How many people live in nursing homes? As of 2024, there were around 1.2 million residents in nursing homes across the United States. The states with the highest numbers of residents in certified nursing facilities were, by far, California and New York, with over 99,000 and 98,000 residents, respectively. On the other hand, Alaska had the lowest number of nursing home residents. Occupancy rates and recovery The COVID-19 pandemic significantly impacted nursing home occupancy rates nationwide. Prior to the pandemic, the median occupancy rate for skilled nursing facilities hovered around 80 percent. However, this figure plummeted to 67 percent by 2021. As of July 2024, occupancy rates for certified nursing homes have begun to recover, reaching 77 percent. This gradual increase suggests a slow but steady return to pre-pandemic levels. Quality concerns and financial penalties Despite the crucial role nursing homes play, quality issues persist in some facilities. In 2024, Aspen Point Health and Rehabilitation in Missouri faced 208 substantiated complaints, the highest number nationwide. Financial penalties for serious violations can be severe, as evidenced by the 1.41 million U.S. dollar fine imposed on Siesta Key Health And Rehabilitation Center in Florida over a three-year period. These cases underscore the ongoing challenges in maintaining high standards of care across the industry.

Health care utilization of patients pre and post-hospitalization due to COVID-19,c,d,e.

Characteristics of patients discharged home from COVID-19 hospitalization from April 2020 to March 2021 in the United States.

Background: It is not known if widespread vaccination can prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in subpopulations at high risk, like older adults in nursing homes (NH). Objective: The objective of the study was to know if coronavirus disease 2019 (COVID-19) outbreaks can occur in NH with high vaccination coverage among its residents. Methods: We identified, using national professional networks, NH that suffered COVID-19 outbreaks despite having completed a vaccination campaign, and asked them to send data, using predefined collecting forms, on the number of residents exposed, their vaccination status and the number, characteristics, and evolution of patients infected. The main outcome was to identify outbreaks occurring in NH with high vaccine coverage. Secondary outcomes were residents’ risk of being infected, developing severe disease, or dying from COVID-19 during the outbreak. SARS-CoV-2 infection was defined by a positive reverse transcriptase-polymerase chain reaction. All residents were serially tested whenever cases appeared in a facility. Unadjusted secondary attack rates, relative risks, and vaccine effectiveness during the outbreak were estimated. Results: We identified 31 NH suffering an outbreak during March–April 2021, of which 27 sent data, cumulating 1,768 residents (mean age 88.4, 73.4% women, 78.2% fully vaccinated). BNT162b2 was the vaccine employed in all NH. There were 365 cases of SARS-CoV-2 infection. Median secondary attack rates were 20.0% (IQR 4.4%–50.0%) among unvaccinated residents and 16.7% (IQR 9.5%–29.2%) among fully vaccinated ones. Severe cases developed in 42 of 80 (52.5%) unvaccinated patients, compared with 56 of 248 (22.6%) fully vaccinated ones (relative risks [RR] 4.17, 95% CI: 2.43–7.17). Twenty of the unvaccinated patients (25.0%) and 16 of fully vaccinated ones (6.5%) died from COVID-19 (RR 5.11, 95% CI: 2.49–10.5). Estimated vaccine effectiveness during the outbreak was 34.5% (95% CI: 18.5–47.3) for preventing SARS-CoV-2 infection, 71.8% (58.8–80.7) for preventing severe disease, and 83.1% (67.8–91.1) for preventing death. Conclusions: Outbreaks of COVID-19, including severe cases and deaths, can still occur in NH despite full vaccination of a majority of residents. Vaccine remains highly effective, however, for preventing severe disease and death. Prevention and control measures for SARS-CoV-2 should be maintained in NH at periods of high incidence in the community.

The average monthly cost for senior housing in the U.S. in 2024 was the highest for memory care and the lowest for independent living facilities. In the fourth quarter of the year, the average monthly cost for independent living housing was 3,269 U.S. dollars. That nearly 550 U.S. dollars (20 percent) higher than in the first quarter of 2019. Senior housing costs also vary vastly across different states.

