UMBC School of Social Work
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Item Nursing Facility Characteristics Are Differentially Associated With Family Satisfaction and Regulatory Star Ratings(Southern Gerontological Society, 2025-01-08) Millar, Roberto J.; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanResearch suggests that nursing facility structural characteristics are important contributors toward residents’ quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1–60, 61–120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.Item Use of Design Thinking to Develop Approaches to Collect and Use Person-Centered Dementia Care Measures in Low-Resource Long-Term Care Settings(Wiley, 2024) Corazzini, Kirsten; Lepore, Michael; Kusmaul, Nancy; Wang, Jing; Rataj, Alison; Kim, Yoon Chung; Murray, Briana; Davie, Laura; McConnell, Eleanor S; Holmes, Sarah DBackground Low-resource residential long-term care (LTC) settings, including settings located in medically underserved and health professional shortage communities, have fewer environmental resources to support high-quality, robust data collection and use of measures to support person-centered dementia care (PCC). Further, such settings are more likely to serve older adults from populations that have experienced historic harms related to misuse of personal data, including low-income and minoritized populations. Design thinking engages community-members to understand a problem from the end-user抯 perspective (empathize and define), brainstorm new solutions (ideate), and develop proposed solutions (prototype and test). This study describes the development of user-design workshops to co-develop, with residents living with dementia (RLWD), their family members and care staff, a person-centered measurement collection and data sharing infrastructure in low-resource residential dementia care settings. Methods The overall approach is a multi-method, community-based, participatory research study with design thinking principles. Stakeholders in each of four low-resource LTC settings provided in depth perspectives on collecting and sharing data about RLWD to support PCC. Results from qualitative thematic analysis informed the development of user-design workshops to co-design feasible and acceptable data collection and use protocols. Results Residents, relatives, and staff community members (N = 68 participants) were recruited from 4 low-resource residential LTC settings (N = 2 rural, 2 urban settings). Journey maps were developed to capture community-member perspectives by drawing upon themes in each of four key areas: identifying information for care; accessing information for care; sharing information for care; and prioritizing information for care. Journey maps provided the structure to develop co-design workshop protocols to re-engage community-members to empathize, define, ideate, and prototype acceptable and feasible data collection and data sharing protocols of PCC measures. Conclusion Findings from this study capture multiple facilitators and barriers to robust data collection and use protocols in resource-constrained LTC environments. However, findings also demonstrate the potential for user-centered design approaches to generate novel solutions in ways that honor the perspectives of RLWD, their family members, and the staff who care for them. Ultimately, such approaches contribute to the growth of inclusive research infrastructure to grow capacity for high quality, person-centered dementia care.Item Stakeholder Perspectives on Providing Person-Centered Dementia Care in Low-Resource Long-Term Care Settings(Wiley, 2024) Holmes, Sarah D; Rataj, Alison; Kusmaul, Nancy; Wang, Jing; Kim, Yoon Chung; Murray, Briana; Davie, Laura; Lepore, Michael; Corazzini, KirstenAbstract Background There is a growing number of residents living with dementia (RLWD) in long-term care (LTC) settings, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Low-resource LTC settings, including poorer urban and rural settings, serve older adults who are at high risk for health inequities in dementia care. These settings can experience barriers in providing quality dementia care due to their limited ability to capture pertinent information about residents’ needs and preferences and ensuring that information is known by dementia care staff. Although there is evidence about the consequences of care inequities for RLWD in low-resource LTC settings, less is known about stakeholders’ perspectives about key issues and opportunities for improving dementia care. This study describes stakeholder perspectives regarding the collection and sharing of information about RLWD for supporting quality dementia care in low-resource LTC settings. Method This was a community-based, participatory research study in four low-resource LTC settings (two rural, two urban) in the United States. All four settings were in medically underserved areas with two rural settings in New Hampshire and two urban settings in Maryland. In-depth semi-structured interviews were conducted with a purposive sample of participants (8 administrators/leaders, 20 care staff, 20 RLWD, and 20 care partners). Interviews were audio recorded, transcribed, and thematically analyzed in NVivo12. Result Themes were identified in four core topic areas: 1) identifying information about RLWD to support quality care; 2) finding and accessing information by the care team; 3) sharing information with RLWD; and 4) describing quality measures