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Long-term Care (long-term + care)
Terms modified by Long-term Care Selected AbstractsLONG-TERM CARE AND FAMILY BARGAINING*INTERNATIONAL ECONOMIC REVIEW, Issue 1 2002MAXIM ENGERS We present a structural model of how families decide who should care for elderly parents. We use data from the National Long-Term Care Survey to estimate and test the parameters of the model. Then we use the parameter estimates to simulate the effects of the existing long-term trends in terms of the common but untested explanations for them. Finally, we simulate the effects of alternative family bargaining rules on individual utility to measure the sensitivity of our results to the family decision-making assumptions we make. [source] Prevention of Hip Fractures in Long-Term Care: Relevance of Community-Derived DataJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010Richard G. Crilly MD Osteoporosis and falling are two major contributing factors to fractures in older persons; the relevant contribution of these may vary according to age, setting, and frailty. The purpose of this review was to examine the existing evidence on osteoporosis treatments to determine whether participants in clinical trials include or resemble the older and frailer adult population living in long-term care (LTC). The trials (N=50) used to support major Canadian guidelines for osteoporosis treatment were reviewed because these are used to recommend treatment for all older adults, and several more-recent studies were added. Trials conducted specifically with participants living in LTC were also reviewed (N=6). The majority of studies (96.0%) on osteoporosis treatments were conducted with community-dwelling participants, with many excluding participants resembling the LTC population. Mean ages ranged from 52 to 84, although for the majority of studies, the mean age was younger than 70. Similarly, 80.0% of studies conducted in LTC included only residents who were ambulatory, mobile, able to transfer independently, or not permanently bedridden. Mean ages in these studies ranged from 83 to 85. These findings suggest that frail older adults, particularly the oldest and frailest adults in LTC, are neglected in clinical trials of osteoporosis fracture prevention. There is little evidence to support the application of community-based guidelines to the LTC population, and studies directly involving this population are needed. The role of age, frailty, and the mechanics of falls in hip fracture are discussed. [source] Nursing Time Devoted to Medication Administration in Long-Term Care: Clinical, Safety, and Resource ImplicationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Mary S. Thomson PhD OBJECTIVES: To quantify the time required for nurses to complete the medication administration process in long-term care (LTC). DESIGN: Time-motion methods were used to time all steps in the medication administration process. SETTING: LTC units that differed according to case mix (physical support, behavioral care, dementia care, and continuing care) in a single facility in Ontario, Canada. PARTICIPANTS: Regular and temporary nurses who agreed to be observed. MEASUREMENTS: Seven predefined steps, interruptions, and total time required for the medication administration process were timed using a personal digital assistant. RESULTS: One hundred forty-one medication rounds were observed. Total time estimates were standardized to 20 beds to facilitate comparisons. For a single medication administration process, the average total time was 62.0±4.9 minutes per 20 residents on physical support units, 84.0±4.5 minutes per 20 residents on behavioral care units, and 70.0±4.9 minutes per 20 residents on dementia care units. Regular nurses took an average of 68.0±4.9 minutes per 20 residents to complete the medication administration process, and temporary nurses took an average of 90.0±5.4 minutes per 20 residents. On continuing care units, which are organized differently because of the greater severity of residents' needs, the medication administration process took 9.6±3.2 minutes per resident. Interruptions occurred in 79% of observations and accounted for 11.5% of the medication administration process. CONCLUSION: Time requirements for the medication administration process are substantial in LTC and are compounded when nurses are unfamiliar with residents. Interruptions are a major problem, potentially affecting the efficiency, quality, and safety of this process. [source] Interactive Video Specialty Consultations in Long-Term CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004Bonnie J. Wakefield PhD Objectives: To assess provider and resident satisfaction with and outcomes of specialist physician consultations provided via interactive video to residents of a long-term care (LTC) center. Design: Cross-sectional survey. Setting: Two Veterans Affairs Medical Centers (VAMC) and a state LTC center. Participants: Physicians (n=12) at the VAMC and nurses (n=30) and residents (n=62) at the LTC center. Intervention: Interactive video conferencing to provide physician specialty visits to residents at the LTC center. Measurements: Satisfaction ratings and record review to determine changes in treatment plan and follow-up care. Results: Data were collected on 76 individual consultations in six clinics. The most frequent