Change In Level Of Care Research Articles

Two-year Follow-up on the Utilization of Home Care Services and the Changes in Levels of Care needs of the Frail Person (2002-2004)

Two-year Follow-up on the Utilization of Home Care Services and the Changes in Levels of Care needs of the Frail Person (2002-2004)

Living arrangements and level of care among clients discharged from a scattered-site housing-based independent living program

There is little recent research in the field of adolescent independent living that looks at the specific living arrangements of youth, who at the point of discharge from the child welfare system, had experienced living independently and had access to a choice of housing options. Administrative data and reviews of client records were used in this study to look at the choice of housing option and the change in level of care of 367 young adults who emancipated from the Lighthouse Youth Services Independent Living Program in Cincinnati, Ohio, during the five-year period 2001–2006. Given a range of housing options at the time of discharge, over half (55%) chose an independent living arrangement, including 41% who lived in their own place, either alone (28%) or with a roommate (13%). Only 21% decided to live in someone else's home, including just 7% with one or both birth parents, 10% with some other relative, and 4% with a non-relative. The remaining 24% of youth were discharged from independent living to a more restrictive living arrangement (a.k.a., higher “level of care”, including a residential treatment program, group home, foster care, or supervised independent living program) (11%) or whose whereabouts were unknown (13%). The outcomes of this study suggest that, when presented with a choice of housing options, most of this county's emancipating foster youth would prefer to live on their own, rather than to return to live with their families of origin. The study also suggests that many youth who participate in a scattered-site housing-based independent living program can succeed in leaving care with affordable housing in place and avoid immediate homelessness.

PAUSE for Assessment: A Multi-Level Long-Term Care Assessment Tool

The author of this article noes that as health care improves, paradoxically, long-term care residents become "older and sicker." In response, many facilities now offer a wide range of levels of residential care, from independent living to Hospice care--and all under the same roof. Chaplains in such facilities can play a key part in identifying changes in individual residents' needs over time. Toward this end, the author introduces PAUSE--a one-page questionnaire designed to be completed by the chaplain after a visit with a resident. The items reflect the chaplain's impressions of several key aspects of the resident's well-being from a single interaction. The questionnaire serves several purposes: it documents the fact of a visit; it allows comparison of impressions at different times and by different visitors; and it quickly highlights "red flag" areas of possible concern for interdisciplinary referral, pastoral follow-up, or possible change in level of care. It might also function as a teaching tool for student chaplains.

A new system for defining endoscopic complications emphasizing the measure of importance

Background: Currently, there are no satisfactory systems for defining, classifying, and/or scoring endoscopic complications, although it would be important for quality assurance, comparative studies, and outcomes research. Recently the term “negative outcomes” was proposed rather than “complications,” and an approach that incorporates “measures of importance” was added to compare negative outcomes. Methods: A system was developed that defines, classifies, and grades negative outcomes with a scoring system based on measures of importance. Information was recorded on a Morbidity and Mortality (M & M) form, which was used at a monthly quality assurance (M & M) conference. Several measures of importance related to the immediate negative outcome (O) were quantified (effect of the complication on completion of the endoscopy, change in level of care, change in number of hospital days, necessity for new invasive procedures). The disability (D), defined as a residual or chronic negative outcome caused by the complication, was characterized and scored. Death (D) was also characterized, the value varying with circumstances. As a quantitative measure, an overall ODD score was used. Results: One hundred twenty-three negative outcomes were retrospectively classified using the new M & M form and the ODD score was applied for 117 complications. Complications were ranked according to the ODD score. Conclusion: A system for defining, classifying, and grading negative outcomes of endoscopic procedures is proposed with a quantitative scoring system that emphasizes measures of importance. The ODD score looks at the immediate negative outcome and also the separate long-term issues of disability and death. (Gastrointest Endosc 1997;45:128-33.)

Avalanche or Glacier?: Health Care and the Demographic Rhetoric

ABSTRACTClaims that the health care system is about to be engulfed in a “wave of grey” have become commonplace. Recent cost escalation is commonly attributed to the aging of the population, and there is no shortage of dire warnings about the cost implications of the even more dramatic aging, and costs, still to come. These claims have been largely unsubstantiated. Yet they persist for a number of reasons. First, over long periods of time, the effects of demographic trends can be (and probably will be) quite substantial. But these effects move like glaciers, not avalanches. Second, the effects of aging populations on some types of services which cater differentially to seniors will be much more dramatic; observers of those sub-sectors (such as long-term care) tend to extrapolate that sector-specific experience to health care generally. Third, at the “coal-face,” health care providers are seeing their practices become ever more dominated by seniors. They mistake this increased “presence” of patients aged 65 and over in their practices as evidence of the effects of demographic changes. In this paper we discuss each of these sources of error about the effects of aging population on health care costs. We focus primarily on the confusion between changes in patterns of care for particular age groups, and changes in overall levels of care. Quite extensive empirical evidence has been collected over the past decade from analyses of British Columbia data bases, and these findings are not unique, in Canada, or beyond. The common finding of this body of research is that population aging has accounted for very little of the increase in health care costs over the past three decades, in Canada or elsewhere. Health care utilization has increased dramatically among seniors. But this has had less to do with the fact that there are more of them, than with the fact that the health care system is doing much more to (and for) them than was the case even a decade ago. This suggests that the appropriate care of elderly people should be a central issue for health care policy and management, but that demographic issues are, in the short run at least, largely a red herring.

Self-reported functional status predicts change in level of care in independent living residents of a continuing care retirement community.

To test the hypothesis that self-reported functional status predicts change in level of care from independent to dependent in residents of a continuing care retirement community (CCRC). Two-year longitudinal descriptive study of change in level of care and survival. One hundred fifty-two residents in the independent-living unit of a non-profit CCRC. Mean age at initial evaluation was 82.3 years, SD 6.2. Predictor variables assessed at baseline were age, sex, physician estimate of functionally significant disease, self-reported functional status, and performance-based hand function. Criterion variables collected at 2-year follow-up were level of care (independent/dependent) and survival (alive/dead). Self-reported functional status (P less than 0.01) and age (P less than 0.05) were significant predictors of change in level of care in a logistic regression analysis containing all predictor variables. No variable predicted survival. Self-reported functional status may help to predict dependency in older adults in good health who have few markers of dependency risk.