Sleep disturbances are common in people with dementia, particularly those living in care homes. However, there is little research in this population into the persistence, causes and consequences of sleep disturbances, including whether quality of life is impacted upon. Existing studies are often small with contradictory findings. It is important to clarify these factors, as they have practical implications on how, sleep disturbances in dementia should be managed. Furthermore, though hypnotic medications are commonly used, they are not recommended as they have been linked to increased risk of falls and mortality, and have little efficacy. There are currently no evidence-based treatments. Lastly, previous qualitative work on sleep disturbances in care home residents with dementia has not focussed on the perspectives of care home staff. The data shared here is from the qualitative part of this studentship, which was a study named the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff). In the study we aimed to explore the causes, impacts and management of sleep disturbances in residents with dementia from the perspectives of care home staff. We interviewed 18 nurses and care assistants working both day and night shifts at four care homes in the UK providing residential and nursing care. Each interview was a one-to-one interview in a private room of the care home. The 18 care home staff members were purposively recruited to reflect the diversity in staff working in care homes. The care homes were all in Greater London, but included urban and surburban areas. On average, in each interview the care home staff member spoke about three residents with dementia and sleep disturbances. We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio-recorded, transcribed, and analysed thematically by two researchers independently. The collection consists of data from one-to-one semi-structured interviews with 18 nurses and care assistants in four UK care homes.

Sleep disturbances are common in people with dementia, particularly those living in care homes. However, there is little research in this population into the persistence, causes and consequences of sleep disturbances, including whether quality of life is impacted upon. Existing studies are often small with contradictory findings. It is important to clarify these factors, as they have practical implications on how, sleep disturbances in dementia should be managed. Furthermore, though hypnotic medications are commonly used, they are not recommended as they have been linked to increased risk of falls and mortality, and have little efficacy. There are currently no evidence-based treatments. Lastly, previous qualitative work on sleep disturbances in care home residents with dementia has not focussed on the perspectives of care home staff.

The data shared here is from the qualitative part of this studentship, which was a study named the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff). In the study we aimed to explore the causes, impacts and management of sleep disturbances in residents with dementia from the perspectives of care home staff.

We interviewed 18 nurses and care assistants working both day and night shifts at four care homes in the UK providing residential and nursing care. Each interview was a one-to-one interview in a private room of the care home. The 18 care home staff members were purposively recruited to reflect the diversity in staff working in care homes. The care homes were all in Greater London, but included urban and surburban areas. On average, in each interview the care home staff member spoke about three residents with dementia and sleep disturbances.

We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio-recorded, transcribed, and analysed thematically by two researchers independently.

Many western European countries rely heavily on home care or informal methods to care for the elderly. In 2020, nearly ************* German elderly people potentially received informal care, while ************ received home care, and *********** were formally cared for by an institution. Elderly care in Italy and France also relied heavily on informal care. Why does Europe rely on informal care? Informal care is typically delivered within families and households and while difficult to quantify is very common. Indeed, an important share of healthcare expenditure is spent on long-term residential care in European countries. Therefore, some governments encourage and incentivize informal care to reduce healthcare expenditure by the state. For instance, Italian workers are granted up to ** days of paid leave per year to provide care to dependent relatives, while French employees are entitled to ** days of paid leave. In addition, the extent of informal care can also be the result of economic factors. In 2019, the average monthly cost of care homes reached ************** euros in some European countries. A sustainable strategy for European healthcare systems? The elderly population is expected to grow significantly in Europe. In 2020, Italy had notably the highest old-age dependency ratio in Europe, with a rate of **** people aged over ** to 100 people of working age. Furthermore, the ability of many families to assist elderly relatives is decreased with the loss of multi-generational household culture in modern Western Europe. Finally, some health conditions linked to elderly age require specialist nursing and a residential care setting. Therefore, although a heavy reliance on informal care can reduce healthcare costs, it could be a risky strategy to hold on in the long run.

Like most OECD countries, Australia’s population is ageing and will require an increasingly robust aged care sector to support the growing number of people aged 65 and over. With this said, the vast majority of aged care consumers require only minimal support through basic home support services. In financial year 2021, home support clients accounted for ** percent of over *** million aged care consumers. This was more than ***** times the number of people being cared for in residential aged care facilities. In total, the Australian government contributed **** billion Australian dollars to aged care in financial year 2021.

Three levels of support

The Australian aged care system is divided into ***** fundamental levels of care based on the intensity of care required. Home support is the most basic care type and includes domestic assistance, meals on wheels, community transport, and social support. Home care packages also provide care in the home through a coordinated service package. Residential care is the highest care level and by far the most expensive to fund, with the Australian government paying on average ****** Australian dollars per person in care in 2017. Naturally, as the average age of the population increases, it is expected that the cost of aged care will continue to rise as well.

