Showing papers in "Home Health Care Services Quarterly in 1986"
TL;DR: Findings indicate that a home care program based solely on professionally assessed need admits only a small minority of elderly and that, next to age, difficulty in coping with the instrumental activities of daily living is one of the best predictors of subsequent home care use.
Abstract: Data from the Manitoba Longitudinal Study on Aging is used to describe the 1975-78 home care utilization of a large probability sample of elderly interviewed in 1971. The predictors of home care use of these interviewees are identified by multiple logistic regression analysis. Findings indicate that a home care program based solely on professionally assessed need admits only a small minority of elderly and that, next to age, difficulty in coping with the instrumental activities of daily living is one of the best predictors of subsequent home care use. Differences between the determinants of home care and long-term institutional care are noted and the policy implications of the findings are discussed.
26Â citations
TL;DR: A study of staff at 3 Older Americans Act-funded home care programs provides strong evidence that even the most concrete of home-delivered services are powerfully colored by client expectations for non-instrumental (i.e., affectivelemotional) forms of aid.
Abstract: A study of staff (N = 91) at 3 Older Americans Act-funded home care programs provides strong evidence that even the most concrete of home-delivered services are powerfully colored by client expectations for non-instrumental (i.e., affectivelemotional) forms of aid. Furthermore, regardless of the nature of the service package which has been laid out for the worker to perform, emotional demands and counseling requests were dominant delivery problems. Results are seen to have important implications for designing more effective models in gerontological home care.
17Â citations
TL;DR: States vary considerably with respect to relative utilization, visits, and visit-expenditures under Medicare; and states vary in terms the role visits versus visit-reimbursements play in shaping overall costs.
Abstract: Expenditures for home health services provided under Medicare and Medicaid nearly tripled between 1977 and 1982. Utilization and expenditures for home health services vary widely across the states for both programs, and this article examines in some detail the nature and extent of these variations. States vary considerably with respect to relative utilization, visits, and visit expenditures under Medicare; and states vary in terms the role visits versus visit-reimbursements play in shaping overall costs. The Medicaid program is effectively two programs: New York; and the other states, with eight accounting for half of Medicaid expenditures outside New York.
16Â citations
TL;DR: The Multipurpose Senior Services Project implemented a case management model of service coordination for aged Medicaid recipients at eight sites throughout California showing that MSSP increased longevity, decreased nursing home days, and decreased hospital days (in 1982); these results were most efficient for the frailest clients.
Abstract: The Multipurpose Senior Services Project implemented a case management model of service coordination for aged Medicaid recipients at eight sites throughout California. The answers to the evaluation questions-"What works?", "For whom?", and "At what cost?" provide policy direction for longterm care programs. The research and demonstration Project ended in June 1983 and an on-going Program began in July 1983. Dynamic modeling of the outcomes of MSSP and of a comparison group served by the existing service system showed that MSSP increased longevity, decreased nursing home days, and decreased hospital days (in 1982); these results were most efficient for the frailest clients. This group had the greatest savings in public service dollars, with the Federal government the beneficiary through lower than expected Medicare expenditures. In-home supportive services proved to be the most productive non-medical service in both systems, but was more productive through MSSP. The evaluation methodology provides a multiv...
12Â citations
TL;DR: Home health agencies are beginning to change their tax status to for-profit and to try to attract private insurance clients which may potentially alter the home health market in favor of younger clients.
Abstract: Home health agencies are examined in terms of changes their organizations have experienced as a result of federal health care cost-containment policies. Contrasts are made between data collected from a sample of home health agencies in 1983 and 1984. Some attention is also given to differences in home health agency experiences by state. Home health agencies are beginning to change their tax status to for-profit and to try to attract private insurance clients which may potentially alter the home health market in favor of younger clients. The agencies experienced many more denial of claims by the Medicare fiscal intermediaries in 1984 than in 1983.
10Â citations
TL;DR: It is suggested that the program may be a practical model for local, community social service and health agencies seeking a way to increase continuity of care, improved quality, and reduce costs without difficult organizational and system changes.
Abstract: This article describes a program designed by a case management organization and home health agency to improve the delivery of home care to the elderly. The results of a modified experimental-control study indicate that the cost of the services to the experimental group, who received comprehensive assessments, consolidated case management and joint monitoring, was less than the control group with an accompanying improvement in the quality of care. It is suggested that the program may be a practical model for local, community social service and health agencies seeking a way to increase continuity of care, improved quality, and reduce costs without difficult organizational and system changes.
8Â citations
TL;DR: The conceptual framework for this quality assurance program and the outcome criteria which have been identified are presented are presented.
Abstract: Following the introduction of a provincially funded Coordinated Home Care Program in Alberta in 1978, a Home Care Standards Committee was established to develop a comprehensive program for evaluating the quality of support service and home health care. The conceptual framework for this quality assurance program and the outcome criteria which have been identified are presented.
6Â citations
6Â citations
TL;DR: The results indicate that a gap exists between the demand for services by the elderly and the evaluation of needs by experts and it is recommended that home health care programs must develop support mechanisms that integrate formal and informal networks into a holistic model of health care.
Abstract: Increasing attention has been given to the identification and description of variables associated with health and social services needed, sought and used by the elderly. Little is known, however, about the home health care needs of the elderly. Moreover, since the inception of the diagnostic related group concept, no one has determined the elderly's perception of Home Health Care. The purpose of this study is to identify and describe the factors which determine the use of home health care services among the Lucas County, Ohio elderly. Particular attention will be given to the role of need, knowledge, and risk factors in the use of home care. The methods of analysis are that of descriptive analysis, population demand projections, and professional needs estimates. The results indicate that a gap exists between the demand for services by the elderly and the evaluation of needs by experts. It is recommended that Home Health Care programs must develop support mechanisms that integrate formal and informal netwo...
