Term Care System Research Articles

Dignity in the care of older adults living in nursing homesand long-term care facilities.

Depending on the fields and actors involved, dignity may involve, signify, and encompass different meanings. This fundamental right can be subjectively experienced and rooted in a person's perception of being treated and cared for. Care refers to a set of specific activities combined in a complex life-sustaining network, including long-term Care, which involves various services designed to meet a person's health or personal care needs. However, older residents' human rights have been disrespected and widened the gaps between theory and practice regarding the precarious protection of their rights and dignity inside long-term facilities and nursing homes. This paper aims to discuss threats to dignity and elucidate some strategies to promote and conserve dignity in care, including the person-centered practice in long-term care. Some barriers to the dignity of older residents involve the organizational culture, restraints of time, heavy workload, burnout, and lack of partnership between the residents, their families, and the long-term care homes' staff. Person-centered integrated care quality frameworks are core components of a good quality of care in these spaces in high-income countries. Unfortunately, the COVID-19 pandemic highlighted how weak long-term care policies were and demonstrated that much progress in the dignity of care in long-term care facilities and nursing homes is needed. In low- and middle-income countries, long-term care policies do not accompany the accelerated and intense aging process, and there are other threats, like their invisibility to the public sector and the prejudices about this service model. It's urgent to create strategies for designing and implementing sustainable and equitable long- term care systems based on a person-centered service with dignity to everyone who needs it.

Economics of the system of long-term care for senior citizens

The article is devoted to the study of the system of long-term care for senior citizens. The purpose of the article is to analyze the current state of the sphere of social services of the population, as well as to consider the essence, tasks, advantages and disadvantages of the introduction of a long–term care system on the territory of Russian Federation. According to the study results, the authors conclude that the introduction and development of a system of longterm care for senior citizens is one of the foreground and socially significant tasks of Russian Federation. The authors propose to use public-private partnership as one of the tools to provide senior citizens with the necessary level of availability of qualified and permanent assistance in the long-term care system. In the process of writing the article, the authors used such research methods as analysis, synthesis, a systematic approach, methods of displaying and processing the information received.

Dignity in the care of older adults living in nursing homes and long-term care facilities

Depending on the fields and actors involved, dignity may involve, signify, and encompass different meanings. This fundamental right can be subjectively experienced and rooted in a person's perception of being treated and cared for. Care refers to a set of specific activities combined in a complex life-sustaining network, including long-term Care, which involves various services designed to meet a person's health or personal care needs. However, older residents' human rights have been disrespected and widened the gaps between theory and practice regarding the precarious protection of their rights and dignity inside long-term facilities and nursing homes. This paper aims to discuss threats to dignity and elucidate some strategies to promote and conserve dignity in care, including the person-centered practice in long-term care. Some barriers to the dignity of older residents involve the organizational culture, restraints of time, heavy workload, burnout, and lack of partnership between the residents, their families, and the long-term care homes' staff. Person-centered integrated care quality frameworks are core components of a good quality of care in these spaces in high-income countries. Unfortunately, the COVID-19 pandemic highlighted how weak long-term care policies were and demonstrated that much progress in the dignity of care in long-term care facilities and nursing homes is needed. In low- and middle-income countries, long-term care policies do not accompany the accelerated and intense aging process, and there are other threats, like their invisibility to the public sector and the prejudices about this service model. It's urgent to create strategies for designing and implementing sustainable and equitable long- term care systems based on a person-centered service with dignity to everyone who needs it.

End-of-life care and depression

ABSTRACT The time around the death of a parent may be particularly stressful. The existing literature provides mixed evidence on the effects of the death of a parent on the caring effort and mental health conditions of adult children. By exploiting longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we study adult children’s provision of care and mental health before and after the death of their mother. We pinpoint the time of death of the mother and estimate its impact by following an event study approach, accounting for differences in Long Term Care (LTC) systems and social norms across Europe. Our findings show that caregiving increases before mother’s death, and especially for women and in low LTC spending countries. Depression symptoms increase significantly in the pooled sample and more so for women. Our interpretation is that adult children (typically daughters) must step in to guarantee care when this is scarcely provided by the public welfare system. The combination of care burden and grief for the loss of the mother negatively affects daughters’ mental health.

