Barriers and Challenges Faced by Social Workers Caring for Dementia Patients in Acute Care Settings

Abstract The nature of dementia care provided by social workers across various hospital settings is unexplored. This study utilized the “rigorous and accelerated data reduction” (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings. Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016. Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition). Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP. While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g. there is more focus on discharge planning and less management of competing demands in the IP than in the ED. Also, social workers were more involved in the diagnosis of dementia in the ED than other settings. We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.

this role.Compared to non-caregivers, for example, spouses who provided care to someone with no need for assistance with activities of daily living had lower odds of experiencing a hospitalization (OR 0.77; CI 0.66 to 0.89).In contrast, caregivers who provided care to someone with dementia for 4 to <6 years had 3.29 times the odds of experiencing an overnight hospitalization (CI 1.04 to 10.38;.Findings indicate that, although caregivers overall appear to use acute health services about as much as non-caregivers, large differences exist between caregivers.Results emphasize the importance of recognizing diversity within caregiving experiences.

THE PATH TO CAREGIVING: ASSESSING CAREGIVERS AND DEVELOPING A CAREGIVER PLAN OF CARE IN THE ACUTE CARE SETTING
Michelle Camicia, 1 and Barbara Lutz, 2 1. Kaiser Permanente, Novato, California, United States, 2. University of North Carolina-Wilmington, Wilmington, North Carolina, United States Family caregivers of older adults report lack of preparation for their role, particularly upon acute hospital discharge following a medical event.Addressing the needs of family caregivers in the acute care setting prior to hospital discharge requires the identification of the caregiver, an assessment of caregiver preparedness, and a plan of care to address gaps in preparedness.The Preparedness Assessment for the Transition Home 7-item (PATH-7) is a valid and reliable instrument developed to assess family caregivers readiness for the caregiving role during acute care.The PATH-7 paper-pencil self-administered assessment was implemented in clinical care in medical-surgical nursing units in 2 acute care hospitals.Interventions to address gaps in preparedness were selected from a catalogue of interventions to develop a caregiver plan of care.The most frequent challenge identified by family caregivers was fulfilling the caregiving role on top of their other roles and responsibilities.This illustrated the need to assist family caregivers with exploring options for recruiting others to help with their roles and responsibilities and identify solutions soliciting and organizing help.This novel program promotes addressing the needs of the family unit, moving to a family-integrated are delivery model.Implementation challenges included in-person contact with caregiver to administer assessment, resources to respond to identified gaps in readiness, and lack of technology-enabled assessment administration.Positive staff experience with identifying and addressing needs of caregivers was a facilitator of staff engagement.Identifying, assessing, and addressing the needs of family caregivers of older adults is feasible in the acute care setting.Sutherland, 2 Helen Kales, 3 Cathleen Connell, 1  and Amanda Leggett, 4 1 The nature of dementia care provided by social workers across various hospital settings is unexplored.This study utilized the "rigorous and accelerated data reduction" (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings.Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016.Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition).Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP.While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g.there is more focus on discharge planning and less management of competing demands in the IP than in the ED.Also, social workers were more involved in the diagnosis of dementia in the ED than other settings.We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.

DEMENTIA SEVERITY IS ASSOCIATED WITH EARLY POTENTIALLY AVOIDABLE READMISSIONS IN AN ACUTE CARE HOSPITAL
Seigo Mitsutake, 1 Tatsuro Ishizaki, 1 Rumiko Tsuchiya-Ito, 2 Akira Hatakeyama, 3 Mika Sugiyama, 4 Ko Furuta, 5 Kenji Toba, 6 and Hideo Ito, 5 1.Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan, 2. Dia foundation for research on Ageing Societies, Tokyo, Japan, 3. Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Japan, 4. Tokyo Metropolitan Institute of Gerontology, Tokyo, Tokyo, Japan, 5. Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan, 6. Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, Japan Understanding the association of dementia severity with early potentially avoidable readmissions (PAR) could encourage the identification of the target patients for the health care providers to provide transitional care (i.e.follow-up and coordination care) to prevent early readmissions.This study examined whether dementia severity before admission was associated with PAR within 90 days (90-day PAR).This retrospective cohort study was conducted using a Diagnosis Procedure Combination database linked with routinely collected dementia assessment data from a large acute general hospital in Tokyo, Japan.Patients aged 65 or older who were discharged to home or facilities (n=8,910; mean age: 79.8 years, standard deviation: 7.4 years) between July 2016 and September 2018.The dementia severity was classified as normal, slight, moderate, severe dementia based on the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) from the patient or their family at admission.We conducted a multivariable logistic regression adjusted for covariates (sex, age, insurance copayment rate, diagnosis at admission, Charlson Comorbidity Index, unscheduled admission, ICU utilization, surgical treatment, length of hospital stay, discharge place) to examine the association of severity of dementia with 90-day PAR.Among the patients, 225 (2.5%) experienced 90-day PAR.The adjusted odds of 90-day PAR among patients with moderate dementia were 1.571 times (95% confidence interval [CI]: 1.102-2.240)and patients with severe dementia were 2.386 times (95% CI: 1.294-4.398)higher than the odds among patients without dementia.Patients with moderate and severe dementia before admission would be the target with high priority for providing transitional care.

DISPARITIES IN COMMUNITY IMMUNIZATION RATES IN NEW ENGLAND: FINDINGS FROM THE HEALTHY AGING DATA REPORTS
Alison Rataj, 1 Nina Silverstein, 2 Chae Man Lee, 3 Haowei Wang, 4 Richard Chunga, 4 Taylor Jansen, 4 Beth Dugan, 4 and Shuangshuang Wang, 5 1.University of Massachusetts Boston, Kingston, New Hampshire, United States, 2. University of Massachusetts Boston,Needham,Massachusetts,United States,3. University of Massachusetts Boston,Boston,United States,4. University of Massachusetts Boston,Boston,Massachusetts,United States,5. Shandong University,Jinan,Shandong,China Vaccinations are effective preventive tools yet are underutilized in the older adult population.The purpose of this study was to describe community rates of three vaccines (flu, pneumonia, and shingles) in MA, NH, and RI.State and community rates were compared to identify disparities.Data sources were the CMS Medicare Current Beneficiary Summary file (2013)(2014)(2015) for the vaccine rates and the American Community Survey (2012-2016) for population characteristics.Small area estimation techniques were used to calculate age-sex adjusted community rates in each state and are reported at the community level and statewide.Results showed comparable rates of flu immunization (MA 60.8%; RI 59.1%; NH 59.3%).NH had the best statewide rate of pneumonia immunization (77.8%) and MA had the worst (72.0%).There was variation in shingles vaccination rate: 39.7% in MA and 30.3% in RI, perhaps reflecting differences in access.Within state disparities were observed.MA shingles vaccine rates ranged 57.80% -21.17%, pneumonia ranged 79.78% -61.21%, and flu ranged 71.09% -51.46%.In RI shingles vaccination rates ranged 42.1% -21.1%, pneumonia ranged 82.1% -61.8% and flu ranged 68.4% -52.1%.In NH pneumonia rates ranged 84.18% -71.87% and flu ranged 67.14% -52.11%.Strategies to address within and between state disparities are needed.Greater awareness of the benefits of preventive measures like vaccines may also help improve rates.Materials like the GSA guideline about aging and immunizations could be useful in educating providers and policymakers.This research is funded by the Tufts Health Plan Foundation.
. University of Michigan, Ann Arbor, Michigan, United States, 2. Wayne State University, Detroit, Michigan, United States, 3. UC Davis, Sacramento, California, United States, 4. The University of Michigan, Ypsilanti, Michigan, United States