HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility
- 144 Downloads
- 21 Citations
Abstract
Objective
To describe the characteristics and outcomes of the first 3 years of admissions to a dedicated skilled nursing facility for people with acquired immunodeficiency syndrome (AIDS).
Methods
Systematic chart review of consecutive admissions to a 30-bed, AIDS-designated long-term care facility in New Haven, Connecticut, from October 1995 through December 1998.
Results
The facility has remained filled to 90% or more of its bed capacity since opening. Of 180 patients (representing 222 admissions), 69% were male; mean age was 41 years; 57% were injection drug users; 71% were admitted directly from a hospital. Leading reasons for admission were (1) the need for 24-hour nursing/medical supervision, (2) completion of acute medical treatment, and (3) terminal care. On admission, the median Karnofsky score was 40, and median CD4+ cell count was 24/mm3; 48% were diagnosed with serious neurologic disease, 44% with psychiatric illness; patients were receiving a median of 11 medications on admission. Of 202 completed admissions, 44% of patients died, 48% were discharged to the community, 8% were discharged to a hospital. Median length of stay was 59 days (range 1 to 1,353). Early (≤6 months) mortality was predicted by lower admission CD4+ count, impairments in activities of daily living, and the absence of a psychiatric history; long-term stay (>6 months) was predicted by total number of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significantly decreased mortality rates and increased prevalence of psychiatric illness between the two periods (P<.01).
Conclusions
A dedicated skilled nursing facility for people with AIDS can fill an important service need for patients with advanced disease, acute convalescence, long-term care, and terminal care. The need for long-term care may continue to grow for patients who do not respond fully to current antiretroviral therapies and/or have significant neuropsychiatric comorbidities. This level of care may be increasingly important not only in reducing lengths of stay in the hospital, but also as a bridge to community-based residential options in the emerging chronic disease phase of the AIDS epidemic.
Key Words
AIDS End-of-Life Care Health Services Long-Term Care Palliative Care Skilled Nursing FacilitiesPreview
Unable to display preview. Download preview PDF.
References
- 1.Centers for Disease Control and Prevention.HIV/AIDS Surveillance Report. Estimated Incidence of AIDS and Deaths of Persons with AIDS, Adjusted for Delays in Reporting, by Quarter-Year of Diagnosis/Death, United States. January 1985 through June 1997. Atlanta, GA: Centers for Disease Control and Prevention; 1997;9:1–44.Google Scholar
- 2.Centers for Disease Control and Prevention. Update: trends in AIDS incidence, deaths, and prevalence—United States 1996.MMWR Morb Mortal Wkly Rep. 1997:46:165–173.Google Scholar
- 3.Carpenter CC, Fischl MA, Hammer SM, ei al. Antiretroviral therapy for HIV infection in 1997: updated recommendations of the International AIDS Society-USA Panel.JAMA. 1997;277:1962–1969.CrossRefPubMedGoogle Scholar
- 4.Moore R, Stanton D, Gopalan R, Chaisson R. Racial differences in the use of drug therapy for HIV disease in an urban community.N. Engl J Med. 1994;330:763–768.CrossRefPubMedGoogle Scholar
- 5.Bangsburg D, Tulsky J, Hecht F, Moss A. Protease inhibitors in the homeless.JAMA. 1997;278:63–65.Google Scholar
- 6.Selwyn PA. HIV therapy in the real world.AIDS. 1996;10:1591–1593.PubMedGoogle Scholar
- 7.Slavin P. AIDS death rates are down. Is less simply more?Hospice. 1997;(Summer): 30–33.Google Scholar