Idősgondozás az ellátórendszeren kívül: A családi gondozók kihívásai

A tartós gondozási rendszer túlterheltsége miatt egyre fontosabb a családi gondozók szerepe az idősellátásban. A gondozás felvállalása azonban jelentős megterheltséggel jár, melynek számos negatív következménye lehet a családi gondozók családi élete, munkavállalása, testi-lelki egészsége tekintetében. A jelenlegi hazai ellátórendszer kizárólag a gondozottak szükségleteire fókuszál, a családi gondozók támogatására még nincsenek szolgáltatások. Tanulmányunkban 10, családi gondozóval készített mélyinterjú tükrében ismertetjük legfontosabb nehézségeiket.

User activity recognition system to improve the performance of environmental control interfaces: a pilot study with patients

BackgroundAssistive technologies aim to increase quality of life, reduce dependence on care giver and on the long term care system. Several studies have demonstrated the effectiveness in the use of assistive technology for environment control and communication systems. The progress of brain-computer interfaces (BCI) research together with exoskeleton enable a person with motor impairment to interact with new elements in the environment. This paper aims to evaluate the environment control interface (ECI) developed under the AIDE project conditions, a multimodal interface able to analyze and extract relevant information from the environments as well as from the identification of residual abilities, behaviors, and intentions of the user.MethodsThis study evaluated the ECI in a simulated scenario using a two screen layout: one with the ECI and the other with a simulated home environment, developed for this purpose. The sensorimotor rhythms and the horizontal oculoversion, acquired through BCI2000, a multipurpose standard BCI platform, were used to online control the ECI after the user training and system calibration. Eight subjects with different neurological diseases and spinal cord injury participated in this study. The subjects performed simulated activities of daily living (ADLs), i.e. actions in the simulated environment as drink, switch on a lamp or raise the bed head, during ten minutes in two different modes, AIDE mode, using a prediction model, to recognize the user intention facilitating the scan, and Manual mode, without a prediction model.ResultsThe results show that the mean task time spent in the AIDE mode was less than in the Manual, i.e the users were able to perform more tasks in the AIDE mode during the same time. The results showed a statistically significant differences with p<0.001. Regarding the steps, i.e the number of abstraction levels crossed in the ECI to perform an ADL, the users performed one step in the 90% of the tasks using the AIDE mode and three steps, at least, were necessary in the Manual mode. The user’s intention prediction was performed through conditional random fields (CRF), with a global accuracy about 87%.ConclusionsThe environment analysis and the identification of the user’s behaviors can be used to predict the user intention opening a new paradigm in the design of the ECIs. Although the developed ECI was tested only in a simulated home environment, it can be easily adapted to a real environment increasing the user independence at home.

장기요양 서비스 이용자와 미이용자의 의료비 지출 차이 및 의료비 지출에 미치는 영향 - 요양병원 의료비 지출을 중심으로 -

This study aims to analyze the effect of long-term care utilization on health care utilization of the national health insurance elderly. This study is a secondary data analysis of the long-term care insurance data that comprised of total 21,213 long-term care insurance with the level 1 elders who received either service or non-service. This study evaluated the impact of long-term care service on the probability of health care utilization experience and costs of health care utilization. The total medical cost, geriatric hospital's medical cost, inpatient day and geriatric hospital's inpatient day by 2007-2009 were significant factor influencing the long-term care utilization. This study suggests long term care system should proper medical service linkage system. The current long-term care insurance system should more resource allocation on long-term care utilization to increase the efficiency of insurance system.

P423: How to compare the performance of three European long term care systems by using the Balanced ScoreCard framework

Introduction: The economic context is characterized by a decline in revenues of the state and an increase in deficits and debt. Even if this context has an impact on healthcare systems, it is no sufficient to limit the thinking to the economic dimension to evaluate healthcare systems performance. In fact, the only measure of the efficiency of financial indicators, leads to a ‘management by the mirror’. It is therefore necessary to adopt a more balanced and forward-looking. A tool for performance evaluation, called Balanced ScoreCard (BSC) seems appropriate mainly because it measures criteria for recognition and anticipation. Thus, the aim of our study was to compare systems of care for elderly in France, Germany and the UK using the BSC approach. Method: We aggregated values of each country for the four dimensions of BSC (financial, customer/user/patient, internal process and organizational learning). We select the best value among the three studied countries and we calculated the percentage difference between the value of each country and the reference value of each indicator. Results: We found that French system of care for elderly people is quite efficient compared to the resources allocated and results recorded. Furthermore, France system approaches evenly the four dimensions of BSC compared to the other countries. Limitations: the multidimensional nature of our comparison (three countries compared according four dimensions). Conclusion: The research shows that the theory and the concept of the BSC, initially designed for industries in the private sector may be applied in the context of healthcare systems to compare healthcare performance across organizations, sectors and countries.

