A retrospective cohort study published in the Journal of the American Geriatrics Society used propensity score matching to investigate the effect of the presence and timing of do-not-resuscitate (DNR) orders on short-term outcomes among hospitalized persons 65 and older, reports HealthDay News . Data was included for 1,347 subjects in the DNR group and 9,182 in the no-DNR group. The researchers determined the DNR group had significantly longer stays and were more likely to be discharged to hospice and to die. A significant difference in average length of stay was observed for those who had a DNR written within 24 hours of admission compared to those who had a DNR written more than 24 hours after admission. Subjects with early DNR were less likely to spend time in intensive care, receive a palliative care consultation, be restrained, have an order for nothing by mouth, have a bladder catheter, or die in the hospital. In addition, they were more likely to be sent home. "Further studies are necessary to better understand the presence and timing of DNR orders in hospitalized older adults," the authors note.

Fewer than 20 acute-care hospitals in the U.S. have dedicated spaces for family caregivers, but advocates expect more hospitals to invest in them out of economic necessity, reports Modern Healthcare . For one thing, the Affordable Care Act imposed penalties for avoidable readmissions, which caregivers can help prevent, while some programs are compensating caregivers for their labor. "The caregivers in the population we're taking care of need to be recognized as a component that will reduce readmissions to hospitals and keep length of stay shorter," says Burke Rehabilitation Hospital CEO Jeffrey Menkes. "So, yes, we would hope this would be an operating cost that would be recognized, because right now it's not." Leah Eskenazi with the National Center on Caregiving's Family Caregiver Alliance notes that hospital administrators do not always see value in caregiver centers because they do not perceive a direct connection between supporting caregivers and important results such as reducing preventable emergency room visits. AARP supports a law requiring hospitals to provide caregivers with education and instruction on at-home medical tasks. Meanwhile, the Centers for Medicare and Medicaid Services has been fining hospitals with excess readmissions to reduce wasteful Medicare spending and improve care.

A study from the University of Minnesota's School of Public Health published in the Journal of Rural Health found caregivers in rural areas often lack the workplace "flexibility and support they need to juggle their many responsibilities," reports CBS Minnesota . The researchers surveyed 635 caregivers who work and live in either a rural or urban area across the country. Generally, caregivers in rural areas received less workplace support than those living in urban areas. Specifically, 15 percent of rural caregivers have access to supportive programs through their workplace, versus 26 percent of employed urban caregivers. Meanwhile, less than 10 percent of rural caregivers are able to work from home, compared to 25 percent of caregivers in urban areas. In addition, 18 percent of caregivers in rural areas have access to paid leave, compared with 34 percent of urban caregivers. "These findings should raise concern about the well-being of employed rural caregivers who are juggling multiple roles with less support from their workplaces," says University of Minnesota Professor Carrie Henning-Smith. "As caregiving needs rise — especially in rural areas — it will become increasingly urgent to find ways to support all caregivers." The study's organizers suggest employers should offer more support to workers who also care for loved ones, including flexible hours, working from home, and paid leave.

Making a company more diverse involves understanding both inherent and acquired diversity, reports Forbes . Inherent diversity deals with characteristics such as race, gender, or age, while acquired diversity involves experiential traits. Diversification can be accomplished by going to employees, asking them about their experiences and backgrounds, and soliciting their opinions and recommendations. Another approach is to compose job descriptions based on results rather than qualifications, while still another is to diversify the worker pipeline. This can be achieved by exploring third-party websites to post open job opportunities instead of relying on employee referrals. A structured interview process can also foster diversification, as asking each candidate a set of similar questions will help develop a dataset that is analyzable, and offers a better option than gut feelings. A fifth strategy is to become conscious of the team's biases as well as one's own.

Despite assumptions to the contrary, few managers understand leadership coaching very well, report researchers Julia and Trenton Milner in the Harvard Business Review . They analyzed more than 900 assessments of pre-training and post-training coaching conversations, accompanied by polls of participants' attitudes and experiences with leadership coaching. "The biggest takeaway was the fact that, when initially asked to coach, many managers instead demonstrated a form of consulting," the Milners note. "Essentially, they simply provided the other person with advice or a solution." The researchers cite nine leadership coaching skills to emphasize, including listening, questioning, giving feedback, assisting with goal setting, expressing empathy, letting the coachee arrive at their own solution, recognizing and pointing out strengths, providing structure, and encouraging a solution-focused approach. "The skill the participants were the best at before training was listening, which was rated 'average' by our experts," the Milners write. "After the training, the experts' rating increased 32.9 percent, resulting in listening being labeled 'average-to-good.' The skills the participants struggled with the most before the training were 'recognizing and pointing out strengths' and 'letting the coachee arrive at their own solution.'" The Milners stress that coaching strategy should begin by clearly defining that strategy and how it differs from other types of manager behavior. "The next step is to let managers practice coaching in a safe environment before letting them work with their teams," they note.

