Field Notes

When Choosing a Nursing Home, Residential Freedom Is Important

Although the nursing home quality rating system has several dimensions, experts say it fails to address what may be the most important question: Are the residents who live there happy? When choosing a nursing home, Kansas State University aging experts suggest visiting the facility in the morning. If some of the residents are still sleeping while others are eating breakfast, that’s a sign that they’re determining their own schedules rather than doing what’s easiest for staff, says Gayle Doll, PhD, director of Kansas State’s Center on Aging.

She and fellow researchers at the center say that government ratings like the five-star system instituted by the Centers for Medicare & Medicaid Services don’t necessarily reward nursing homes for offering a homelike setting and giving residents as much freedom as possible.

Stephanie Gfeller, a research assistant at the Center on Aging, says consumers are familiar with a five-star rating system for other services, such as restaurants and hotels, which seemingly makes it easier to understand. But she adds that the system can penalize nursing homes that recognize problems and are working to address them. In addition, Doll says the freedoms that make many people happy aren’t necessarily reflected in ratings that emphasize safety, often at the expense of freedom. “A resident might be really, really happy in a three-star home but not so in a five-star home,” she says.

The researchers say the following questions can help future residents and their families determine whether a nursing home offers people-centered care:

• Are schedules built around an individual resident’s wishes, rather than staff preferences or arbitrary policies?

• Are the same staff members routinely working with the same residents? What’s the turnover rate for staff? Potential residents should ask direct care staff how they like their jobs. Also, to get a more complete picture of how the staff interacts with residents and families, they should ask visitors whether they feel like they can communicate openly with staff.

• How well is residents’ privacy respected? Are there places where residents can be alone? Do staff members knock and ask permission before entering a room?

• Are residents engaged in activities on the weekends when regular staff are gone? If someone has a special interest or hobby, is there a place where he or she can engage in this? Do residents participate in unscheduled activities, even if they’re everyday tasks such as helping with meal preparation or housekeeping?

Gfeller says a scenario that potential residents or families can consider is what it would take for a resident to go out for an ice cream cone. In some facilities, this could mean getting permission from various caretakers, withdrawing money from the resident’s account at the business office, finding transportation, and then several days later, finally getting an ice cream cone.

In a people-centered nursing home, Gfeller says, the process may be as simple as asking, “Who else wants to come?”

“The choice of a nursing home usually comes when someone is in the hospital, and often times, the doctor makes a suggestion or one is chosen based on convenience of location,” Doll says. It’s important to ask a potential resident what he or she would choose. “You might start the conversation by asking, ‘If you’re injured and you can’t stay at home, where do you want to go?’ If you present it as a temporary situation, it might be easier to talk about,” she says.

— Source: Kansas State University

Prostate Cancer’s Genetic Fingerprint: How Estrogen May Play a Role

One in six American men are diagnosed with prostate cancer within their lifetime, and 186,000 will be diagnosed this year. For most men, their disease is confined to the prostate gland, making it easier to treat and less lethal. However, some patients suffer from a more aggressive cancer that metastasizes. Physician-scientists are trying to uncover part of the disease’s molecular fingerprint with the hope of explaining why some forms metastasize. Their findings may help physicians provide tailored and more effective treatments for patients.

Mark A. Rubin, MD, a professor of pathology and laboratory medicine and the vice chair for experimental pathology at Weill Cornell Medical College and an attending pathologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, believes that the common joining of two genes to form a new fusion gene influences a certain type of prostate cancer that is more aggressive and sensitive to hormones. In an article published in the Journal of the National Cancer Institute, he describes how, in addition to testosterone, estrogen can stimulate this fusion gene. Rubin’s group is currently exploring how this mechanism may help scientists understand how aggressive prostate cancer progresses in the absence of male hormones.

Currently, researchers are testing blood samples and comparing the DNA of more than 2,500 men with and without prostate cancer. They hope to discover clear genetic indicators of prostate cancer, especially its aggressive forms. Their findings will potentially lead to the development of diagnostic tests and preventive drugs for prostate cancer.

— Source: Weill Cornell Medical College