outcome was a change in treatment plan with the resident remaining at the LTC setting (n=29, 38%) or no change in treatment (n=26, 34%). Physicians' ratings were 78% good to excellent for usefulness in developing a diagnosis, 87% good to excellent for usefulness in developing a treatment plan, 79% good to excellent for quality of transmission, and 86% good to excellent satisfaction with the consult format. Overall, 72% of residents were satisfied with the consult format, and 92% felt that it was easier to obtain medical care via telemedicine. Nurses felt that the telemedicine clinics were a good use of their time and skills (100%). Conclusion: There was a high rate of physician, patient, and nurse satisfaction with interactive video conferencing. Care delivered to residents of LTC settings via video conferencing offers a number of potential advantages, including avoidance of travel for patient and provider and potentially greater continuity of care. [source] Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2003American Association for Geriatric Psychiatry, American Geriatrics Society The American Geriatrics Society and American Association for Geriatric Psychiatry Expert Panel on Quality Mental Health Care in Nursing Homes developed this consensus statement. The following organizations were represented on the expert panel and have reviewed and endorsed, the consensus statement: Alzheimer's Association, American Association for Geriatric Psychiatry, American Association of Homes and Services for the Aging, American College of Health Care Administrators, American Geriatrics Society, American Health Care Association, American Medical Directors Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long-Term Care, National Citizen's Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners. The following organizations were also represented on the expert panel and reviewed and commented on the consensus statement: American Psychiatric Association: Council on Aging, American Psychological Association. [source] Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Rate of Gastrointestinal Hospitalizations Among People Living in Long-Term CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Kate L. Lapane PhD OBJECTIVES: Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota). PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992,1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs. MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531,534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios. RESULTS: NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17,5.99) and women (RR = 3.23; 95% CI = 1.85,5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27,16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49,14.58). CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population. [source] Effects of the Interaction Between Reaction Component of Personal Need for Structure and Role Perceptions on Employee Attitudes in Long-Term Care for Elderly People,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 12 2008Tarja Heponiemi This study examined the interaction of reaction component of personal need for structure (reaction to lack of structure, RLS) and role perceptions in predicting job satisfaction, job involvement, affective commitment, and occupational identity among employees working in long-term care for elderly people. High-RLS employees experienced more role conflict, had less job satisfaction, and experienced lower levels of occupational identity than did low-RLS employees. We found individual differences in how problems in roles affected employees' job attitudes. High-RLS employees experienced lower levels of job satisfaction, job involvement, and affective commitment, irrespective of role-conflict levels. Low-RLS employees experienced detrimental job attitudes only if role-conflict levels were high. Our results suggest that high-RLS people benefit less from low levels of experienced role conflicts. [source] Stress and Burnout of Nursing Staff Working With Geriatric Clients in Long-Term CareJOURNAL OF NURSING SCHOLARSHIP, Issue 4 2005Bernice Roberts Kennedy [source] Medicare and Medicaid: Conflicting Incentives for Long-Term CareTHE MILBANK QUARTERLY, Issue 4 2007DAVID C. GRABOWSKI The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives,capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government,may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades. [source] Improving the Quality of Long-Term Care with Better InformationTHE MILBANK QUARTERLY, Issue 3 2005VINCENT MOR Publicly reporting information stimulates providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the public reporting of comparative quality data. This article reviews the conceptual and technical challenges of applying information about the quality of long-term care providers and the evidence for the impact of information-based quality improvement. Quality "tools" have been used despite questions about the validity of the measures and their use in selecting providers or offering them bonus payments. Although the industry now realizes the importance of quality, research still is needed on how consumers use this information to select providers and monitor their performance and whether these efforts actually improve the outcomes of care. [source] Strengthening Research to Improve the Practice and