. Experiments to follow.

A synthesis of the last decade of literature on elder abuse in residential long-term care (i.e., Nursing Homes and Assisted Living) is discussed. Presented are definitions of abuse, theoretical and conceptual models, prevalence rates of abuse, outcomes and costs, and sources of abuse. The synthesis represents an update to the literature in the infl...

Purpose: To examine accreditation from nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and whether this is associated with improved rehabilitation care. Design: Cross-sectional association of CARF accreditation and quality. Methods: Comparison of the short-stay quality measures (influenza and pne...

Background: Nursing home administrators (NHAs) are in key positions to improve nursing home quality. NHAs require state-level licensure, which involves passing a national NHA licensure examination and fulfilling state-level licensure requirements that vary widely across states. With multiple pathways to NHA licensure, little is known about NHAs' p...

Assisted Living (AL) currently represents one of the most numerous institutional care settings for elders. Very little information exists on abuse in AL. Descriptive information on elder abuse reported by nurse aides working in AL is presented from a survey sent to nurse aides. The questionnaire had items addressing verbal, physical, psychological,...

Eucrite pyroxenes from four meteorites with matching oxygen isotopes are inconsistent with cogenesis by existing petrogenetic models, implying multiple sources.

Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting da...

There is evidence that staffing characteristics influence quality of care in nursing homes. Federal and state surveyors conduct inspections of homes to assess their compliance with regulatory standards, including requirements related to staffing. Deficiency citations are issued when these standards are not met. This article examines the relationshi...

Characteristically, nursing home care in the United States was focused on improving clinical outcomes for residents (Castle and Ferguson, 2010). Much less attention was paid to the living environment and quality of life while delivering this care. However, in the 1990s, some providers began to move nursing home care towards a more home-like environ...

Background & objective: Approximately 8 million adverse events occur annually in nursing homes (NHs). The focus of this research is to determine barriers and health information technology (HIT)-related facilitators to adverse event reporting among U.S. NHs. Methods: Surveys were returned by 399 nursing home administrators using a mailed survey a...

Background: Antipsychotic medications are commonly prescribed to nursing home residents despite their well-established adverse event profiles. Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of...

The purpose of this article was to investigate nursing homes' (NHs') readiness to implement a quality assurance and performance improvement (QAPI) program as required by Section 6102 of the Affordable Care Act. Nursing home administrators (NHAs) in 3000 NHs (response rate, 67%) were surveyed using a 70-item questionnaire to assess: (1) current faci...

Information on the scale and scope of resident-to-resident abuse, including verbal, physical, material, psychological, and sexual abuse, is presented. Nursing homes (n = 249) from ten states were used, with a total of 4,451 nurse aides in these facilities returning the questionnaire. Most nursing homes experienced verbal, physical, material, and ps...

Background: Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. Pur...

Further understanding of patient safety in health care is still needed. This is particularly evident in long term care settings, where relatively little information exists. Safety culture has emerged as a critical component of efforts to improve patient safety; it is strongly associated with iniatatives that influence patient safety and quality of...

Using Non-numerical Unstructured Data Indexing Searching and Theorizing (NUD'IST) software to extract and examine keywords from text, the authors explored the phenomenon of nursing home closure through an analysis of 30 major-market newspapers over a period of 66 months (January 1, 1999 to June 1, 2005). Newspaper articles typically represent a car...

Using data from the 2007 National Home and Hospice Care Survey, this study provides an update of nursing staff turnover at U.S. home health and hospice agencies and explores correlates of nursing staff turnover. Results show that the three-month turnover rates of registered nurses (RNs), licensed practice nurses (LPNs), home health aides (HHAs), an...

Verbal, physical, psychological, caregiving, medication, material, and sexual abuse perpetrated by staff are examined. Information came from nurse aides included in the Pennsylvania nurse aide registry. A total of 4,451 nurse aides returned a 46-item questionnaire (response rate = 64%). A 3-month frame of reference was used, and the questionnaire a...

Safety culture interventions in hospitals have been found to be associated with improved safety practices and outcomes. Studies in nursing homes generally report a poorly developed safety culture. Voluntary accreditation provides a structure for organizing care processes and is known to stimulate continuous quality improvement and thereby has the p...

This study examines the association between accreditation and select measures of quality in U.S. nursing homes, both cross-sectionally and over time. Data analyzed in this research originated from a web-based search of The Joint Commission (TJC) accredited facilities and the Nursing Home Compare set of Quality Measures relating to physical restrain...

Alcohol misuse and abuse in Assisted Living (AL) as reported by nurse aides is examined. Data came from a secondary analysis of nurse aides included in the Pennsylvania nurse aide registry. A total of 832 nurse aides had a prior place of employment in AL. Information reported from these nurse aides include the percent of residents identified as dri...

