PERCEPTIONS OF NURSES DELIVERING NURSING HOME VIRTUAL CARE SUPPORT: A QUALITATIVE PILOT STUDY

Abstract Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program’s services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses’ perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.


REFLECTIONS OF ADULTS TRANSITIONING TO LONG-TERM CARE FACILITIES: LOOKING BACK AND LOOKING FORWARD
Making a transition to a long-term care facility (LTCF) is often difficult for older adults. This study's intent was to explore ways in which life experiences and culture of older persons facilitate a successful transition to a LTCF. Eighteen participants were interviewed using a semi-structured interview guide to understand significant life events and personal factors impacting their lives. Interview data were analyzed using NVivo software to organize and manage emerging themes. The analysis revealed three related themes: person, current environments, and lifelong occupations. Within each major theme, subthemes were identified providing greater detail of how adaptive strategies are utilized to make such transitions positive. Participants were enabled to reflect upon their strengths and strategies available to adapt to these new residential settings. These perspectives are beneficial for healthcare practitioners to understand so as to personalize care and individualize the person's adjustment to a 'new' home. Avoidable hospitalizations among nursing home residents result in poorer health outcomes and excess costs. Consequently, efforts to reduce avoidable hospitalizations have been a priority over the recent decade. However, many potential interventions are time-intensive, require dedicated clinical staff, and nursing homes are chronically understaffed. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project was one of seven sites selected by CMS as "enhanced care & coordination providers" and was implemented from 2012 to 2020. A virtual program based on the principles of OPTIMISTIC was developed in the spring of 2020 with the goal of expanding the reach of the program's services. This qualitative study explores the perceptions and experiences of the nurses that piloted a virtual care support project in 11 nursing homes in a midwestern state, and identified the nurses' perceived facilitators of, and barriers to, the effectiveness of delivering a novel virtual care support program. A key finding from this analysis is that relationships, communication, and access to information were identified as common themes facilitating or impeding the perceived effectiveness of implementation of virtual care support programs within nursing homes, from the perspective of the nurses delivering the services. The experiences and recommendations of the program nurses provide insights into crucial elements important to the implementation of similar virtual care support models, and the role of telehealth in bridging healthcare workforce gaps.

CHRONIC DISEASE AND LIFE EXPECTANCY DISPARITIES OF OLDER ADULTS IN SINGAPORE
Xueying Guo 1 , Hwee lin Wee 2 , and Cynthia Chen 3 , 1. national university of singapore, Singapore, Singapore, 2. National University of Singapore, Singapore, Singapore, 3. National University of Singapore, Singapore, Singapore Singapore is one of the countries with longest life expectancy, also one of the most rapidly ageing societies in the world. This study investigates the future demographic transitions in Singapore, focusing on the life expectancy disparities of the older adults. We developed a dynamic Markov microsimulation model based on the Singapore Multi-Ethnic Cohort study. The model was adapted to project future trends of chronic diseases, mental illnesses as well as hospitalisation costs of Singapore older people from 2020 to 2050. The prevalences of diabetes, heart disease, hypertension, stroke, disability, dementia and depression of people aged 51 and above was projected to be increasing. Overall projected life expectancy at age 51 for male is 27.8 years, and for female is 34.5 years. Moreover, for older people with secondary or upper education, the overall projected life expectancy at age 51 is 34.1 years, active life expectancy at age 51 is 28.6 years. For older people with primary or lower education, the overall life expectancy at age 51 is projected to be 27.9 years, and active life expectancy projected to be 23.9 years. Our study has significant social and economic implications for policymakers in the way that it demonstrates disparate trends in aging and costs among different education groups in Singapore.

HOME-BASED EXERCISE PROGRAM WITH MEAL DELIVERY INCREASES DAILY STEP COUNT IN HOMEBOUND OLDER ADULTS Harmanpreet Kaur, and Jessica Lee, McGovern Medical School at UTHealth, Houston, Texas, United States
The United Nations projects adults aged 60 and older will reach 2.1 billion by 2050. With this trend, there will be an increase in older adults who are homebound, leading to more frailty with increased healthcare utilization and institutionalization. Improvements in frailty and homebound status may occur through increased physical activity, which has been shown in multiple randomized controlled trials to improve frailty. Our study aims to evaluate the effects of a home-based exercise program, administered through Meals on Wheels, on gait speed and frailty status in sixty-four homebound adults age 60 and older. All participants receive meal delivery for 12 weeks and half are randomized to receive an exercise kit with weekly exercise handouts. All participants are asked to wear an activity tracker with an additional longitudinal measure at 6 months. We now have 6 participants who have completed the study. Preliminary analysis was conducted on step count between the exercise and non-exercise group using two-sample t-tests. Average daily step count in the exercise group (n=3) was 2656 compared to 813 in the non-exercise group (n=3), p< 0.00001 during the first 12 weeks. The step count in the exercise group did decrease during the weeks after the intervention stopped, however they remained more active than the non-exercise group, 1112 vs 548, p< 0.0001. No adverse events were noted. As we continue to enroll participants, we are encouraged that the home-based exercise program with meal delivery appears to be a safe and effective way to increase physical activity in homebound older adults.

PERCEIVED ROLES IN MEDICATION SAFETY: PATIENTS' PERSPECTIVES
Fatoumata Jallow 1 , Elisa Stehling 1 , Zara Sajwani 2 , Kathryn Daniel 1 , Yan Xiao 1 , Kimberly Fulda 3 , and Anna Espinoza 3 , 1. University of Texas at Arlington, Arlington,Texas,United States,2. Children's Health,Dallas,Texas,United States,3. University of North Texas Health Science Center,Fort Worth,Texas,United States Community-dwelling older adults are vulnerable to medication safety-related harms. Prevention of medicationrelated harms in the outpatient setting starts with thorough and thoughtful medication reconciliation at each patient encounter. Comprehensive medication reconciliation is challenging for prescribers to provide in busy time-pressured practices. Older adults currently taking five or more daily prescription medications were recruited for this qualitative study. From the participants' perspective, we explored the role of the prescriber, pharmacist, and patient in medication safety. During the COVID-19 pandemic, interviews were conducted from October 2020 to June 2021. Results from these interviews suggest that older adults recognized their role in medication safety supersedes just taking the pills as prescribed. Older adults understand that they must play an essential role in the coproduction of quality health services. Subthemes that emerged from the patient's perceived role were "taking fewer medications," "locking them up," "keeping appointments," and "reading the label." Pharmacists were expected to inform participants of any changes in their medications, such as the color, shape, or dosage, and ensure no drug interactions. Primary care providers are expected to coordinate care between all specialists treating their patients and any medication prescribed by those specialists. There was a high level of trust in the provider's knowledge, skill, and experience, along with a low level of patient engagement in decision-making around deprescribing. Among older adults, self-perceptions of their role in medication safety varied widely. Educating prescribers and pharmacists about the role expectations of this vulnerable population can help improve medication safety.

SOCIAL INTERACTION AND PSYCHOLOGICAL WELL-BEING OF PERSONS LIVING WITH DEMENTIA IN LONG-TERM CARE
Kyung Hee Lee, and Ji Yeon Lee, Yonsei University, Seoul, Seoul-t'ukpyolsi, Republic of Korea Although social interaction might play a critical role to improve psychological well-being of old adults with dementia in long-term care, lack of social interaction between staff and residents has been reported. The purpose of this study