Multi-disciplinary communication networks for skin risk assessment in nursing homes with high IT sophistication

BackgroundThe role of nursing home (NH) information technology (IT) in quality improvement has not been clearly established, and its impacts on communication between care givers and patient outcomes in these settings deserve further attention. ObjectivesIn this research, we describe a mixed method approach to explore communication strategies used by healthcare providers for resident skin risk in NH with high IT sophistication (ITS). MethodsSample included NH participating in the statewide survey of ITS. We incorporated rigorous observation of 8- and 12-h shifts, and focus groups to identify how NH IT and a range of synchronous and asynchronous tools are used. Social network analysis tools and qualitative analysis were used to analyze data and identify relationships between ITS dimensions and communication interactions between care providers. ResultsTwo of the nine ITS dimensions (resident care-technological and administrative activities-technological) and total ITS were significantly negatively correlated with number of unique interactions. As more processes in resident care and administrative activities are supported by technology, the lower the number of observed unique interactions. Additionally, four thematic areas emerged from staff focus groups that demonstrate how important IT is to resident care in these facilities including providing resident-centered care, teamwork and collaboration, maintaining safety and quality, and using standardized information resources. ConclusionOur findings in this study confirm prior research that as technology support (resident care and administrative activities) and overall ITS increases, observed interactions between staff members decrease. Conversations during staff interviews focused on how technology facilitated resident centered care through enhanced information sharing, greater virtual collaboration between team members, and improved care delivery. These results provide evidence for improving the design and implementation of IT in long term care systems to support communication and associated resident outcomes.

Comparison of Unmet Care Needs across The Dementia Trajectory: Findings from The Maximizing Independence at Home Study

Introduction: The aging of the population will bring with it an increase in the number of individuals with dementia living in the community. This will result in a greater demand on family caregivers and the long term care system to deliver care that is consistent with patient needs across the dementia trajectory, and requires a thorough understanding of an individual’s care needs as they change over the disease course. This study compares the unmet care needs of community dwelling persons with dementia across the stages of the dementia.

노인장기요양보험의 보험수리적 분석

최근 노년기의 삶에 대비하기 위한 은퇴자금 마련이 중요한 개인적, 사회적 문제로 부각되고 있다. 특히, 앞으로 노년인구의 비율이 지속적으로 상승할 것이라는 전망과 더불어 이러한 개인의 재무설계 및 그와 관련한 리스크와 관련한 문제는 그 중요성이 날로 커질 것이다. 노년기의 질병에 따른 의료비 지출은 특히 재무적인 리스크와 밀접한 관련이 있는데, 유병 기간이 상대적으로 긴 질병의 경우에는 수발비용을 포함한 장기적인 의료비 지출로 인하여 재무적인 위험을 증가시키고 노년기의 삶의 질을 크게 떨어뜨릴 수 있다. 따라서, 각 개인이 장기적인 비용 지출을 요하는 질병에 대하여 예상되는 비용의 규모를 파악하고 이를 사전에 대비할 수 있는 방안을 모색하는 것이 필요하다. 본 연구에서는 노인장기요양보험의 실적 자료와 다중상태모형을 토대로, 노년기에 노인장기요양보험을 통하여 장기요양보호가 필요한 기간과 이에 따른 비용 규모의 추정을 통하여, 각 개인이 장기간병을 위해 준비해야 하는 필요금액을 도출하여 보았다. Retirement income is an important personal and social issue. Problems associated with financial risk wil1 become more pronounced with the growth in the elderly population. Medical expenses in senescence is closely related to financial risk; in addition, some diseases that require long term care will increase financial risk which result in lower quality of life for the elderly. Therefore, it is necessary to understand expected long-term care costs and to manage financial risk from the perspective of an individual. This study evaluate the length of period in which a person is expected to need long term care and actuarial present values of the total cost which needs to be prepared for the care through the Korean public long term care system based on the experience data obtained from Long Term Care Insurance for the Elderly in Korea and a multi-state model.

