Home Providers Research Articles

EU Law as Private International Law? Re-Conceptualising the Country-of-Origin Principle as Vested Rights Theory

One of the most pertinent issues in contemporary European conflict of laws is the tension between Community law and traditional choice of law rules. The biggest problem comes not from the transposition of member state rules on choice of law into methodologically comparable EC Regulations, but rather from the so-called country-of-origin principle. This principle holds, broadly, that EU member states may not impose obligations on a provider of goods and services that go beyond the obligations imposed by the provider's home state. Originally conceived mainly with public law obligations in mind, the principle has an impact on choice of law insofar as it bars member states from applying their own law to the provider's conduct, even if they have the closest connections to this conduct. The exact relationship between the so called country of origin principle, and private international law, has long puzzled scholars and courts. Yet attempts at explanation and reconciliation have so far been unsuccessful because they started from an inappropriately narrow understanding of private international law. Integrating comparative legal history, this paper proposes a broader understanding of private international law beyond the current post-Savignyan approach. Thus broader approach makes it possible to recognize how the country of origin principle is remarkably similar to an almost forgotten and universally rejected private international law approach - the vested rights theory. The article demonstrates the parallels between the country of origin principle and US, English, French and German historical versions theories of vested rights. This insight presents an interesting challenge. The vested rights theory is now universally rejected because the criticism brought forward against it was and is felt to be irrefutable. One might think the same criticism would be able to bring the country of origin principle down, too. Indeed, the article shows how current criticism of the country of origin principle replicates to a large degree earlier criticism made against the vested rights theory. Remarkably, however, it shows also that the country of origin principle can refute the criticism. The return of vested rights, and its regained ability to overcome seemingly irrefutable criticism, hold a broader lesson. The rise and fall (and rebirth) of private international law approaches depends less on abstract considerations and more on general ideas and ideologies of the times - in this case, economic liberalism.

Assessing Unmet Needs of Older Adults Receiving Home and Community-Based Services

Abstract The purpose of this study is to review the conceptualization and measurement issues related to unmet service needs of older adults receiving home and community-based services. We summarize and synthesize the recent literature on unmet service needs to examine (1) how this concept is conceptualized and measured and (2) how this concept could be used to advance the provision of home and community-based services. The findings suggest that measures of unmet needs varied in terms of their focus (e.g., function-specific or service-specific) and sources of information (e.g., care receivers, caregivers, or professions). The findings underscore the need to further refine the conceptualization and measurement of unmet service needs and to assure the proper use of existing measures by social service providers.

Delivery of High-Tech Home Care by Hospital-Based Nursing Units in Quebec: Clinical and Technical Challenges

The role that hospital-based nurses should play in the delivery of high-tech home care, and how they should be supported in that role, are topics that remain understudied. Our research objective was to document how hospital-based nursing teams perceive and deal with the clinical and technical challenges associated with the provision of high-tech home care. Four home care interventions were selected: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. A self-administered survey was sent to all hospital-based units providing these interventions in the province of Quebec, Canada (n = 154; response rate: 70.8%). We used descriptive statistical analyses to derive mean values for scores on either a five- or a six-level Likert scale. Despite variation across the four interventions, our results indicate that while nursing teams believe these interventions increase patients' autonomy, they also recognize that they generate anxiety and impose constraints on patients' lives. Nurses must increase efforts to deal with both clinical and technical challenges and help patients overcome the barriers to appropriate use of home care technologies. While nursing teams generally perceive high-tech home care as beneficial, they still experience significant technical and clinical challenges. Some of these challenges could be addressed by strengthening professional training initiatives, while others require broader home care policy interventions.

Part of the Problem or Part of the Solution? The Role of Care Homes in Tackling Delayed Hospital Discharges

As part of current UK policies to reduce the number of delayed hospital discharges, a number of commentators have identified an alleged crisis in the care home market as one of key contributing factors. With local authorities under pressure to cut costs, it is argued, the number of care homes is reducing, and delays in hospital can often result. Behind this diagnosis is a series of assumptions about the role and nature of care home provision, the appropriateness of this form of service for many older people, and the need for more care homes to reduce the number of hospital delays. In order to explore and critique these assumptions, this paper reviews the role of care homes in tackling delayed discharges, and argues the need for fewer and different care home placements rather than more of this type of provision.

Home and Community Occupational Therapy for Children and Youth: A before and after Study

There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.

Excluding exceptions: Housing non-affordability and the oppression of environmental sustainability?

This paper explores the provision of homes for less wealthy households in rural England. By allowing ‘exceptions’ to UK planning law to provide low-income housing for local residents, the national government seeks to secure dwellings for the less wealthy and so sustain socially mixed rural villages. This paper explores how the production of homes through the exception policy is not conducive to the construction of many new houses. The particular emphasis in the paper is on how responsible agents are discouraged from being more active in erecting new village homes for low-income households. Empirically, the paper draws on documents, interviews and a social survey in the counties of Bedfordshire, Cambridgeshire and Norfolk to investigate the process of delivering rural exception homes. It is concluded that, despite Government assertions that a socially mixed countryside is desirable, the decision-making criteria that dominate the worldviews of agents in social housing provision work against this outcome.

