Background
Care-dependency in Germany and increase in nursing home admissions
Challenges of nursing home admissions for individuals
Challenges of nursing home admissions for the German health system
Methods
Eligibility criteria
Key elements | Eligibility criteria |
---|---|
Population | (1) Older individuals (aged 65 or older) who are in need of nursing care and were admitted to nursing homes (2) Health professionals/ health providers or informal caregivers (families/friends, paid/unpaid) who were involved in the admission to the nursing home |
Concept | Challenges and care strategies (e.g., interventions, best-practice examples, recommendations) of admissions to nursing homes |
Context | (1) Admissions to nursing homes in Germany (this setting includes discharging settings, e.g., acute care hospitals, rehabilitation facilities, and other nursing homes as discharging institutions) (2) Publication languages: German, English (3) Publication date: since 1995 (introduction of the Social Security Code XI (SGB XI), the German long-term care insurance) (4) Types of evidence sources: all study types with an IMRaD structure (Introduction, Materials and Methods, Results, Discussion and Conclusions) including (i) peer-reviewed and non-peer-reviewed journal articles and conference proceedings, (ii) grey literature such as preprints and reports from official agencies/policy documents, and doctoral theses Excluded evidence sources: (i) Poster and only-abstract publications; (ii) articles dealing with mixed populations including younger adults |
Information sources
Search
MEDLINE via Pubmed | |||
# | Input | Hits | |
# | "NURSING HOME*"[TITLE/ABSTRACT] OR "LONG-TERM CARE"[TITLE/ABSTRACT] OR "NURSING HOMES"[MESH TERMS] | 67,867 | |
# | "ENTRY"[TITLE/ABSTRACT] OR "TRANSITION*"[TITLE/ABSTRACT] OR "PLACEMENT"[TITLE/ABSTRACT] OR "ADMISSION*"[TITLE/ABSTRACT] OR "DISCHARG*"[TITLE/ABSTRACT] OR "PATIENT DISCHARGE"[MESH TERMS] OR "PATIENT TRANSFER"[MESH TERMS] OR "TRANSITIONAL CARE"[MESH TERMS] OR "PATIENT ADMISSION"[MESH TERMS] | 1,198,833 | |
# | "GERMAN*"[TITLE/ABSTRACT] OR "GERMAN*"[AFFILIATION] OR "DEUTSCH*"[AFFILIATION] OR "GERMANY"[MESH TERMS] | 1,275,601 | |
# | #1 AND #2 AND #3 | 428 | |
# | #4 FILTERS APPLIED: FROM 1995—3000/12/12 | 403 | |
Web of Science Core Collection | |||
# | Input | Hits | |
1 | TS = ("NURSING HOME*" OR "LONG-TERM CARE") INDEXES = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI TIMESPAN = 1995–2021 | 51,298 | |
2 | TS = (ENTRY OR TRANSITION* OR PLACEMENT OR ADMISSION* OR DISCHARG*) INDEXES = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI TIMESPAN = 1995–2021 | 2,686,846 | |
3 | TS = (GERMAN* OR DEUTSCH*) OR OO = ( GERMAN* OR DEUTSCH*) OR CU = GERMANY INDEXES = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI TIMESPAN = 1995–2021 | 3,608,966 | |
4 | #3 AND #2 AND #1 INDEXES = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI TIMESPAN = 1995–2021 | 538 | |
CINAHL | |||
# | Input | Hits | |
# | TI "NURSING HOME*" OR AB "NURSING HOME*" OR TI "LONG-TERM CARE" OR AB "LONG-TERM CARE" OR MH NURSING HOMES | 49,065 | |
# | TI ENTRY OR AB ENTRY OR TI TRANSITION* OR AB TRANSITION* OR TI PLACEMENT OR AB PLACEMENT OR TI ADMISSION* OR AB ADMISSION* OR TI DISCHARG* OR AB DISCHARG* OR MH TRANSITIONAL CARE OR MH PATIENT ADMISSION OR MH PATIENT DISCHARGE + | 284,755 | |
# | TI GERMAN* OR AB GERMAN* OR TI DEUTSCH* OR AB DEUTSCH* OR AF GERMAN* OR AF DEUTSCH* OR MH GERMANY | 177,279 | |
# | #1 AND #2 AND #3 | 193 | |
# | LIMITERS—PUBLISHED DATE: 19,950,101–20,211,231 | 192 | |
CC Med and PSYNDEX via LIVIVO | |||
# | Input | Hits | |
# | FS = ("NURSING HOME" OR "NURSING HOMES" OR "LONG-TERM CARE" OR ALTENHEIM* OR ALTENHEIME OR PFLEGEHEIM* OR PFLEGEHEIME OR LANGZEITPFLEGE) | 9965 | |
# | FS = (ENTRY OR TRANSITIONS* OR TRANSITION OR PLACEMENT OR ADMISSION* OR ADMISSION OR DISCHARG* OR DISCHARGE OR EINZUG OR UMZUG OR ÜBERGANG OR EINTRITT OR ENTLASSUNG OR ÜBERLEITUNG) | 17,148 | |
# | FS = (GERMAN* OR DEUTSCH*) | 214,258 | |
# | #1 AND #2 AND #3 | 46 | |
# | FILTER AB 1995 | 34 | |
PROSPERO | |||