The Effect on Nursing Home Resident Outcomes of Creating a Household Within a Traditional Structure

Person-centered care (PCC) is a revolutionary approach to the culture change of elder care that is being adopted by nursing home providers across the nation. One aspect of PCC is the introduction of more self-contained units or households within long term care facilities. This study aimed to evaluate the effect of households on nursing home residents' physical and psychological outcomes using the Minimum Data Set (MDS) comprehensive assessment data. A retrospective, longitudinal study. Two care units in a large urban nursing home within the Western New York long term care system. Residents living in two units (household unit and traditional care unit) within one nursing home during January 2005 to April 2007. The MDS 2.0 is a standardized and comprehensive assessment tool that measures long term care facility residents' functional, medical, cognitive, and psycho-social status. The de-identified MDS 2.0 records of residents living in these units during this time period were retrieved from the New York Association of Homes and Services for the Aging. The residents' cognitive patterns, mood and behavior pattern, physical functioning, pain, fall, nutritional status, number of ulcers, medication use, and special treatment were compared. Descriptive and correlational statistics were used for data analysis. MDS records of 35 household-unit residents and 33 traditional-unit residents were analyzed. After adjusting for baseline differences, household-unit residents had better self- performed eating ability, daytime sleepiness, and restraint use; however, more fall incidents were reported for the household unit. Our findings indicate that households generated some better outcomes for residents and provide preliminary evidence to support households in nursing homes. Further research is needed to overcome design issues; however, the MDS may be useful for PCC outcomes measurement.

The U.S. Long Term Care System: Development and Expansion of Naturally Occurring Retirement Communities as an Innovative Model for Aging in Place

The current U.S. health and long term care systems are inadequately prepared to meet the diverse and changing needs of the rapidly growing senior population. This paper describes the importance of naturally occurring retirement communities (NORCs) to promote the health and mental well being of older individuals through the collaborative efforts of formal and informal home and community based services and support. NORCs are considered a crucial model for aging in place since older adults prefer to remain in the comfort of their homes, and services can be provided in a much more efficient and cost effective manner. This paper examines the strengths, opportunities, and challenges of existing NORCs and discusses the need for the development and expansion of additional NORC programs as an innovative and viable solution for older adults aging in place.

Long Term Care in Romania

The increasing life expectancy and the alarming growth in the incidence of chronic illness make long term care services in high demand and in dire need of change and innovation. As part of the ANCIEN initiative, which aims to comprise a database of European approaches for dealing with long term care, this document creates an overview of the health systems organized in Romania which target individuals with long term care needs. The method of governance, the people’s needs and the available services are presented herein. For the most part, the services provided in this field are covered through the efforts of the family of those in need and are therefore difficult to quantify or analyze. Public services are either insufficient (in terms of quality or accessibility) and the moral stigma associated to using them prevents families from making this choice. However, due to a high demand and a low supply of high quality LTC services, the private market of nursing homes has exploded in the last few years, funded either privately, through NGOs or external donations. The quality and number of available services has greatly improved but the accessibility is still low. At this moment, Romania still does not have an integrated long term care system neither from the legal or the organization of services being offered. There are social and medical services that are run, provided and legislated independently. The current national strategy is to coordinate these services and to create an integrated system with multidisciplinary teams which would include different types of medical specialists and nurses but still maintain and improve the services offered formally or informally as a home based care package.

The System of Long-Term Care in the Czech Republic

Developing responsive to needs, efficient and sustainable long-term care systems for elderly becomes due to rising demographic pressures an urgent issue all over Europe. Czech Republic is among the countries that have redesigned long-term care system according the principles of accessibility, quality and fiscal tenacity in the past couple of years. The reform process was well rooted in the practice of local governments and social sector empowering institutions that existed before 2006, when the reform was introduced, but were insufficiently anchored in legal regulations. The newly established long term care system covers a wide spectrum of services, from cash benefits to dependent in need via different types of social services and institutional care. Still, similarly to other countries of the Central and Eastern Europe region long care is disintegrated between the social system and health care which also is responsible for some types of institutional establishments. The system is also not free from critique for the lack of formal definition of long term care, lack of integration of services, their shortage and poor quality. Thus despite state efforts, the care over elderly remains family responsibility and state support is not always sufficient.

What Matters Most to Nursing Home Elders: Quality of Life in the Nursing Home

A growing number of nursing homes across the country are embarking on culture change transformations that focus on maximizing elder residents' quality of life (QOL). Challenges to culture change implementation include the wide range of possible interventions as well as a lack of research-based evidence to guide these choices. The purpose of this study was to determine those components of nursing home QOL that are associated with elder satisfaction so as to provide direction in the culture change journey. A cross-sectional study using a survey administered face-to-face. Three large urban nursing homes within a long term care system in New York State. Sixty-two elder nursing home residents participated in face-to-face interviews. All elders had resided in their nursing communities for at least 3 months before participation. The survey included the Quality of Life Scales for Nursing Home Residents, which examines elder QOL in 11 domains: autonomy, dignity, food enjoyment, functional competence, individuality, meaningful activity, physical comfort, privacy, relationships, security, and spiritual well-being. Elder satisfaction with the nursing home and nursing home staff were also examined. After accounting for cognitive and physical functioning, among the QOL domains, dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction. Additionally, dignity remained a significant predictor of elder satisfaction with staff. These results provide one possible path in the culture change journey based on empirical findings.