State Commitment to Home and Community-Based Services

This study examines the impact of state variation in commitment to the provision of home and community-based services on the living arrangement outcomes of older unmarried females with functional limitations. We combine data from the 1990 U.S. Census of Population (PUMS) with state-level information on long-term care home and community-based service expenditures, nursing home bed availability, and Medicaid nursing home costs from a special report that compares state variation in long-term care systems. Using multilevel logistic regression modeling techniques, we find that the risk of institutionalization compared to community living arrangements is reduced as spending for home and community-based services at the state level increases. We discuss these findings in light of policy changes during the 1990s.

A Fallacy of Dominant Price Vectors in Network Industries

In German mobile phone contracts, calls in the provider's home net are usually less expensive than external calls (to the network of a competitor). Thus customers have to compare vectors of prices, and such a comparison can be the source of a fallacy in the presence of network externalities. Even if a provider with a lower market share requires lower prices for calls in the home as well as to other networks, his average price may be higher than that of a larger provider. Not being aware of this fact is called "a fallacy of dominant price vectors". Based on a questionnaire study this fallacy turns out to be a real phenomenon.

Barriers to the provision of home and community care services to culturally and linguistically diverse populations in rural Australia

In 2002, qualitative methods in the form of in-depth interviews and focus groups were used to gather data from culturally and linguistically diverse (CALD) population residents, service providers and key stakeholders across rural Victoria, to identify and describe barriers to the effective delivery of home services to people from CALD populations in rural Australia. Barriers to the provision of Home and Community Care (HACC) services to CALD populations in rural areas were not specific to HACC programs. For CALD residents, barriers included lack of information about the range of available services, cultural factors, and negative past and recent experiences in dealing with both the broader community and service providers. Service providers indicated lack of information about the profile of the local CALD population and lack of experience in working with these groups to be barriers. Communication was also an issue both for CALD residents and service providers, in terms of cultural factors and specific communication strategies such as inadequate printed material and under-utilisation of existing resources such as interpreter services. As one of the world?s most ethno-culturally diverse nations, Australia has a responsibility to provide health services that are culturally responsive and acceptable. Greater attention needs to be given to the needs of rural CALD population groups in accessing home services.

Consumer-directed services: lessons and implications for integrated systems of care.

Over the past decade, policy makers in developed countries have begun to pay increasing attention to reform of the long-term care system for the frail elderly and younger people with disabilities. A continuum of strategies have generated interest, including integrated systems of care with agency/professionally managed service packages on the one end, and programs offering cash benefits along with the flexibility to decide how to best use these funds to meet individual needs and preferences, on the other. The latter approach, known as "consumer-directed care," is found in various forms and degrees in Europe and North America. Primarily organised around the provision of home and community care, consumer-directed services are aimed at empowering clients and family carers, giving them major control over the what, who and when of needed care. Consumer-directed care appears to be the antithesis of integrated care. However, it actually holds important lessons and implications for the latter. This policy paper explores the rationale and models of consumer-directed services at home, reviews developments, designs and outcomes of programs in the Austria, Germany, The Netherlands, and the US. It also discusses how this experience could be helpful in shaping better and more responsive integrated models of care for vulnerable long term care populations.

Institutional care for elderly people in North and West Belfast. A decade of change from 1989-1999.

We wished to document the pattern of institutional care for dependent elderly people during a period of altered provision of care, namely a shift from National Health Service long-term hospital care provision to residential and nursing home provision in the private sector. We systematically studied all Institutionalized people aged 65+ years in a single geographic area in 1989, 1992, 1995 and 1999. Subjects' physical and mental function was assessed using the Barthel Index and the Abbreviated Mental Test. Descriptive and statistical comparisons between years and care facilities were made. There were large changes in facilities providing for care between 1989 and 1999, with an 84% increase in nursing home placements and an 89% decrease in hospital admissions. Smaller reductions in residential and psychogeriatric placements were observed together with a large increase in Elderly Mentally Infirm (EMI) placements. We found significant increases in the physical dependency and mental impairment of those receiving nursing, psychogeriatric and long-term hospital care. Residential homes are now caring for people who are significantly less physically dependent, and there have been no changes in the dependency level of residents in EMI homes. There has been an overall mean reduction from 4.3 to 3.9% in the percentage of elderly people aged 65 and over receiving institutional care between 1989 and 1999. This trend has included a radical shift in care from hospital-based provision to nursing home care and undoubtedly an increase in support for people wishing to remain in their own homes. The increased dependency found in institutional care is believed to be due to the higher threshold now necessary for provision of care, which may be due to fiscal constraints.