# | Input | Hits | |
# | (NURSING HOME* OR LONG-TERM CARE) | 1933 | |
# | (ENTRY OR TRANSITION* OR PLACEMENT OR ADMISSION* OR DISCHARG*) | 13,528 | |
# | #1 AND #2 | 557 | |
Google Scholar | |||
# | Input | Hits | |
# | NURSING HOME ADMISSION GERMANY | Ca. 385.000 | |
# | PFLEGEHEIM EINTRITT | Ca. 9.830 | |
CareLit | |||
# | Input | Hits | |
# | TITEL = ALTENHEIM* ODER TITEL = PFLEGEHEIM* ODER ABSTRACT = ALTENHEIM* ODER ABSTRACT = PFLEGEHEIM* | 4857 | |
# | FS = (ENTRY OR TRANSITIONS* OR TRANSITION OR PLACEMENT OR ADMISSION* OR ADMISSION OR DISCHARG* OR DISCHARGE OR EINZUG OR UMZUG OR ÜBERGANG OR EINTRITT OR ENTLASSUNG OR ÜBERLEITUNG) | 1370 | |
# | #1 UND #2 | 116 |
Selection of sources of evidence
Data charting process
Synthesis of results
Results
Authors, year | Type of evidence source | Context (Federal state of Germany; discharging/admitting setting) | Objective/Aim | Design | Data collection methods | Data analysis methods | Participants |
---|---|---|---|---|---|---|---|
Nguyen et al., 2018 [48] | Journal publication | North-Rhine-Westphalia Home to nursing home | To investigate experiences and views of informal caregivers and healthcare professionals regarding the transition of people with dementia to a nursing home | Secondary: qualitative cross-sectional study | Focus group interviews | Structured content analysis | Informal caregivers (of persons with dementia and one person with dementia) and interest representatives (n = 17); age: 47–90; healthcare professionals (n = 13); age: 32–62 |
Stephan et al., 2013 [41] | Journal publication | North-Rhine-Westphalia Home to nursing home | To investigate reasons for nursing home entry from the perspectives of informal caregivers and experiences during the first weeks after entry | Primary: qualitative explorative | Interviews | Inductive content analysis | Informal caregivers of persons with dementia, n = 114; age: 38–91 (mean: 59) |
Koppitz, 2010 [38] | Journal publication and doctoral thesis (book) | Bavaria To Nursing home | To gain insight into the experiences of nursing residents in the first 3 months after nursing home entry | Primary: qualitative explorative | Interpretative phenomenology, guided interviews | Interpretative phenomenology; thematic analysis | Nursing home residents (n = 12); age: 68–93 (mean: 83) informal caregivers (n = 12); age: n.a |
Hartmann et al., 2017 [36] | Journal publication | North-Rhine-Westphalia To Nursing home | To investigate which tasks informal caregivers perform in the nursing home during the first months after nursing home entry | Primary: longitudinal study | Standardised questionnaire (InterRAI, frequency and duration of nursing home visits) | Descriptive statistical analysis | Informal caregivers of persons with dementia (n = 119); age: 32–91 (mean: 60) |
Schulte et al., 2017 [40] | Journal publication | Niedersachsen Hospital to nursing home | To investigate the technical and organizational feasibility, usability, usefulness and completeness of an electronic instrument (based on the German HL7 CDA standard for eNursing Summaries) for information transmission between one setting to another | Primary: cross-sectional feasibility study | Mixed methods; document analysis, standardized questionnaire (IsoMetrics), logbooks, transfer forms / reports, focus group interviews | Case analysis, qualitative content analysis, descriptive statistical analysis | Cooperation partners: 9 inpatient + 4 home care institutions; 1 maximum care hospital; users: n = 26 (14 hospital nurses, 12 nurses of nursing homes); patients (n = 14); sender of transfer E-reports (n = 10, receiver of transfer E-reports (n = 9); sender of paper-based transfer reports (n = 5), receiver of paper-based transfer reports (n = 5), n = 69, institutions (provision of care transition forms); age: n.a |