The wisconsin memory screening initiative: Rationale and results

A large proportion of persons with dementia are frequently not diagnosed or are diagnosed at late stages of the disease limiting the ability to implement pharmacologic and caregiver interventions that may reduce the need for long term care services. Because of the significant impact of dementia on the utilization of long term care and because of the potential for cost savings from better management of dementia symptoms and early support of caregivers,the State of Wisconsin and the Wisconsin Alzheimer's Institute piloted a dementia screening program in existing county long term care systems. Aging and long term care staff in eight counties were provided with a basic understanding of dementia, available treatments and supportive services, and were trained in the administration of cognitive screening tools. Physicians and other health professionals in the target counties were trained in how to interpret the screening results and in the diagnosis of cognitve disorders. Persons over age 65 and known not to have a dementia diagnosis were screened initially with the Animal Naming test and if screening positive,were tested with a second screen,the Cognistat. All results were sent to the person's physician for evaluation. The outcome of the physician evaluation was recorded whenever available. 1,355 persons were approached for screening. Ninety-one percent agreed to be screened and of these, 34% screened positive on the Animal Naming test. Eighty-six percent of persons screening positive agreed to additional testing with the Cognistat. Of these, 93% had impaired scores and were referred to a physician for evaluation. Follow up data were available for 108 referrals and of these, 60 received a dementia related diagnosis . Of the remaining 48, the abnormal screening results were attributed to a non dementia cause or no explanation was given. This pilot study found that cognitive screening by county staff is feasible and well accepted by participants. The prevalence of unrecognized cognitive impairment was high but consistent with other studies. Physician follow up of positive screens was inconsistent suggesting that physicians may be important barriers for states seeking to contain long term care costs.

A Study on Long Term Care System in Germany and the Netherlands:Focusing on Cash Payment and Family Caregiver

A Study on Long Term Care System in Germany and the Netherlands:Focusing on Cash Payment and Family Caregiver

Long term care financing in four OECD countries: Fiscal burden and distributive effects

This paper compares long term care (LTC) systems in four OECD countries (UK, Japan, Sweden and Germany). In the UK, provision is means tested, so that out of pocket payments depend on levels of income, savings and assets. In Sweden, where the system is wholly tax-financed, provision is essentially free at the point of use. In Germany and Japan, provision is financed from recently introduced compulsory insurance schemes, although the details of how each scheme operates and the distributive consequences differ somewhat. The paper analyses the effects of importing the other three countries’ systems for financing LTC into the UK, focussing on both the distributive consequences and the tax burden. It finds that the German system would not be an improvement on the current UK system, because it uses a regressive method of financing. Therefore, the discussion of possible alternatives to the present UK system could be restricted to a general tax-based system as used in Sweden or the compulsory insurance system as used in Japan. The results suggest that all three systems would imply increased taxes in the UK.

State Strategies to Support Community Based Long Term Care for the Elderly

States play a principal role in designing and implementing publicly funded long term care programs. They are in a key position to determine what setting, from whom, and under what philosophy of care individuals can access long term care. State long term care systems have evolved over the past 25 years to support increased availability of community based care for older individuals. States have pursued three broad strategies to increase availability. One set of strategies aims to increase capacity through expanding the supply, public funding and eligibility for a wide array of home and community based services (HCBS). A second set of strategies seeks to constrain institutional growth in order to increase the dollars available for HCBS. Managed/capitated long term care is a third strategy that is a hybrid of the other two approaches. Empirically, increased capacity through use of Medicaid and Medicare resources and growth in the supply of community based care providers, combined with moderation of institutional bed supply, are associated with enhanced access and expenditures for community based long term care. The effectiveness of capitated or managed systems of care varies by model and in some cases is still under study. State fiscal resources are key to the ability to support community based care for the elderly. Targeted federal support may be critical to the continued expansion of community based care, given heterogeneity in state resources, coupled with an increasing demand for long term care.