- 8.McCormick W, Inui T, Deyo R, Wood R. Long-term care needs of hospitalized persons with AIDS: a prospective cohort study.J Gen Intern Med. 1991;6:27–34.PubMedGoogle Scholar
- 9.Heath J. Care of persons with AIDS in the nursing home.Fam Med. 1998;30:436–440.PubMedGoogle Scholar
- 10.Glatt A, Risbrook A, Jenna R. Successful implementation of a long-term care unit for patients with acquired immunodeficiency syndrome in an underserved suburban area with a high incidence of human immunodeficiency virus.Arch Intern Med. 1992;152: 823–825.CrossRefPubMedGoogle Scholar
- 11.Koch A. Long-term care for people with HIV/AIDS: challenges and opportunities.J Health Admin Educ. 1992;10:113–128.Google Scholar
- 12.Montoya D, Chenier E, Richard A. Drug abuse, AIDS, and the coming crisis in long-term care.J Nurs Manage. 1996;4:151–162.Google Scholar
- 13.Swan J, Benjamin A, Brown A. Skilled nursing facility care for persons with AIDS: comparison with other patients.Am J Public Health. 1992;82:453–455.PubMedGoogle Scholar
- 14.Department of Public Health and Addiction Services.Connecticut AIDS Surveillance Annual Report. Harford, CT: Department of Public Health and Addiction Services; 1996.Google Scholar
- 15.Selik RM, Chu SY, Buehler JW. HIV infection as leading cause of death among young adults in US cities and states.JAMA. 1993;269:2991–2994.CrossRefPubMedGoogle Scholar
- 16.Folstein M, Folstein S, McHugh P. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975;12:189–198.CrossRefPubMedGoogle Scholar
- 17.Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. The index of ADL: a standardized measure of biological and psychosocial function.JAMA. 1963;185:914–919.PubMedGoogle Scholar
- 18.Centers for Disease Control and Prevention. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adults and adolescents.MMWR Morb Mortal Wkly Rep. 1992;RR-17:1–19.Google Scholar
- 19.Kelleher P, Cox S, McKinney KC. HIV infection: the spectrum of symptoms and disease in male and female patients attending a London hospice.Palliat Med. 1997;11:152–158.PubMedGoogle Scholar
- 20.Bulkin W, Brown L, Fraioli D, ei al. Hospice care of the intravenous drug user AIDS patient in a skilled nurse facility.J Acquir Immune Defic Syndr Hum Retrovirol. 1988;1: 375–380.Google Scholar
- 21.Gibbs L, Ellershaw J, Williams M. Caring for patients with HIV disease: the experience of a generic hospice.AIDS Care. 1997;9:601–607.PubMedGoogle Scholar
- 22.Moss V. Terminal care for people with AIDS.Practitioner. 1991;235:446–449.PubMedGoogle Scholar
- 23.Bacellar H, Munoz A, Miller E, ei al. Temporal trends in the incidence of HIV-1-related neurologic diseases: multicenter AIDS cohort study, 1985–1992.Neurology. 1994;44: 1892–1900.PubMedGoogle Scholar
- 24.Adler-Cohen M. Psychiatric care in an AIDS nursing home.Psychosomatics. 1998;39: 154–161.Google Scholar
- 25.Batki S. Drug abuse, psychiatric disorders, and AIDS. Dual and triple diagnosis.West J Med. 1990;152:547–552.PubMedGoogle Scholar
- 26.Lyketsos C, Federman E. Psychiatric disorders and HIV infection: impact on one another.Epidemiol Rev. 1995;17:152–164.PubMedGoogle Scholar
- 27.Swan J, Benjamin A. IV drug use dementia, and nursing home care for PWAs.J Health Soc Policy. 1998;4:79–91.Google Scholar
- 28.Uldall K, Koutsky L, Bradshaw D, Hopkins S, Katon W, Lafferty W. Psychiatric comorbidity and length of stay in hospitalized AIDS patients.Am J Psychiatry. 1994;151: 1475–1478.PubMedGoogle Scholar
- 29.Selwyn PA, Arnold R. From fate to tragedy: the changing meanings of life, death, and AIDS.Ann Intern Med. 1998;129:899–902.PubMedGoogle Scholar