Nursing homes

Aged care homes in Australia are run by a combination of for-profit, not-for-profit, state, and community providers. For-profit providers represent the largest share of the residential care market, holding over ** percent of approved residential care places. This was more than the total share of homes run by religious and charitable organizations.

Supplementary data set extracts from the Department of Health and Human Services Annual Report additional data for the 2019-20 financial year.\r \r Table 1: Daily average number of children 0–17 years in out-of-home care placements by placement type, by quarter 2019-20\r Table 2: Children less than 12 years of age in residential care\r Table 3: Out of Home Care CIMS investigations 2019-20\r Table 4: Average rates of unallocated clients 2018-19, by division and state, per cent\r Table 5: Child protection demand\r Table 6: Child protection practitioners receiving regular supervision\r Table 7: Child Protection and Family Services Major Impact incidents (CIMS) 2019-20

The national study SNAC - The Swedish National Study on Aging and Care, includes four participating areas: SNAC-Blekinge, SNAC Kungsholmen, SNAC Nordanstig and SNAC Skåne (GÅS). In all four areas, a research centre conducts a population study and a health care system study. (Metadata related to the main study SNAC and the other participating areas can be found under the Related studies tab).

SNAC-K Kungsholmen SNAC-K is conducted by the Stockholm Gerontology Research Center in collaboration with Aging Research Center (ARC), Karolinska Institutet.

SNAC-K population study: The population study consists of a clinical examination of persons over 60 years, who live in the area of Kungsholmen/Essingeöarna. The baseline data collection includes information on present status and past events. The information has been collected through interviews, clinical examinations, and testing. All staff (nurses, psychologists, and physicians) has been trained for data collection. Each subject has been examined for six hours on average; two hours for the social interview and the assessment of physical functioning (performed by a nurse); two hours for clinical examination, including geriatric, neurological and psychiatric assessment (performed by a physician); and two hours for cognitive assessment (performed by a psychologist).

SNAC-K care system study: The care system data collection consists of continuous recording of the provision of public eldercare for persons over 65 years. For 2004-2020, data comprise all recipients of municipal eldercare in the district of Kungsholmen. Starting in 2015, data comprise all recipients of municipal eldercare in the whole municipality of Stockholm. Data are based on individual assessments made by the municipal need assessors for each decicison regarding the provision of eldercare services. Data include information about the type and amount of care and services granted, as well as information on need indicators (e.g., disability,physical function, cognitive impairment, mental health, living situation, housing). For specific research questions, data from the care system study can be complemented with register data on health care consumption provided by the Region of Stockholm (VAL-databas). The care system perspective and the population perspective are joined through those elderly persons who participate in both parts of the study.

Purpose:

Population study: The purpose is to study the transition from normal aging to morbidity and impaired functional ability by identify how social and biological factors, and the environment, affect older people's health, functional ability and life expectancy. The intention is to study the positive and negative events in life that may be relevant to aging.

Care system study: The aim of SNAC-K care system study is to continuously monitor the allocation of public eldercare in relation to need indicators. Collected data can be used as a basis for planning, resource allocation and evaluation of the provision of eldercare services and health care among older adults. Available data can also be used in research and development around the issues of the provision of social and heath care. The connection to the SNAC-K population study gives a unique opportunity for comparisons between care recipients and non-recipients.

Data in the SNAC-K care system study 2004-2020 include all recipients of public eldercare 65 years or older in the district of Kungsholmen. Annually ~1200-1800 individuals and ~2000-3000 registrations (decisions on the provision of eldercare services) are included. Data include information on the type and amount of public eldercare provided, as well as need-indicators: physical and cognitive funkctioning, need of help with activities of daily living (personal and instrumental), incontinence, mental health, pain, dizziness, hearing and vision. Information on age, gender and cohabitation are also included. Since no new need assessments are conducted once a person has moved in to an institutional care facility, a cross-sectional survey among residents in institutional care facilities has been performed (untill 2019).

Further cross-sectional studies have been conducted every year between 2002-2015, and since 2003 with restricted to persons living in special housing.

Effect of allocation to high-dose or standard-dose vitamin D3 supplementation on the primary and secondary outcomes, in intention-to-treat and per-protocol populations.