most relevant for RLWD. Within each theme, subthemes were identified providing greater detail of the process for identifying, collection, and sharing information for supporting quality dementia care. Conclusion This study revealed complexities in providing care for RLWD in diverse low-resource communities and generates directions for addressing dementia care inequities. The findings shed light on practical strategies used by low-resource LTC settings and motivate future research on measuring dementia care quality and advancing capacity among RLWD, their families, and care staff for inclusive, person-centered dementia care.Item Care Compare Star Ratings and Family Satisfaction in Maryland Nursing Facilities: A Comparison by Facility Structure(2024-02-22) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanThese findings were presented at the Gerontological Society of America’s (GSA) 2023 meeting in Tampa, Florida. Part of a Center and Institute Departmentally-Engaged Research (CIDER) award, this is part of several studies focused on examining quality of care in Maryland nursing facilities.Item Nurse Staffing in Nursing Facilities and Family Members' Appraisal of Resident Care(2024-06-29) Millar, Roberto; Diehl, Christin; Cannon-Jones, Stephanie; Kusmaul, Nancy; Stockwell, IanItem Racial differences in the quality of care interactions among nursing home residents with dementia(Taylor & Francis, 2024-05-20) McPherson, Rachel; Resnick, Barbara; Galik, Elizabeth; Gruber-Baldini, Ann L.; Holmes, Sarah; Kusmaul, NancyThe resident population in nursing homes is increasingly racially diverse. The purpose of this study was to assess racial differences in the quality of care interactions among nursing home residents with dementia. The study utilized baseline data from the Testing the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), a randomized controlled pragmatic trial. The Quality of Interaction Scale (QuIS) was used to measure quality of staff-resident care interactions. The sample included 531 residents. An analysis of covariance was conducted to address the aim. The majority of interactions were positive social (42%) or positive care (37%). Black residents living with dementia had higher QuIS scores (M = 5.98, SD = 1.66) than White residents with dementia (M = 5.40, SD = 1.75), whereas higher QuIS scores indicating more positive interactions. However, the results of the analysis of covariance indicated that there was not a significant difference in QuIS scores between Black versus White residents living with dementia (p =.203). The findings suggest that care interactions in nursing homes are consistent between Black residents and White residents. Future research should evaluate the impact of staff race on the quality of care interaction among nursing home residents.Item The Sibling Leadership Network: Ethical Considerations and Policy Recommendations Impacting Sibling Caregivers(Sibling Leadership Network, 2024-08-20) Banks, Tiffany; DeVries, Lindsey; Saxena, Mamta; Weaver, Gracie Lee; Gregory, EmmaThe Sibling Leadership Network (SLN) is a non-profit organization dedicated to supporting siblings of individuals with disabilities. Siblings play an important role as caregivers in the disability community, but also deserve to be recognized as individuals with their owns needs, identities, and roles. One area in which we support siblings is through advocacy and support for sibling caregiver roles.Caregiving is misunderstood. It is providing someone with formal and informal care that may take the form of emotional, physical, or financial support. Caregiving can occur daily or even temporarily, depending on the experience of the individual. There is no one-size-fits-all definition of caregiving, but all care is essential and valued.The Family Medical Leave Act (FMLA) is a policy that allows employees to take unpaid time from work to care for themselves, their spouse, their parent, or their child. Siblings are not included, unless they are providing caregiving for an individual whose disability prevents them from caring for themselves. We believe that this needs to change to acknowledge the important role siblings play in each other’s lives.Home and Community Based Services (HCBS), funds services that allow people with disabilities to live in their community. HCBS is currently struggling with limited funding and a shortage of direct service providers. Investing in HCBS would decrease demands on family caregivers like siblings.Item Measuring Perception of College Welcome Provided to Foreign-Born Students: Validation with Pilot Data(BON VIEW PUBLISHING, 2024-05-06) Evans, KerriImmigrant and foreign-born students are one of the fastest growing populations in higher education across the US, and yet there is a dearth of research around their sense of belonging on campus and in the classroom. Therefore, this paper will cover the development and evaluation process for a scale designed to evaluate the perception of college welcome provided to immigrant students. Data from 94 college students was used to conduct a series of factor analyses to assess the survey questions and their utility for measuring college welcome. The scale is made up of four factors. The Cognitive awareness of college welcome factor showed a Cronbach's alpha of 0.72, the Emotional college welcome factor showed a Cronbach's alpha of 0.732 Behaviors of college welcome showed a Cronbach's alpha of 0.75 and the Relational college welcome showed a