Management of Long-Term CareTHE MILBANK QUARTERLY, Issue 2 2003PENNY HOLLANDER FELDMAN Chronic disease and disability affect Americans of all ages, and millions rely on long-term care (LTC) services,in nursing facilities, in congregate residences, or at home,to meet their health and personal assistance needs. People who are 65 years old today have about a 40 percent chance of spending some time in a nursing home before they die (Kemper and Murtaugh 1991; Murtaugh, Kemper, and Spillman 1990). Almost three-quarters will have had some experience with home care (Stone 2000). The numbers of people, both young and old, in need of long-term care are growing. Changing demographics, a more engaged public, and growing cost pressures are increasing the demand for empirical evidence of the effectiveness and cost effectiveness of alternative LTC approaches and practices. Making the formal LTC system more effective and more efficient requires that research play a more prominent role in informing service delivery. The research agenda should both respond to and push forward the field of practice, and the definitions of appropriate topics should come from both the practitioners and the researchers. [source] Depression in Long-Term Care: Contrasting a Disease Model with Attention to Environmental ImpactCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2005Antonette M. Zeiss The preceding review of depression in long-term care (LTC settings recognizes the prevalence of depression in LTC, addresses problems in assessment of depression, and examines empirical literature on the effectiveness of psychotherapy for depression. This commentary expands on the preceding review by focusing on a theoretical understanding of depression and how that understanding can inform treatment recommendations. The basic argument presented is that psychologists could best serve older adults in LTC settings by extending beyond traditional approaches to treatment of individuals who are depressed; psychologists can become good observers of the relationship of environmental factors in LTC to the internal emotional experience of depression, and then help to serve as change agents by collaborating in designing and implementing change in LTC environments. Such a radical shift could improve the quality of life for LTC residents. It also offers the possibility of defining theoretical linkages among external environmental variables, cognitive understanding of them, and emotional experience that could inform depression theory generally. [source] An Ethnomethodologic Analysis of Accounts of Feeding Elders in Long-term CareNURSING & HEALTH SCIENCES, Issue 2 2000Charon A. Pierson 28,29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University) [source] Homicide and schizophrenia: maybe treatment does have a preventive effectCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2001Martin Erb Background Persons with schizophrenia have been found to be at increased risk for homicide as compared with the general population. The increased risk may be associated with the implementation of the policy of deinstitutionalization. Method Persons with schizophrenia who had committed or attempted homicide in the German state of Hessen from 1992 to 1996 and in the Federal Republic of Germany from 1955 to 1964 were compared. Results Schizophrenia increased the risk of homicide 16.6 times (95% CI 11.2,24.5) in the recent cohort and 12.7 times (95% CI 11.2,14.3) in the older cohort. These odds ratios are not statistically different. The lack of appropriate services for chronic high-risk patients and the non-use of mental health services by first episode, acutely psychotic patients were associated with homicide. Conclusion There has been no increase in the risk of homicide among persons with schizophrenia since the implementation of the policy of deinstitutionalization. The examination of the recent period suggests that the provision of specialized long-term care to persons with schizophrenia who are at high risk for violent behaviour and the use of mental health services by acutely psychotic persons may reduce the risk of homicide. Copyright © 2001 Whurr Publishers Ltd. [source] Ageing and unused capacity in Europe: is there an early retirement trap?ECONOMIC POLICY, Issue 59 2009Viola Angelini Summary We address the issue of how early retirement may interact with limited use of financial markets in producing financial hardship later in life, when some risks (such as long-term care) are not insured. We argue that the presence of financially attractive early retirement schemes in a world of imperfect financial and insurance markets can lead to an ,early retirement trap'. Indeed, Europe witnesses many (early) retired individuals in financial distress. In our analysis we use data on 10 European countries, which differ in their pension and welfare systems, in prevailing retirement age and in households' access to financial markets. We find evidence that an early retirement trap exists, particularly in some Southern and Central European countries: people who retired early in life are more likely to be in financial hardship in the long run. Our analysis implies that governments should stop making early retirement attractive, let retirees go back to work, improve access to financial markets and make sure long-term care problems are adequately insured. , Viola