Although hospitals claim to support "universal coverage," they are opposed to having a state or federal government be the sole funding authority, reports the Washington Examiner . The Medicare for All Act would insure all Americans through Medicare, but hospitals do not relish the idea of the government scrapping private insurers. They say it would either require tax hikes or pay cuts for doctors and hospitals, prompting closures, layoffs, and long lines for care. Hospital lobbyists have been urging Congress to fix the Affordable Care Act (ACA) with additional federal funding, and have attempted to encourage more states to expand Medicaid under the ACA to cover individuals making $16,000 annually. Although Democrats criticize drug and insurance firms for high costs, in point of fact hospitals are the biggest spenders at 32 percent, according to the Centers for Medicare and Medicaid Services. In comparison, prescription drugs comprise 10 percent of spending while doctors account for 20 percent. The balkanized U.S. healthcare system works to hospitals' advantage, as they can charge private insurers more to fill the void left by the uninsured and government programs. "For hospitals single-payer insurance would be devastating," says Healthcare Leadership Council President Mary Grealey. "Fiscally, it would be very difficult for hospitals to survive if the vast majority of their beneficiaries were on Medicare."

Center for Economic and Policy Research analyst Alan Barber says Social Security constitutes about 50 percent of family income for about half of Americans older than 65, while "the percentage of families in which Social Security benefits account for at least half of their retirement income rises to 70 percent for blacks and Hispanics," reports ThinkAdvisor . "Benefits are roughly 90 percent of income for one in four of those 65 or older," Barber notes. He and colleagues analyzed data from the 2015 March CPS to determine Social Security benefits were the largest share of income for the least advantaged recipients, those in the first and second quintiles. Social Security was 59.9 percent of income for the third quintile, and 38.4 percent and 15.1 percent for the fourth and fifth quintiles, respectively. Most married couples in the third quintile depended on Social Security benefits for between 41.9 percent and 49 percent of their income, rising to 63 percent for Hispanic couples. Among single men in the first quintile, Social Security comprised 92.6 percent all of retirement income for those in the Other, Non-Hispanic category. Variation among quintiles was less significant for single women but Social Security benefits were a much larger share of income at the third, fourth, and fifth quintiles for women than for men and married couples.

A study published in the Journal of Elder Abuse & Neglect suggests the analysis of incidents between residents with dementia in long-term care communities may help reduce future deaths, reports ScienceDaily . The researchers determined 44 percent of such fatalities were the results of physical contact classified as push-fall. "Many of the injuries consisted of hip fractures or head or brain injuries and on average it was slightly more than two weeks from the incident to their passing, which speaks volumes to the frailty and vulnerability of this population," says the University of Minnesota School of Nursing's Eilon Caspi. Meanwhile, 75 percent of these incidents were among men. "The preliminary findings may have implications for more targeted interventions," Caspi says. Furthermore, 59 percent of all incidents occurred inside bedrooms and 43 percent involved roommates. "Policies, procedures, and practices related to roommate assignment and monitoring need to be thoughtful and revisited regularly and we need to explore all avenues for reducing to the minimum possible the use of shared bedrooms or at a minimum increasing roommates' sense of privacy and security," Caspi recommends. Also of note was the finding that incidents happened most often on evenings and weekends. "Taking proactive, anticipatory, preventative measures and increasing staffing levels, the active presence of managers, and meaningful engagement during the evenings and weekends could reduce the incidence," Caspi suggests.

University of Pennsylvania nurses in May chaired a think tank, called Assuring High Value Care for Vulnerable Older Adults and their Caregivers: Maximizing the Contributions of Nurses, to discuss how to improve the U.S. health system for older adults with complex chronic conditions, reports Nurse.com . The University of Pennsylvania's Nancy A. Hodgson noted there are nursing care models that would do well in terms of value to address chronically ill older adults, but few are scaled into routine practice. She said such people are being increasingly cared for by relatives, who do not feel prepared to take on such responsibilities, compounded by a fragmented health system that lacks cross-provider communication. "I think nurses are there to pick up the pieces. We're there at every point of care for older adults," Hodgson noted. The think tank offered some geriatric care solutions, including seamless electronic health record systems that could communicate with multiple points of care, and leveraging technologies and innovations in other industries, such as wearables that interface with clinicians and mobile phone apps for easier beneficiary-provider communication. Hodgson stressed the importance of nurses being aware of policy changes focused on advancing care for people with chronic conditions. One example is the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act, which focuses on Medicare and Medicare Advantage plans and emphasizes telehealth and other options for providing coverage for people with chronic diseases.

A growing number of big-name companies are helping educators create skills-based programs and, in turn, future job candidates, reports the Wall Street Journal . Direct ties between major employers and high schools, in particular, are multiplying. For instance, Volkswagen is assisting schools in Tennessee modernize their engineering programs. Tesla, meanwhile, is partnering with Nevada schools on an advanced manufacturing curriculum. The renewed popularity of career education programs marks a step back from the notion that all students should get a liberal-arts education designed to prepare them for college. In Rhode Island, Gov. Gina Raimondo recently redirected funds from lower-performing training programs toward newer ones in engineering, information technology, and welding. The state has partnered with such companies as CVS, which helped establish a curriculum at Davies High School that trains students to become pharmacy technicians.