Adding long-term care to Medicare: The Social HMO Experience.

Advocates of health system reform are striving to assure that a valuable new benefit for home- and community-based long-term care is included. Yet in many legislative proposals, a long-term care benefit is kept separate from the rest of the benefit package. Experience from the social health maintenance organization (social HMO) demonstration shows that for the elderly at least, community long-term care can be integrated with acute care, at a manageable cost. Acute and chronic disease and disability are experienced concurrently. Moreover, disability is not confined to a small group of permanently disabled persons but affects many other persons for short periods. Integration of long-term and acute care in a managed care model serving a broad population may promote more effective acute care and more efficient and affordable long-term care.

Large increases in the need for long-term care (LTC) services are expected as baby boomers age. Little has been published about patient and caregiver preferences for information about LTC. However, our qualitative research findings suggest that potential consumers may find it difficult to obtain accurate and timely information about LTC programs and services. In-person, semistructured interviews were conducted with 47 subjects, including patients (n = 25) within 90 days of their referral to a LTC placement (including NH, assisted living, home care, and community) and their caregivers (n = 22). Interview questions addressed the events that seemed to trigger their need for a LTC referral, the resources they used to become more informed about LTC options and the issues they confronted with the LTC referral process. Qualitative analyses identified a number of patient and informal caregiver-reported barriers to making decisions about LTC services, including insufficient information about LTC programs and community resources, unclear funding requirements and inadequate funding, and difficulty knowing how to plan for LTC or make LTC decisions. A potential solution may be an online LTC Guide designed to provide accurate information about the range of LTC services, with an emphasis on home and community-based services. This Guide was developed to address the gap in comprehensive LTC information identified in the findings of this study.

Nursing Programs Could Sharpen LTC Focus

Use of hospital and long-term institutional care services in relation to proximity to death among older people in Finland

AN INVESTIGATION OF A NON-INVASIVE JUGULAR VENOUS PRESSURE POINT OF CARE DEVICE TO DIAGNOSE AND ASSESS HEART FAILURE IN LONG TERM AND PRIMARY CARE: A MIXED METHOD APPROACH

Depending on their place of residence, older persons have unequal access to long-term care (LTC) services. This article investigates how the county-level supply of inpatient and outpatient LTC services influences individual-level LTC choices of older persons. Administrative data on LTC service supply from the German Care Statistic are combined with representative survey data on the LTC choices of N = 1303 persons aged 80+ from the German Federal State North Rhine-Westphalia. Random utility models are applied to model the choice among three care arrangements: receiving inpatient care in an institutional setting (e.g., nursing home), receiving outpatient care in the community, and living in the community without receiving inpatient or outpatient care. The main findings are: Higher inpatient service supply increases the probability that older persons leave the community and enter institutional LTC. Higher outpatient service supply increases the probability that older persons choose to receive outpatient care in the community instead of entering institutional LTC. The results suggest that policy makers must consider the county-level LTC service supply when designing equitable LTC systems that meet the needs of older persons in a cost-effective way.

Purpose The purpose of the study was to examine the frequency and competency in care services by length of job experience and level of service difficulty among direct care-workers in long-term care facilities in Korea. Methods A cross-sectional survey study design was used and data for 383 care-workers were analyzed. The case workers were recruited from 29 nursing homes located in different areas of Korea. Results Mean age of care-workers was 53.42±7.14, (M±SD) scores for frequency and competency were 4.08±0.59 and 3.92±0.66, respectively. There was no significant difference in frequency of long term care services, but competency was significantly different by length of job experience (t=-3.27, p=.001). For level of service difficulty, frequency of long term care service was highly significant only for level 5 service difficulty (t=-2.70, p=.007), but competency case-workers with over 3 years of job experience was highly significant for level 3 (t=-3.00, p=.003), level 4 (t=-3.61, p<.001), and level 5 (t=-3.78, p<.001) service difficulty. Conclusion Findings indicate that competency of long term care service is significant by length of job experience and a high level of service difficulty, thus these factors should be considered in assigning roles for direct care-workers in long-term care facilities. 주요어: 요양보호사, 장기요양, ë ¸ì¸ìš”ì–‘ì‹œì„¤, ìˆ™ë ¨ë„, 난이도 Key Words: Health personnel, Long-term care, Nursing homes, Work performance

The Uncertain Future of Nursing Home Post-Acute Care.

Over the past decades, there has been an increasing attention to develop systems of ageing-related services in China to meet the swelling long-term care (LTC) needs along with a rapid aging population. However, it is challenging to design and evaluate integrated LTC service systems, especially of the resource distribution among various care service types, i.e. home-based care, hospital care and nursing house care. Furthermore, the divergent LTC needs and biased LTC service supply lead to unclear implications of any policy changes on distributional impacts. Therefore, by deploying an agent-based simulation approach, this paper aims to evaluate LTC service resource distribution, in terms of equity and effectiveness, among types of care provided in China. We first estimate LTC needs across different age groups and their preference on different types of LTC services. Subsequently, we evaluate service distribution plans by simulating individuals’ care-seeking behaviors towards corresponding service providers. Simulation results indicate the co-existence of a waste of LTC service resource and unmet needs of LTC service in certain districts. The results also suggest disparities in unsettled rate among different social groups. This work is expected to further facilitate policy-makers on LTC resource distributive plans.