5Â citations
TL;DR: In this paper, the characteristics of items designed to identify Physical Abuse and Physical Neglect, two types of abusive behavior included in the measures analyzed, were analyzed and recommendations are made for improving methods for identifying elderly victims of physical abuse and neglect, including the need to develop measures of sexual abuse; to specify techniques for distinguishing abuse/neglect from symptoms of normal aging; and to clarify abuse andneglect symptoms more specifically.
Abstract: As part of a project to develop and test a comprehensive measure for identifying victims of elder abuse, this study examined seven elder abuse identification indices developed by different agencies and researchers. Each index was separated into its constituent items. The items were examined to determine the type of abuse which they represented. This paper analyzes the characteristics of items designed to identify Physical Abuse and Physical Neglect, two types of abusive behavior included in the measures analyzed. Recommendations are made for improving methods for identifying elderly victims of Physical Abuse and Neglect, including the need to develop measures of sexual abuse; to specify techniques for distinguishing abuse/neglect from symptoms of normal aging; to clarify abuse/neglect symptoms more specifically; and to summarize case history data.
5Â citations
TL;DR: These two groups of patients show differences demographically, in length of stay, and in use of some services, thus implying that type of admission i.e., first or subsequent, should be used routinely as a descriptive or explanatory variable in any analysis.
Abstract: Most previous papers on home care client populations, by not distinguishing between first and subsequent admissions, may create the impression that the characteristics of these two groups of patients are similar. When analysing these two groups from this data set separately, however, they show differences demographically, in length of stay, and in use of some services. Although, in many instances, these differences are not large, they are statistically significant, thus implying that type of admission i.e., first or subsequent, should be used routinely as a descriptive or explanatory variable in any analysis.
TL;DR: Examination of New Jersey home health data and case examples illustrate the increased demand, conflict with federal policy (as experienced in claim denials and loss of waiver of liability), and effect on patients and their families.
Abstract: Federal and state efforts to control hospital costs have increased the demand for home health services, especially services for the more acutely ill patient. At the same time, recent regulatory policies on Medicare eligibility and reimbursement are limiting the ability of home health agencies to respond. Examination of New Jersey home health data and case examples illustrate the increased demand, conflict with federal policy (as experienced in claim denials and loss of waiver of liability), and effect on patients and their families.
TL;DR: Results indicate that trained RNs can rate the severity of communication dysfunction in this home-bound population in much the same way as a SLP.
Abstract: Five Registered Nurses (RNs) and a Speech-Language Pathologist (SLP) independently rated the communication difficulty of home-bound older adults. The assessment instrument was divided into three major communication areas; within each area severity was rated along a 5-point equidistant scale. Results indicate that trained RNs can rate the severity of communication dysfunction in this home-bound population in much the same way as a SLP. In addition, the vast majority of older persons in the sample (N = 25) were rated by both the SLP and the RNs as evidencing some degree of communication difficulty. Such rcsults have implications for inservice training programs and for extending thc identification-and referral network for speech, language, and hearing disorders.
TL;DR: This study of a sample of patients discharged from the Visiting Nurse Association of Greater St. Louis focused on the extent to which VNA services were used as an alternative to institutional care, saving more than $3,300 per patient.
Abstract: This study of a sample of patients discharged from the Visiting Nurse Association of Greater St. Louis (VNA) focused on the extent to which VNA services were used as an alternative to institutional care. Based on physician estimates, patients averaged 18 fewer days in the hospital due to home care, saving more than $3,300 per patient. Utilization patterns are discussed for patients grouped by age, diagnosis, payment source and disposition upon discharge. Variations observed suggest valuable avenues for additional investigation into the types of patients for whom home care is most likely to be an appropriate alternative to hospital care.
TL;DR: The financial incentives of Medicare's Prospective Payment System are encouraging hospitals to discharge patients sooner and at a lower functional status, and the possible impact of the subacute patient on the community system of care is analyzed.
Abstract: The financial incentives of Medicare's Prospective Payment System are encouraging hospitals to discharge patients sooner and at a lower functional status. This discussion analyzes the possible impact of the subacute patient on the community system of care. Three broad areas of potential impact are examined: the systemic changes in the community system of care stimulated by vertical integration and the influx of proprietaries into community service delivery; structural changes which may be experienced by community service agencies in meeting the demands of increased volume and increased acuity; the impact on the family and the informal system of care delivery as it responds to the increased demands of caring for the subacute patient.
TL;DR: This article investigates Adult Day Care in the state of New Jersey from its inception to the present and includes the findings of a survey of thirty-four Adult Day Centers.
Abstract: This article provides historical and statistical information on the development of this service option in the State of New Jersey. It investigates Adult Day Care in the state from its inception to the prescnt and includes the findings of a survey of thirty-four Adult Day Centers. Future planners, policymakers, funding sources and providers of service will garner much useful information for their projects.
TL;DR: The use of a little known provision of the Rural Health Clinics Act, P. L. 95-210, as a vehicle for creating an economically viable home health program in an isolated mountain community of Northern California is discussed.
Abstract: Developing financially sound home health agencies in isolated rural communities is a continuing problem. This article discusses the use of a little known provision of the Rural Health Clinics Act, P. L. 95-210, as a vehicle for creating an economically viable home health program in an isolated mountain community of Northern California.