Data set extracts from the The Department of Health and Human Services Annual Report for the 2018-19 financial year, tabled in Parliament on 17 October, 2019. Table 1: Daily average number of …Show full descriptionData set extracts from the The Department of Health and Human Services Annual Report for the 2018-19 financial year, tabled in Parliament on 17 October, 2019. Table 1: Daily average number of children 0–17 years in out-of-home care placements by placement type, by quarter 2018-19 Table 2: Children less than 12 years of age in residential care Table 3: Out of Home Care CIMS investigations 2018-19 Table 4: Average rates of unallocated clients 2018-19, by division and state, per cent Table 5: Child protection demand Table 6: Child protection practitioners receiving regular supervision Table 7: Child Protection and Family Services Category One incidents (CIA) 2018-19 Table 8: Child Protection and Family Services Major Impact incidents (CIMS) 2018-19

Abstract

The Coronavirus Rapid Mobile Survey of Maternal and Child Health (CRAM-MATCH) was a rapid SMS (Short Message Service) survey conducted in South Africa conducted among pregnant women and mothers registered with the MomConnect mhealth platform in South Africa. This national survey was conducted in June (n=3140) with a follow up in July (n=2287). The survey collected data from pregnant women and new mothers in South Africa on how the Coronavirus pandemic has affected their health including their access to health care.

Geographic coverage

National coverage

Analysis unit

Individuals

Universe

The survey collected data from pregnant women and new mothers in South Africa.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sample was drawn from the Momconnect mhealth platform created by the South African National Department of Health (NDOH) in 2014. MomConnect is a mobile health (mHealth) solution created to improve and promote maternal health services in South Africa by providing pregnant mothers with free messaging facility and a helpdesk. The mobile health application also created a national pregnancy registry which has excellent coverage of pregnant women and new mothers. By 2017 more than half of the women attending public sector antenatal care services in South Africa were registered on the Momconnect platform. By 2019 there were over 2 million registered MomConnect users.

A self-weighted sample of 15 000 pregnant women and mothers with children under 12 months was drawn from the database of MomConnect users. The sample was stratified based on province, gestational age or age of their baby and their type of phone. The 15 000 women all received an invitation to join the SMS survey on the afternoon of 24 June 2020. They could respond by SMS with "JOIN" to participate in the survey, by SMSing "STOP" to not participate or to reply with "MORE" if they needed more information. Those who participated in the survey received R10 in airtime. The wave 1 survey was completed on June 30, 2020. The wave 2 survey invitation was sent on the 2nd of July 2020 and the survey ended on the 5th of July 2020.

Poverty Quintiles Two sets of poverty quintiles were created for respondents by constructing poverty quintiles for primary care public health facilities. The first poverty quintile measures the wealth quintile of the small area place where the facility that the respondent last visited is located. The second poverty quintile measures the average wealth quintile of the catchment area that the facility covers. Because of the focus on access to primary care and because the Momconnect moms' registrations are at their local primary care facility, only data related to public sector primary care facilities was extracted from the government database of facilities (clinics, community health centres and community day centres).

The richest 15% of areas was also excluded since these individuals are unlikely to make use of public facilities. This implies that the 'wealthiest' quintile only represents the wealthiest of the 85% poorest South Africans. Each small area place in Census was then linked to their closest public primary care facility, using the GIS codes in both the Census and the national facility database to create a catchment area for each facility.Poverty quintiles were created by deriving a measure of living standards and wealth measures via Principal Component Analysis (PCA), using data on employment status, education level, earnings, household size, and cell phone and car ownership of the residents of the area collected during the 2011 census. PCA was used to calculate wealth scores and these were aggregated over the entire catchment area, weighted by the population size of each Small Area place in the Census 2011. The sample of respondents was matched to these poverty quintiles via the Momconnect facility identifier, which captures the facility where the mother was registered.

Mode of data collection

Other [oth]

Research instrument

Two questionnaires were used, one for the Wave 1 Survey and another for the Wave 2 Survey.

Response rate

Assuming a response rate of 20%, from the targeted sample of 15 000 women, the project aimed to achieve a survey sample of 3000 and realised a sample of 3140 for wave 1 and thus had an effective response rate of 21%. Of the 3140 individuals who responded to wave 1, 2287 also responded in wave 2. The attrition rate between wave 1 and wave 2 was thus about 27%.

Number and percentage of deaths, by place of death (in hospital or non-hospital), 1991 to most recent year.

Socio-demographic characteristics of the patients and primary caregivers.

Symptom profile of each domain of quality of life (n = 51).

BackgroundAcute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization.Methods and findingsPatients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan–Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study’s patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves.ConclusionsPatients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.

Estimates of factors associated with death among adolescents and adults in care and treatment.