 This study examines the association between nursing home accreditation and deficiency citations.   Data originated from a web-based search of The Joint Commission (TJC) accreditation and On-line Survey Certification of Automated Records from 2002 to 2010. Deficiency citations were divided into 4 categories: resident behavior and facility practices...

This article examines whether nursing home facility-level characteristics are associated with the likelihood of receiving deficiency citations for physical restraints, including restrictive side rails. Data from the On-Line Survey Certification of Automated Records were used to calculate odds ratios for facility-level characteristics associated wit...

Purpose of the study Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian’s Structure–Process–Outcome (SPO) model, we examined the relationships among top management’s ratings of NH PSC, a process of care, and safety outcomes. Desi...

We examined the range of pyroxene major, minor and trace element chemistry in the three eucrite trends, and compared them with clasts in NWA 6475, a polymict eucrite. Existing models relating the three chemical trends were examined with this new data.

Commentary on: Spilsbury K, Hewitt C, Stirk L, et al. The relationship between nurse staffing and quality of care in nursing homes: a systematic review. Int J Nurs Stud 2011;48:732–50.[OpenUrl][1][CrossRef][2][PubMed][3] This research comes at a time when NHs are being increasingly asked to do more with less. Revenues for NHs do not appear to be k...

Nursing home report cards can be potentially key tools for disseminating information to consumers. However, few accounts of state-based nursing home report cards are available. In the research presented here, the scale, scope, utility, and changes over time in these nursing home report cards are described. This article finds that the number of repo...

Nursing home report cards can be potentially key tools for disseminating information to consumers. However, few accounts of state-based nursing home report cards are available. In the research presented here, the scale, scope, utility, and changes over time in these nursing home report cards are described. This article finds that the number of repo...

The objectives of this study were to describe state policies for the frequency of adverse event reporting and follow-up that occurs in U.S. nursing homes, and to identify the health information technology used to facilitate these processes. The study was conducted using a mailed survey to the Departments of Health (DOH) in all 50 states, specifical...

The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations). Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The information including...

The association of job tenure among nursing home administrators (NHAs) and directors of nursing (DONs) with the prevalence of pressure ulcers, pain, and physical restraint use was examined. Data sources included the 2004 National Nursing Home Survey and quality measures from the Centers for Medicare and Medicaid Services. Regression models examined...

To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents. Longitudinal study. One hundred thirty-three VA CLCs. Three thousand six hundred ninety-two veterans aged 65 and older admitted betwe...

To the Editor: Despite the importance of alcohol misuse and abuse in elders, 1 very little empirical research exists among institutional settingsdand none exists in assisted living (AL). We would like to bring to your readers’ attention some recent information we have collected on alcohol misuse and abuse in AL reported by nurse aides. In this rese...

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary...

There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research. The data used came...

This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g., ownership, size), and quality (i....

This study examined the deficiency citation for infection control (ie, F-Tag 441). This information represents potential problems in infection control as identified in the yearly certification process of almost all US nursing homes. The data used came primarily from the Online Survey, Certification, and Reporting data base, which contains informati...

Examining the perception of patient safety culture (PSC) of top managers in health care settings is important because their orientation to PSC can have a large influence on the facility. In this research, the perception of PSC of nursing home administrators (NHAs) and directors of nursing (DONs) is examined. Primary data were collected to examine t...

The purpose of this study was to compare the patient safety culture between nationally representative samples of hospitals and nursing homes.This research is important in expanding our understanding of safety culture, to better understand the differences and similarities between healthcare settings, and to promote shared learning of best practices...

To estimate the use of different types of physical restraints and assess their associations to falls and injuries among residents with and without Alzheimer's disease (AD) or dementia in US nursing homes. Data were from the 2004 National Nursing Home Survey. AD or dementia was identified using International Classification of Diseases, Ninth Revisio...

Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nu...

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the...

Several sources of variation are associated with the number of survey deficiencies that can be received by nursing homes in the yearly survey and certification process. One source is variation across states. A second source of variation occurs within states. A third source of variation occurs for each facility across time. As measures of quality, l...

Nursing home residents' quality of life (QoL) is directly related to the quality improvement (QI) processes mandated by federal law. This article describes a 3-year longitudinal study of QI process innovations in two nursing homes and highlights details of a successful 6-month initiative. The initial QI initiatives were based on the principles of s...

Deficiency citations for resident abuse from U.S. nursing homes from 2000 to 2007 are examined. Deficiency citations are given to nursing homes that are in violation of Medicare/Medicaid regulations and four specific deficiency citations (representing, abuse; neglect by staff; criminal screening investigating and reporting; and, abuse prevention an...

to examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience-perpetrator, frequency, and degree of upset-of psychological mistreatment in the past 6 months. random digit dial telephone recruitment and population-based survey (telephone a...

