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Home Facilities (home + facility)
Kinds of Home Facilities Selected AbstractsAre Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3-year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full-time equivalents (FTEs) (range 0,50), compared with a mean of 2.2 FTE faculty in 2002 (P,.001). Internal medicine educators are continuing to improve the training of residents so that, as they become practicing physicians, they will have the knowledge and skills in geriatric medicine to care for older adults. [source] A Cost-Benefit Analysis of External Hip Protectors in the Nursing Home SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Lisa A. Honkanen MD Objectives: To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. Design: A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data. Setting: Nursing home facilities in the United States. Participants: Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture. Intervention: Program of hip protectors reimbursed by Medicare. Measurements: Number of fractures, life years, and dollars saved. Results: Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of $223 per resident. When the annual cost of hip protectors is less than $151 per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save $136 million in the first year of a hip-protector reimbursement program. Conclusion: From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects. [source] Potentially Inappropriate Prescribing in Ontario Community-Dwelling Older Adults and Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004Christopher J. Lane BASc Objectives: To compare patterns of potentially inappropriate drug therapy prescribing in community-dwelling older adults and nursing home residents in Ontario, Canada. Design: A retrospective cohort study using administrative databases. Setting: Ontario community and nursing home facilities. Participants: All 1,275,619 older adults aged 66 and older in Ontario (1,216,900 community-dwelling and 58,719 nursing home residents) who were dispensed at least one prescription from the comprehensive provincial drug plan in 2001. In Ontario, the provision of clinical pharmacy services is mandated in the nursing home setting. No comparable program exists for older adults in the community setting. Measurements: Potentially inappropriate drug prescribing was compared between community-dwelling and nursing home residents in two categories: those to always avoid and therapies considered rarely appropriate to prescribe. Results: Of the 1,275,619 adults in the cohort, nursing home residents were older (mean age±standard deviation=84.2±7.6 vs 75.0±6.5, P<.001), included more women (73.3% vs 57.7%, P<.001), had higher comorbidity scores (measured by the number of distinct drug therapies dispensed in the prior year (10.7±6.8 vs 7.2±5.7, P<.001) and Charlson comorbidity scores (1.4±1.6 vs 0.9±1.5, P<.001)) than community-dwelling individuals. Community-dwelling older adults were significantly more likely to be dispensed at least one drug therapy in the always avoid or rarely appropriate category than nursing home residents (3.3% vs 2.3%, P<.001). Using a logistic regression model that controlled for age, sex, and comorbidity (number of distinct drug therapies dispensed in the prior year), nursing home residents were close to half as likely to be dispensed one of these potentially inappropriate drug therapies as community-dwelling older adults (odds ratio=0.52, 95% confidence interval=0.49,0.55, P<.001). Conclusion: Potentially inappropriate drug therapy in the always avoid and rarely indicated categories is dispensed less often to nursing home residents than to older community-dwelling adults. Clinical pharmacist services, which are mandated in the nursing home setting, may be responsible for these differences in Ontario, Canada. [source] Barriers and Enablers to the Use of Measures to Prevent Pediatric Scalding in Cape Town, South AfricaPUBLIC HEALTH NURSING, Issue 3 2010Ashley Van Niekerk ABSTRACT Objective: Little attention has been paid to the prevention of pediatric scalding injuries in low-income settings, especially from the standpoint of local stakeholders. This study investigates stakeholder understandings of potential measures to prevent childhood scalding and the related hinders and enablers to such measures. Design and Sample: The study utilized an exploratory qualitative design. Content analysis was applied to the transcriptions of interviews with 13 caregivers and 8 burn prevention research, policy, and practitioner professionals. Measures: The study used semistructured interviews using illustrations to generate data. The 21 individual interviews were audio-recorded, transcribed verbatim, and analyzed using content analytic steps. Interviews focused on 2 illustrations that depict circumstances that surround the occurrence of pediatric scalding typical for Cape Town. Results: 3 categories of prevention measures were identified: enhancements to the safety of the home environment, changes to practice, and improvements to individual competence. The barriers identified were spatial constraints in homes, hazardous home facilities, and multiple family demands. Conclusions: Caregivers and professionals report a similar range of measures to prevent pediatric scalding. Many of these might not be readily implementable in low-income settings with key barriers that would need to be addressed by policymakers and prevention practitioners. [source] Cost Analyses of Home Care and Nursing Home Services in the Southern Taiwan AreaPUBLIC HEALTH NURSING, Issue 5 2000Lian Chiu Sc.D. This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence. [source] Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patientsACTA NEUROLOGICA SCANDINAVICA, Issue 5 2006S. K. Saxena Background,,, Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. Aim,,, The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Methodology,,, Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. Results,,, The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index , 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01,12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32,14.98). Conclusion,,, Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed. [source] | ||||||||||