Cash fix insufficient for people like Enid.

The additional £1 billion funding to go into social services by 2006 has been warmly welcomed, along with the key reforms announced recently by health secretary Alan Milburn ( pages 4 , 6 ). Increased funding is urgently needed to stabilise the care home market, and specifically to increase the fees that social services can offer. Even with the relaxation in the enforcement of environmental standards, the real costs of providing care home places have long exceeded social services fee rates, and £1 billion was exactly the uplift recommended in the recent Joseph Rowntree Foundation analysis of care home provision costs.

Time is right for decisive action.

Warnings of a looming crisis in care home provision for older people are becoming increasingly alarming. Two new Department of Health-funded surveys report a closure rate of around 5 per cent of homes per year, the main reason being business failure due to inadequate local authority fee rates. Among the closures are many homes that offered good quality care (see page 5 ).

Journal scan

There is concern among researchers in the United States that some communities predominantly settled by members of minority ethnic groups have lower levels of nursing home provision than the average for the society as a whole. Similarly, there is some evidence that elders from such communities may be 'steered' towards segregated facilities. Data from the 1990 US Census of Population and the 1994 Illinois Long-Term Care Facility Survey were analysed to see what patterns emerged for the Chicago area. The results showed that both African American and Latino nursing home residents tend to be found in their own neighbourhoods, although overall Latinos demonstrated the greater mobility. 19 references.

Distribution and Utilization of Home- and Community-Based Long-Term Care Services for the Elderly in North Carolina

ABSTRACT Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.

Letters

In response to the article ‘Winter of discontent ‘(November 2000), I too recognise there is a vast difference between standards in nursing home provision, particularly with rehabilitative care. I feel that there should be a greater emphasis on educating nurses and carers that rehabilitative care has benefits to all age groups and the stereotype of older people as dependent is oppressive.

Client Satisfaction with Service Coordinators' Provision of Home Based Long-Term Care Services

ABSTRACT This descriptive study investigates the reliability and validity of the Service Coordinator Satisfaction Measure (SCSM) which was developed to measure client satisfaction with service coordination in a pilot home based long-term care (LTC) program. The SCSM measures the subdimensions of service delivery and service sufficiency, as well as overall satisfaction with service coordination. Reliability testing with a sample of 213 clients indicated that the SCSM had high internal consistency (Cronbach's alpha =.86) and validity testing with the SCSM and a criterion measure also yielded significant positive correlations (r = .57, p <.01). Results showed that clients ranged between being unsure and satisfied with their service coordinator. Analysis of the subdimensions in the SCSM indicated clients were more satisfied with service delivery than they were with service sufficiency, suggesting that clients were somewhat ambiguous about assuming a greater role in managing their own home based LTC needs.

Factors affecting the establishment of occupational therapy services in retail pharmacy: The pharmacist’s perspective

The establishment of occupational therapy services in retail pharmacy is a relatively new development in New South Wales (NSW). Hence there is a lack of literature addressing this innovative area of occupational therapy practice. The aims of this study were to determine if retail pharmacists identify a role for occupational therapy services in retail pharmacy, to ascertain what occupational therapy services retail pharmacists identify as being appropriate for establishment in retail pharmacy, and to find out what factors retail pharmacists identify as affecting the establishment of those services. A questionnaire was developed and mailed to 207 retail pharmacists in NSW. The response rate was 32% (n = 67). The findings indicated that 59% of respondents identified a role for occupational therapy services, the most common role being the provision of home health‐care services. Factors that support or limit the establishment of occupational therapy services in retail pharmacy were also identified. The importance of the results for occupational therapy practice are discussed, and future research directions are proposed.

Raising standards in continuing care

In the first of a series, Linda Nazarko examines current standards of nursing home provision and how purchasers can encourage excellence

HCFA stepping up investigations into medical fraud, abuse

The Health Care Financing Administration (HCFA) estimates 10 percent to 14 percent of all health care dollars are lost to systemic fraud, abuse and waste. If these government figures are correct, the losses to the Medicare and Medicaid programs alone could be as high as $20 billion to $28 billion per year. HCFA now claims the 1998 losses were cut in half, amounting to only $12 billion as a result of its crackdown on fraud and abuse in hospitals, home health services and provision of durable medical equipment. In 1999, HCFA will broaden its fraud and abuse probe to include Medicare Part B providers. The investigation expansion stems from a 1998 HCFA study, which reported that 60 percent of Medicare Part B claims were insufficiently documented. Pediatricians may think that because they are good guys or because they don't bill under Medicare this doesn't apply to them. Yet the zero tolerance fraud and abuse stance of federal health programs has implications for the entire health care industry. Coordinated efforts among government agencies to expunge health care fraud go beyond Medicare to Medicaid, extending to other government programs such as the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS). Ultimately, such efforts may be applicable to payments to practitioners in the private sector.