Cronbach's alpha 0.767. Overall, Cronbach's alpha is 0.864 for the perception of college welcome which is excellent. While the results are promising that this scale could indeed be measuring college welcome, it is important that more data be collected, reflect a higher percentage of immigrant students, and that future research be done to continue to assess the reliability and validity of this scale. This scale is the first step in better understanding the perception of welcome provided to foreign-born students, which is critical so that social workers can intervene and help improve the social and emotional well-being of students.Item Developing and Testing a Model of the Assisted Living Environment(Taylor & Francis, 2020-07-21) Holmes, Sarah; Resnick, Barbara; Galik, Elizabeth; Kusmaul, NancyThe assisted living (AL) environment plays an important role in supporting residents’ satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD = 26.2) beds and the majority were for profit facilities (n = 41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ²/df = 1.861, p < .05; CFI = .858, RMSEA = .126). Having a comprehensive AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. Findings from this study will inform interventions and programs designed to modify AL environments to optimize residents’ satisfaction with AL.Item My loved one might need more care than I can provide. What do I do?(The University of Alabama, 2022-07-07) Kusmaul, NancyCaring for another person can be rewarding, challenging, and overwhelming . Many caregivers choose to care for family members and friends out of a sense of love, or paying someone back for care they have received earlier in life. But what happens when you can no longer provide that care?Item Professional Social Workers in the Nursing Home(ELSEVIER, 2022-11-01) Hector, Paige; Kusmaul, NancyThe International Federation of Social Work defines social work as “a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledges, social work engages people and structures to address life challenges and enhance wellbeing” (“Global Definition of Social Work,” IFSW, July 2014, https://bit.ly/3TsJszN). Social work practice is also shaped by a professional code of ethics that focuses on person-directed care and competent practice that supports ethical decision-making when there are conflicts of interest.Item Discharge Planning Best Practices to Avoid Hospital Readmissions(American Association of Post-Acute Care Nursing, 2023-09-19) Stewart, Amy; Kusmaul, NancyIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Dr. Nancy Kusmaul, PhD, MSW, associate professor in the baccalaureate social work program at the University of Maryland, Baltimore County, discuss discharge planning best practices to avoid hospital readmissions.Item Addressing the Needs of an Aging Population Through Health Professions Education: Proceedings of a Workshop(National Academy of Sciences, 2023-10-12) Cuff, Patricia A.; Forstag, Erin Hammers; Kusmaul, NancyItem Guide to Elder Abuse and Home Safety(Today's Homeowner, 2024-04-15) Bennett, Alexis; Kusmaul, Nancy; Mosqueda, LauraOur respected elders, who harbor a lifetime of experiences and wisdom, are a vital part of our communities. Unfortunately, it’s a sobering reality that approximately one in six individuals aged 60 and above experienced some form of abuse in 2021. The COVID-19 pandemic exacerbated the problem, with incidents of elder abuse seeing a concerning increase. It’s high time we took a closer look at the issues surrounding elder abuse and how we can ensure safety at home for our seniors.Item Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop(National Academy of Sciences, 2023-05) Andrada, Alexandra; Andrada, Kat M.; Nass, Sharyl J.; Kusmaul, NancyItem “Knowing when it's time to take a break”: Nursing home social workers’ coping during COVID-19(ELSEVIER, 2023-06) Fields, Noelle L.; Schuman, Donna L.; Miller, Vivian J.; Kunz-Lomelin, Alan; Kusmaul, Nancy; Anderson, Keith A.BackgroundNursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs.MethodsThis study employed a cross-sectional survey of NH social workers via social media and professional networks about their coping strategies during COVID-19. Open-ended responses were analyzed qualitatively using the rigorous and accelerated data reduction technique (RADaR).ResultsThe study included a sample of 63 (N = 63) NH social workers. Four themes defined ways the in which NH social workers coped with stress during COVID-19, including relying on friends and family, mindfulness and spirituality/religion, self-care strategies, and setting boundaries at work.ConclusionThese techniques appear to be effective; however there remains a need for institutional programs and policies to provide the time and space to holistically support coping in NH social workers and to prevent burnout and turnover, particularly during times of crisis.Item Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review of Recent Empirical Research(LSE Press, 2024-05-01) Millar, Roberto J.; Diehl, Christin; Blake, Elizabeth; Fakeye, Oludolapo; Kusmaul, NancyContext: Nursing facilities are an essential part of the long-term care continuum, providing a setting where older adults and persons with disabilities receive critical services and supports. Despite extensive research linking facility characteristics to resident outcomes, the facility and resident factors under investigation vary in the context of a diverse industry landscape and poor