Angelini, Agar Brugiavini and Guglielmo Weber [source] Amputation of the equine distal limb: indications, techniques and long-term careEQUINE VETERINARY EDUCATION, Issue 4 2005T. P. Vlahos First page of article [source] Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and deathGERODONTOLOGY, Issue 3 2005Ina Nitschke Objective:, The aim of the study was to reveal barriers to providing dental care for residents in long-term care (LTC) facilities. Design:, Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self-employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part-time in an LTC facility. In semi-structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. Results:, The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty-six per cent of the participants (63% of the men and 51% of the women; 52% of the self-employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC-facility. Thirty-two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p < 0.001). Dentists who work partly in LTC facilities were the least concerned about the confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). Conclusion:, It can be concluded that the awareness of infra-structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re-structuring the consultancy services to LTC facilities. Further it would be desirable to establish more postgraduate training programmes to increase clinical and ethical competence in the area of gerodontology. [source] Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessonsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2006Dennis L. Kodner PhD Abstract Irrespective of cross-national differences in long-term care, countries confront broadly similar challenges, including fragmented services, disjointed care, less-than-optimal quality, system inefficiencies and difficult-to-control costs. Integrated or whole-system strategies are becoming increasingly important to address these shortcomings through the seamless provision of health and social care. North America is an especially fertile proving ground for structurally oriented whole-system models. This article summarises the structure, features and outcomes of the Program of All-Inclusive Care for Elderly People (PACE) programme in the United States, and the Système de soins Intégrés pour Personnes Âgées (SIPA) and the Programme of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in Canada. The review finds a somewhat positive pattern of results in terms of service access, utilisation, costs, care provision, quality, health status and client/carer satisfaction. It concludes with the identification of common characteristics which are thought to be associated with the successful impact of these partnership initiatives, as well as a call for further research to understand the relationships, if any, between whole-system models, services and outcomes in integrated care for elderly people. [source] Care needs among the dependent population in Spain: an empirical approachHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2004J. Garcés PhD Abstract The objective of the present paper was to identify the profile and needs of social and healthcare users in Spain who required long-term care. To achieve this goal, an extensive empirical study was carried out in 2001 of a typical southern European region: the Valencia Autonomous Region in Spain. The method used was a questionnaire-based survey. The data collection instrument was a questionnaire comprising 119 questions grouped into seven sections: social and demographic data; clinical diagnosis and treatment; living environment; degree of dependence in activities of daily living (ADLs); cognitive state; social support; and the social, demographic and attendance data of the carer, if available. The sampling was carried out in two strata, i.e. social and healthcare: first, the authors randomly selected the centres and services as sampling points, and then they randomly selected the subjects. A total of 1265 people were interviewed. The results show different care profiles: users aged under 65 years were mostly mentally ill and/or drug users requiring short- and medium-term care from the health services, while those aged over 65 years had chronic illnesses for which they were actively receiving treatment, were functionally dependent for ADLs, and were normally receiving social care that basically provided company and resolved functional limitations. [source] Older patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] Providing care for an elderly parent: interactions among siblings?HEALTH ECONOMICS, Issue 9 2009Roméo Fontaine Abstract This article is focused on children providing and financing long-term care for their elderly parent. The aim of this work is to highlight the interactions that may take place among siblings when deciding whether or not to become a caregiver. We look at families with two children using data from the Survey of Health, Ageing and Retirement in Europe; our sample contains 314 dependent elderly and their 628 adult children. In order to identify the interactions between siblings, we have specified a two-person discrete game model. To estimate this model, without invoking the ,coherency' condition, we have added an endogenous selection rule to solve the incompleteness problem arising from multiplicity or absence of equilibrium. Our empirical results suggest that