Kathryn A. Frahm

Racial Disparities in Receipt of Hospice Services Among Nursing Home Residents

This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented “do not hospitalize” order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance.

Trends in hospice utilization across age among the veteran population.

Hospice is a major expansion area within the Veterans Health Administration (VHA). The objective of this retrospective study was to explore trends in hospice utilization among older veterans receiving services at the end of life over a 4-year (2006-2009) time period. Reviewing trends, the number of veterans receiving hospice services increased annually, with 5779 veterans receiving services during 2009, up from 1742 veterans in 2006. The total cost of providing hospice rose dramatically, increasing from

Use of Outpatient Mental Health Services by Homeless Veterans After Hurricanes

1.98 million in 2006 to

Social Service Staffing in U.S. Nursing Homes

5.91 million in 2009. More funds were spent on younger veterans, with an average of

Perceptions of Homelessness in Older Homeless Veterans, VA Homeless Program Staff Liaisons, and Housing Intervention Providers

1.5 million spent on veterans aged 55 to 64 and less than

Crisis Counselors’ Perceptions and Assessment of Suicidal Behavior Among Hurricane Survivors Receiving Crisis Counseling Services

400,000 spent on veterans aged 85 and older. Findings highlight the growing need and demand for hospice within the VHA to provide end-of-life services.

Community-based disaster coalition training

Little is known about the impact of hurricanes on people who are homeless at the time a disaster occurs. Although researchers have extensively studied the psychosocial consequences of disaster produced homelessness on the general population, efforts focused on understanding how homeless people fare have been limited to a few media reports and the gray literature. In the event of a hurricane, homeless veterans may be at increased risk for negative outcomes because of their cumulative vulnerabilities. Health care statistics consistently document that homeless veterans experience higher rates of medical, emotional, substance abuse, legal, and financial problems compared with the general population. This study used the 2004 to 2006 Veterans Health Administration (VHA) Outpatient Medical Dataset to examine the effects of hurricanes on use of outpatient mental health services by homeless veterans. Homeless veterans residing in hurricane-affected counties were significantly more likely to participate in group psychotherapy (32.4% vs. 13.4%, p < .002), but less likely to participate in individual 30-40-min sessions with medical evaluations (3.5% vs. 17.3%, p < .001). The study findings have implications for homeless programs and the provision of VHA mental health services to homeless veterans postdisaster.

Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

Using data from the 2003 national Online Survey Certification and Reporting System, this study examines how the structure of social service staffing in nursing homes is affected by organizational and contextual factors. The results suggest that, although federal regulations impose minimal obligation, requiring only facilities with more than 120 beds to employ qualified social service providers, nearly 12 percent of these facilities failed to meet this staffing requirement in 2003. Results further suggest that the skill mix of social service providers in nursing homes is influenced by market competition, market demand, facility ownership, aggregate resident acuity, and the proportion of facility residents funded by Medicare.

The Impact of Disasters: Implications for the Well-Being of Older Adults

Purpose. To understand the needs and challenges encountered by older homeless veterans. Methods. We conducted six focus groups of older veterans, two focus groups, and one semi-structured interview of VA staff liaisons, and two focus groups and one semi-structured interview of housing intervention providers. Results. Major themes for older veterans: 1) negative homelessness experience; 2) benefits of the structured transitional housing program; 3) importance of peer outreach; and 4) need for age-tailored job placement programs. Major themes for VA staff liaison/housing intervention providers: 1) belief that the transitional housing program has made a positive change; 2) need for individualized criteria to address the unique needs of veterans; 3) distinct differences between older and younger homeless veterans; 4) outreach services; 5) permanent housing issues; and 6) coordination of services. Discussion. Compared with younger veterans, older veterans have less social support, greater employment and health challenges, and, perhaps greater motivation to change.

Florida Public Health Training Center: Evidence-Based Online Mentor Program.

OBJECTIVE The aims of this study were to assess the awareness of risk for suicidal behaviors and perspectives of Project Recovery counselors who provided crisis counseling services to hurricane survivors. METHODS The Short Posttraumatic Stress Disorder Rating Interview-Extended, a quantitative disaster mental health measure, was used to assess distress and dysfunction to the recent hurricanes. Project Recovery counselor data were collected through a 22-item qualitative interview. RESULTS Seven out of 207 clients (3.4%) endorsed the quantitative item measuring suicidal ideation. Clients who reported suicidal ideation had significantly higher scores on items indicating a loss of enjoyment, feelings of depression, feeling less able to handle stress, and other mental health items. Counselor responses fell into 5 major themes: Assessment and Action, Client Characteristics, Services, Counselor Training and Preparedness, and Future Directions. CONCLUSIONS Suicidal behavior is a serious mental health emergency, yet it remains a challenging issue as suicidal behaviors are complex and disaster survivors with suicidal ideation may experience intense psychological reactions to the event. In order to provide competent care to survivors experiencing suicidal thoughts or behaviors, the need for counselors to receive adequate training in suicide assessment and management is essential.