We first presented the steps taken to develop the nursing home certified nurse assistant job satisfaction questionnaire (NH-CNA-JSQ) and, second, the psychometric properties of this instrument. Certified nurse assistants (CNAs) from 22 nursing homes in Pennsylvania were mailed the NH-CNA-JSQ. Of the 726 surveys mailed, 479 usable surveys were retur...

A commentary of the article discussing the possible reimagining of long-term care (LTC) is provided. The reimagining article examines how to diminish the role of nursing homes in the LTC system. The text is provocative. It is also thought-provoking. In this commentary I provide a further opinion that we could do better within the current system usi...

Demographic trends indicate an aging population, highlighting the importance of collecting valid survey data from older adults. One potential issue when surveying older adults is use of technology to collect data on sensitive topics. Survey technologies like A-CASI and IVR have not been used with older adults to measure elder mistreatment. We surve...

In this commentary, we examine nursing home quality and indicators that have been used to measure nursing home quality. A brief review of the history of nursing home quality is presented that provides some context and insight into currently used quality indicators. Donabedian's structure, process, and outcome (SPO) model is used to frame the discus...

Local efforts to redesign systems of care offer fertile ground for community-based participatory research approaches to take hold and flourish. Drawing on the experiences of a learning collaborative of maternal and child healthcare stakeholders in Allegheny County, Pennsylvania, this article describes 8 action steps for operationalizing key communi...

Few studies have examined factors associated with antidepressant prescribing in older nursing home residents. The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and sta...

To examine the overall responses of nursing home staff to a newly developed nursing home specific survey instrument to assess patient safety culture (PSC) and to examine whether nursing home staff (including administrator/manager, licensed nurse, nurse aide, direct care staff, and support staff) differ in their PSC ratings. Data were collected in l...

Few studies have examined employee turnover and associated costs in emergency medical services (EMS). To quantify the mean annual rate of turnover, total median cost of turnover, and median cost per termination in a diverse sample of EMS agencies. A convenience sample of 40 EMS agencies was followed over a six-month period. Internet, telephone, and...

Understanding the relationship between top management turnover and quality of care is important because turnover among top managers in nursing homes is generally high. In this research, the direct and indirect relationships among top management turnover, the number of staff, the types of staff, and the quality indicators are examined. The top manag...

Information technology (IT) has been recommended to improve the quality of health care. Nursing homes use very little IT, but they have been required by the federal government to electronically submit resident assessments (via commercial Minimum Data Set [MDS] software). This article examines whether use of the advanced IT features commonly found i...

Residents with cognitive limitations by necessity are excluded from nursing home satisfaction initiatives. We used national data from the Minimum Data Set (MDS) to examine the distribution of resident cognitive status across nursing homes to gain further insight into how residents with cognitive limitations could impact the sample size of responden...

Nursing facilities that are determined to have a greater number of quality problems, more serious problems than average, and a demonstrated pattern of quality problems are included in the Special Focus Facility (SFF) initiative. The purpose of this research was to provide descriptive information on these SFFs and to examine the quality characterist...

Special Focus Facilities (SFFs) are nursing facilities designated by the Centers for Medicare & Medicaid Services to be of chronic poor quality. Relatively few nursing facilities are included in this initiative. The purpose of this research was to examine whether nursing facilities included in the 2007 SFF initiative subsequently influenced the qua...

OBJECTIVES: To examine the joint effect of Medicaid census and nursing home resident and organizational factors on the recognition rate of depressive symptoms across nursing homes in New York State. DESIGN: A cross-sectional study of the sample, derived from a combined data set of the 2003 Online Survey Certification and Reporting System (OSCAR)...

Using a national longitudinal sample of nursing homes residents (N = 264,068), we examine whether physical restraint use contributes to subsequent physical or psychological health decline. The minimum data set, the on-line survey certification and recording system, and the area resource file were the data sources used. This data represented the per...

To understand key characteristics of the leadership team, and to examine if differences in these factors exist between for-profit (FP) and not-for-profit (NFP) nursing homes (NHs). Cross sectional. US nursing homes. A nationally representative sample of 1174 US NHs conducted in 2004. N/A. Reported data on tenure, education, and certification of NH...

Few studies have addressed the extent to which consumers use nursing home report cards and how they use this information. These questions, which are significant because the nursing home market presents several challenges to the effectiveness of report cards, were pursued in a study. Data used in this investigation came from three mail surveys condu...

The aim of this work was to examine the association between organizational characteristics, market characteristics, and changes in antipsychotic medication use in US nursing homes over time. This was a longitudinal study comparing antipsychotic use in US nursing homes from 1996 through 2006 using Medicare and Medicaid data (the Online Survey Certif...