the three classical effects identified by Manski could potentially explain the observed correlation between the siblings' caregiving behaviour. Correlated effects alone appear to be weak. Contextual interactions and endogenous interactions reveal cross-effects. The asymmetric character of the endogenous interactions is our most striking result. The younger child's involvement appears to increase the net benefit of caregiving for the elder one, whereas the elder child's involvement decreases the net benefit of caregiving for the younger child. Copyright © 2009 John Wiley & Sons, Ltd. [source] Proximity to death and participation in the long-term care marketHEALTH ECONOMICS, Issue 8 2009France Weaver Abstract The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care , i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+from the 1993,2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care. Copyright © 2008 John Wiley & Sons, Ltd. [source] Monitoring political decision-making and its impact in AustriaHEALTH ECONOMICS, Issue S1 2005Adolf Stepan Abstract The range of services provided by the Austrian health care system has been greatly extended over the last few decades. The accompanying measures for long-term care bring the situation closer to the ideal concept of a ,seamless web' between primary, secondary and tertiary care. Due to the expansion in services it has become increasingly difficult to ensure the balance between the financing and degree of usage of the services. The reiterated political aim has been to achieve balanced financing via legally fixed social health insurance (SHI) contributions and taxation. A steadily expanding part is contributed by the private sector. In the 1980s, measures for SHI expenditure containment were implemented; in 1997 a new hospital financing system based on flat rates was introduced. In order to guarantee hospital financing, the historical financing shares of the SHI for the hospitals were introduced in the form of valorised global budgets. The contradictory incentives arising from the flat rates and global budgets lead hospitals to shift services to the primary and tertiary care sector, causing additional expenditure for SHI. Currently, attempts are being made to secure the financing by increasing the SHI contribution rates and patients' co-payments. Copyright © 2005 John Wiley & Sons, Ltd. [source] Measuring the productive efficiency and clinical quality of institutional long-term care for the elderlyHEALTH ECONOMICS, Issue 3 2005Juha Laine Abstract The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care. Copyright © 2004 John Wiley & Sons, Ltd. [source] Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?HEALTH SERVICES RESEARCH, Issue 1p2 2008Peter Kemper Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source] Expanding the Andersen Model: The Role of Psychosocial Factors in Long-Term Care UseHEALTH SERVICES RESEARCH, Issue 5 2002Elizabeth H Bradley Objective. To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care. Study Setting. Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000. Study Design. Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups. Data Collection. Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation. Principal Findings. Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination. Conclusions. More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups. [source] Effectiveness of topical skin care provided in aged care facilitiesINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2005Brent Hodgkinson MSc GradCertPH GradCertEcon(Health) Executive summary Background, The 2001 Australian census revealed that adults aged 65 years and over constituted 12.6% of the population, up from 12.1% in 1996. It is projected that this figure will rise to 21% or 5.1 million Australians by 2031. In 1998, 6% (134 000) of adults in Australia aged 65 years and over were residing in nursing homes or hostels and this number is also expected to rise. As skin ages, there is a decreased turnover and replacement of epidermal skin cells, a thinning subcutaneous fat layer and a reduced production of protective oils. These changes can affect the normal functions of the skin such as its role as a barrier to irritants and pathogens, temperature and water regulation. Generally, placement in a long-term care facility indicates an inability of the older person to perform all of the activities of daily living such as skin care. Therefore, skin care management protocols should be available to reduce the likelihood of skin irritation and breakdown and ultimately promote comfort of the older person. Objectives, The objective of this review was to determine the best available evidence for the effectiveness and safety of topical skin care regimens for older adults residing in long-term aged care facilities. The primary outcome was the incidence of adverse skin conditions with patient satisfaction considered as a secondary outcome. Search strategy, A literature search was performed using the following databases: PubMed (NLM) (1966,4/2003), Embase (1966,4/2003), CINAHL (1966,4/2003), Current Contents (1993,4/2003), Cochrane Library (1966,2/2003), Web of Science (1995,12/2002), Science Citation Index Expanded and ProceedingsFirst (1993,12/2002). Health Technology Assessment websites were also searched. No language restrictions were applied. Selection criteria, Systematic reviews of randomised controlled trials, randomised and non-randomised controlled trials evaluating any non-medical intervention or program that aimed to maintain or improve the integrity of skin in older adults were considered for inclusion. Participants were 65 years of age or over and residing in an aged care facility, hospital or long-term care in the community. Studies were excluded if they evaluated pressure-relieving techniques for the prevention of skin breakdown. Data collection and analysis, Two independent reviewers assessed study eligibility for inclusion. Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data. Results, The resulting evidence of the effectiveness of topical skin care interventions was variable and dependent upon the skin condition outcome being assessed. The strongest evidence for maintenance of skin condition in incontinent patients found that disposable bodyworn incontinence protection reduced the odds of deterioration of skin condition compared with non-disposable bodyworns. The best evidence for non-pressure relieving topical skin care interventions on pressure sore formation found the no-rinse cleanser Clinisan to be more effective than soap and water at maintaining healthy skin (no ulcers) in elderly incontinent patients in long-term care. The quality of studies examining the effectiveness of topical skin care interventions on the incidence of skin tears was very poor and inconclusive. Topical skin care for prevention of dermatitis found that Sudocrem could reduce the redness of skin compared with zinc cream if applied regularly after each pad change, but not the number of lesions. Topical skin care on dry skin found the Bag Bath/Travel Bath no-rinse skin care cleanser to be more effective at preventing overall skin dryness and most specifically flaking and scaling when compared with the traditional soap and water washing method in residents of a long-term care facility. Information on the safety of topical skin care interventions is lacking. Therefore, because of the lack of evidence, no recommendation on the safety on any intervention included in this review can be made. [source] Correlates of knowledge and beliefs about depression among long-term care staffINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2008Liat Ayalon Abstract Context Despite the high prevalence of depression in long-term care (LTC), it often is unrecognized and inadequately treated. Thus, the goals of the present study were to evaluate LTC staff characteristics that are associated with knowledge and beliefs about depression. Methods A cross sectional study of 371 LTC staff members completed a knowledge and beliefs about depression questionnaire, a short demographic questionnaire, a burden measure, and a questionnaire about attitudes associated with working with depressed residents. Results Relative to nurses, social workers, and activity staff, paraprofessional caregivers had a lower score on the depression measure and a higher score on the burden measure. Paraprofessional caregivers were more likely to view depression as a normal phenomenon, held less accurate beliefs about signs and symptoms of depression, and were less familiar with the effectiveness of specific treatments of depression. Conclusions Educational interventions about depression should be specifically geared to meet the needs of paraprofessional caregivers who provide the majority of care to LTC residents, yet possess less knowledge about depression and its treatments. Copyright © 2007 John Wiley & Sons, Ltd. [source] Guidelines on the insertion and management of central venous access devices in adultsINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 4 2007L. BISHOP Summary Central venous access devices are used in many branched of medicine where venous access is required for either long-term or a short-term care. These guidelines review the types of access devices available and make a number of major recommendations. Their respective advantages and disadvantages in various clinical settings are outlined. Patient care prior to, and immediately following insertion is discussed in the context of possible complications and how these are best avoided. There is a section addressing long-term care of in-dwelling devices. Techniques of insertion and removal are reviewed and management of the problems which are most likely to occur following insertion including infection, misplacement and thrombosis are discussed. Care of patients with coagulopathies is addressed and there is a section addressing catheter-related problems. [source] Improving geriatric mental health nursing care: Making a case for going beyond psychotropic medicationsINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2003Philippe Voyer ABSTRACT Providing high-quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high-quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high-quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well-being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first-line interventions used by health-care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long-term care setting who are experiencing mental health challenges is examined. Alternative non-pharmacological approaches that nurses can use to augment care are also briefly discussed. [source] | ||||||||||||||||||||||||||||||||||||||||