Reinspach & Kraus, 2006 [46] | Project report (web document) | Bavaria To nursing home | To evaluate the effectiveness, cost-efficacy, acceptance, quality of and satisfaction with the programme‚ Pflegeüberleitung’ (care transition) | Primary: longitudinal mixed methods | Mixed-methods; questionnaires, problem-centred / expert interviews; group discussions/group interviews, workshop | Descriptive statistical analysis of documents, qualitative analysis of documents, case analysis | Nursing homes (n = 40); nursing home residents (n = 7); relatives (n = 5); nurses (of nursing homes); care transition nurses (n = 40); other staff (hospital staff, social service, staff from the social services department, other experts ((n = 6)); nurses and management of nursing homes (n = 560); age: n.a |
Neubert, 2016 [45] | Journal publication | n.a. (North- and South-Germany) Home to nursing home | To investigate how informal caregivers experience the waiting period until a place in a nursing home gets vacant | Primary: qualitative explorative | Guided episodic interviews | Qualitative content analysis | Informal caregivers (n = 6); age: 45–84 (one person n.a.) |
Hesse & Klewer, 2013 [44] | Journal publication | Saxony Hospital to nursing home (and other facilities) | To analyse the requirements on the nursing discharge management of a general hospital from the perspective of aftercare institutions | Primary: quantitative cross-sectional | Standardized anonymous questionnaire | Descriptive statistical analysis | 22 nursing homes, 1 acute hospital, (other aftercare institutions: outpatient nursing services (n = 22); assisted living facilities (n = 3); short-term care facilities (n = 7); rehabilitation facilities (n = 14)); age: n.a |
Bräutigam et al., 2005 [42] | Journal publication | North-Rhine-Westphalia Hospital to nursing home (and other facilities / home) | To investigate to what extent the “Pflegeüberleitung” (care transition) contributes to the assurance of continuity of care | Primary: qualitative Primary: cross-sectional | Qualitative, participatory semi-structured Observation, documentation using a semi-structured data-gathering instrument, questions to the involved HPs after each situation | Descriptive running text, structured content analysis and discussion with professionals, interpretative evaluation (hermeneutics) | 3 hospitals, 980 situations / 100 shifts (involving 4 patients per institution and the involved HPs); age: n.a |
Ernst, 2019 [43] | Doctoral thesis (web document) | North-Rhine-Westphalia Home to nursing home | To investigate transitions of care- needing people with dementia from home settings to nursing homes to gain knowledge about the special needs of this group of patients and about the reasons for their transfer | Primary: qualitative explorative | Guided interviews | Qualitative content analysis | Relatives (informal caregivers) who had accompanied patients into formal nursing home settings (n = 17); age: 76–97 (mean: 86,9) |
Pieper & Kolankowska, 2011 [39] | Journal publication | North-Rhine-Westphalia Hospital to nursing home (and other facilities / home) | To evaluate the status quo of transition in a major German city after standardization of procedures and implementation of standard forms to evaluate satisfaction with handling of standard forms and improvement of procedures and satisfaction of patients with the discharge process | Primary: quantitative cross-sectional | Standardized questionnaires | Inductive bivariate statistics | Nursing homes (n = 41), nursing services (n = 27), rehabilitation clinic (n = 1), GPs (n = 27); age: n.a.; hospitals (n = 13); patients (n = 634); age: mean: 62 (+ -15 years) |
Zielke, 2020 [47] | Doctoral thesis (book) | North-Rhine-Westphalia; Niedersachsen; Saxony-Anhalt Home to nursing home | To investigate the nursing home transition relating to housing and the design possibilities | Primary: longitudinal qualitative | Participatory observation 4 field phases (1 in an assisted living facility), comprehensive interviews | Grounded theory | Nursing homes (n = 3); nursing home residents (n = 29); age: n.a |