[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Straipsnyje, remiantis gerovės kultūros prieiga ir viešųjų vertybių vadybos idėjomis, analizuojama ir įvertinama ilgalaikės senyvo amžiaus asmenų globos ir slaugos (IGS) problematika Lietuvoje. Pradžioje apžvelgiami Lietuvos mokslininkų darbai, susiję su socialine politika ir IGS, bei apibūdinama šios srities būklė šalyje. Visuomenės nuostatos ir paslaugų teikėjų požiūriai į atsakomybę už rūpinimąsi senyvo amžiaus asmenimis bei į socialinių paslaugų plėtros poreikį IGS srityje interpretuojami kaip kompleksinė reakcija į nepatenkinamą IGS situaciją. Straipsnis baigiamas rekomendacijomis stiprinti viešųjų vertybių vadybos propaguojamus demokratinius svarstymus ir kitus instrumentus, kuriais būtų geriau atliepiama į visų suinteresuotų šalių vertybines nuostatas ir lūkesčius ir būtų geriau derinami jų interesai IGS srityje.

Long-term health care in Greece is covered by a variety of health structures. In contrast to other northern European countries, it is incomplete and fragmented or even absent. The demand for long-term care has been addressed through informal caregiving, provided by family members supporting voluntarily or caregivers getting informal compensation. In recent years, efforts have been made to restructure long-term health care and to introduce services and structures that are conducive to this purpose. In our country there is no corresponding planning or any support for informal care. The provision of informal care has multiple benefits, mainly financial and organizational, for patients, health systems and the state. Compared to Greece, other European countries support informal care through various financial, insurance and social benefits for its providers, thus favoring and facilitating their work. Given that the need for long-term health care and, by extension, the need for informal care will increase continuously and exponentially over time, it is important to recognize and meet the needs of informal caregivers and to formalize this form of care provision. The development of a policy of formal recognition of informal care and the establishment of supportive measures, such as financial assistance, insurance, and education will ensure the sustainability of long-term health care and the health system in general.

Long-term care (LTC) in Belgium consists of a wide range of benefits in cash and in kind, organized at the federal, regional and municipal levels, and is related to health and social service provision.1 The bulk of LTC services are provided as part of the federal public compulsory health insurance system, which is financed by social security contributions and general taxes. The main actors in the management of the system are the federal parliament (issuing the main laws governing the system), the Ministries of Health and Social Affairs, the National Institute for Health and Disability Insurance (NIHDI) and the sickness funds, which serve as intermediaries between the administration, the providers and the patients. Since public health insurance covers practically the whole population, LTC coverage is also nearly universal. However, since LTC services provided through the health insurance system cover only nursing care (as well as paramedical and rehabilitation care) and part of personal care to dependent persons, a whole range of services is organized and provided at the regional and local level. Indeed, while there is no specific LTC legislation at the federal level, the regional governments have issued decrees that regulate a wide range of issues related to LTC services: certification of facilities such as nursing homes and day care centres, integration and coordination of services at the local level, quality monitoring systems and so on.

Commentaries on health services research

Due to the trends of the increase in life expectancies and decrement in fertility rates, the world population is moving towards becoming an ageing nation. With the rise in the number of older people, the demand for long-term care services is expected to increase. Long-term care services are ubiquitous in the developed country, especially in the European region as the countries have become the aged nations. Apart from that, the cost for long-term care services differs for individuals based on the level of needs and the service provider, either public or private nursing home for long-term care. Due to the growing cost of long-term care services, a long-term care insurance policy may be seen as an alternative to covering the cost of long-term care services because the risk is mitigated for individuals. However, most Asian countries are not familiar with the long-term care insurance policy as there is no specific insurance policy for long-term care services offered yet in these countries. The essential factor in constructing a long-term care insurance policy is to identify the risks that are insurable to be included in the policy to be used later for pricing long-term care insurance policy in Malaysia. This study provides an in-depth review and understanding of the insurable risks associated with long term care insurance in European and Asian countries.

Introduction: It is forecasted that in the near future, the United States will not have enough long-term care (LTC) nurses qualified or interested in the LTC arena to sustain the healthcare delivery system. The overall effectiveness of any health care delivery system hinges on a sustainable nursing workforce, which is the largest health professional group. Globally, a significant segment of the nursing workforce is nearing retirement age. Methods: Using pre- and post-intervention recruitment strategy surveys detailing the Realistic job preview (RJP), the Best-Foot-Forward, and a control brochure, this study investigated senior nursing students’ image and perception of long-term care nursing compared to their image and perception of other areas in nursing. The effects of prior experience with or exposure to LTC on students’ intention to apply for a position in LTC were examined in 221 senior year students earning the Bachelor of Science in nursing degree from three California universities. Results: The first hypothesis stated that pre-intervention students’ intent to apply for a position in LTC upon graduation would be significantly and positively associated with their pre-intervention image of LTC. A Pearson correlation coefficient between pre-intervention intent to apply and pre-intervention image was statistically significant, r = -.368, n = 221, p &lt; .001, supporting the first hypothesis. Hypothesis 2: Post-intervention RJP students would have a significantly more positive perception of LTC nursing than BFF or control-group students. There would be no significant difference in the RJP, BFF and control group students’ pre-intervention image of LTC nursing. Hypothesis 2 was not significant. Hypothesis 3: Post-intervention RJP students would have a significantly stronger intent to apply for jobs in LTC nursing than BFF or control-group students. There would be no significant difference in RJP, BFF, and control group students’ pre-intervention intent to apply for a position in LTC nursing. Hypothesis 3 was not significant. Hypothesis 4: Senior nursing students’ pre-intervention intent to apply for a position in LTC upon graduation would be significantly and positively associated with prior experience in or exposure to LTC. Hypothesis 4 was not significant. Conclusions: To enhance LTC nursing image and to improve students’ perceptions of this line of nursing may be accomplished, in part, through program curriculum, including internships in LTC, offering multiple dedicated courses in LTC, and increasing the emphasis on LTC during nursing programs. Realistic job preview technique shows significant positive result over the Best-Foot-Forward technique. Keywords: Recruitment methods, realistic job preview, long-term care, nursing, LTC experience