understanding of key quality of care outcomes.Objectives: This scoping review focused on identifying key concepts, summarising existing findings, and identifying gaps in research linking nursing facility characteristics and resident outcomes.Methods: Guided by PRISMA-ScR guidelines, this scoping review focused on empirical, English-language research published in five databases between 2005 and 2022. The research studies meeting specified inclusion criteria were subjected to thematic analysis for the extraction of key concepts and synthesis of findings.Findings: The 91 research studies in the final analytic sample conceptualised facility-level characteristics and resident outcomes using six and nine broad domains, respectively. The subcategories making up these discrete domains varied widely across studies. While evidence of linkages between facility environments and resident outcomes varied, there was general support that higher staffing capacity and home-like environments with support for autonomy and social integration were linked to better functional outcomes and higher overall subjective well-being of residents.Implications: It is imperative to understand how facility-level characteristics influence resident outcomes, and this scoping review provides insight into these complex relationships. A better understanding of this area is key to improving policies and regulatory oversight, as well as more broadly inform data driven decision-making.Item 2024 Nancy Kusmaul, Social Work, Receives “Outstanding Individual In Academia” Award From The Congressional Research Institute For Social Work And Policy(2024-04-26) Duque, Catalina Sofia Dansberger; Demond, MarlaynaUMBC's Nancy Kusmaul, associate professor of social work, a scholar and advocate for the rights of older adults and professional caregivers, received the “Outstanding Individual in Academia” award from the Congressional Research Institute for Social Work and Policy in March 2024 at a ceremony on Capitol Hill. Kusmaul’s work is informed by her 10 years of experience as a social worker and over a decade of novel scholarship.Item An Assessment of MSW Social Work Curricula: Semester-Long Courses Specifically Related to Immigrants and Immigration(Taylor & Francis, 2024-03-14) Evans, Kerri; Figuereo, Victor; Rosales, Robert; Woo, Bongki; Perez-Aponte, JaimeSocial workers are well positioned to meet the needs of the immigrant population in the United States (U.S.) and social workers across all fields and specializations should both feel competent and have the appropriate skills to work with immigrant clients. In this paper, we provide context around the immigrant population in the U.S. and discuss social work’s role in helping immigrants, and the role of the MSW degree in helping to prepare social workers to work with immigrants. Using publicly available data on MSW school websites, we analyze the prevalence of courses that specifically focus on immigrants or immigration. We found a lack of semester-long immigrant-specific courses in that only 12% of the programs offered these courses. We also noted the geographic clustering of some programs that offer these courses. We propose that schools do one of the following depending on their current course offerings, faculty expertise, and other resources: ensuring that basic content and case examples about immigrants are included in foundational social work courses, and when feasible or appropriate create elective courses, or create a concentration for those wishing to specialize in social work practice with immigrants.Item CARE COMPARE STAR RATINGS AND FAMILY SATISFACTION IN MARYLAND NURSING FACILITIES(Oxford University Press, 2023-12-21) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanNursing facilities provide critical services and supports to individuals with long-term care needs. The quality of care in nursing facilities varies depending on facility structural characteristics. Moreover, the measurement and perceptions of what constitutes quality of care varies across stakeholders. We used publicly available data to examine the association between family satisfaction with care and the Centers for Medicare & Medicaid Services’(CMS’s) Care Compare five-star quality ratings in the context of facility characteristics. Facility-level data of family satisfaction with care were merged with CMS’s five-star star ratings of 220 Maryland nursing facilities in 2021. Using univariate and bivariate statistics, we explored differences in family ratings and five-star ratings across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and average resident occupancy (1-60, 61-120, and 121+). Relationships were examined across overall ratings, as well as across subdomain of the two quality rating frameworks (e.g., staffing, autonomy, health inspections). Family members of residents in non-profit, rural, and low-occupancy facilities rated facilities higher. Non-profit and low-occupancy facilities were statistically more likely to be rated four or five stars, while no significant association was observed across geographic location. The association between subdomain-specific family satisfaction and star ratings varied across facilities of different structures. Findings emphasize the need for comprehensive quality of care frameworks that consider views of quality across stakeholders and types of facilities. A clear understanding of nursing facility structure and quality of care is critical to advance data-driven decision making.