The determinants of care home closure.
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ABSTRACT:
SUBMITTER: Allan S
PROVIDER: S-EPMC4403979 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.
| S-EPMC5407841 | biostudies-literature
Project description:Bacterial diversity in home and personal care products
| PRJEB19391 | ENA
Project description:ObjectiveThe study assessed gaps between published best practices and real-world practices of treating depression in home health care (HHC) and barriers to closing gaps.MethodsThe qualitative study used semistructured interviews with nurses and administrators (N=20) from five HHC agencies in five states. Audio-recorded interviews were transcribed and analyzed by a multidisciplinary team using grounded theory method to identify themes.ResultsRoutine HHC nursing overlapped with all functional areas of depression care. However, gaps were noted between best and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care clinicians.ConclusionsStrategies to close gaps between typical and best practices include enhancing HHC clinicians' knowledge and self-efficacy with depression treatment and improving the quality of antidepressant management and communication with primary care.
| S-EPMC4666762 | biostudies-literature
Project description:In most effectiveness studies on lumbar supports for patients with low back pain, insufficient data are reported about adherence. In a secondary preventive RCT, we found beneficial effects and a good adherence among home care workers with low back pain. To target the use of lumbar supports on those patients who can benefit optimally from usage, we need to know why people are adherent. We used the attitude, social support and self-efficacy model to identify determinants for prolonged adherence to wearing a lumbar support. The strongest predictor for intending sustained use of a lumbar support was a positive attitude towards lumbar supports, explaining 41% of the variance (B = 1.31; p < 0.001). Social support and self-efficacy played a minor role. The intention for prolonged use of a lumbar support for workers with recurrent back pain was mainly explained by a positive attitude. The discomfort of a lumbar support was outweighed by perceived benefit.
| S-EPMC2989292 | biostudies-literature
Project description:IntroductionAntenatal care (ANC), health facility birth and postnatal care services are proved to reduce maternal and newborn morbidity and mortality. In Ethiopia, even though antenatal care coverage is good, still home birth is high. This study aimed to assess the prevalence and determinants of home birth among women who were booked for ANC in public hospitals in Wolaita zone, southern Ethiopia.MethodsA cohort study was conducted from February to May 2017 among 554 third trimester pregnant mothers who visited public hospitals of Wolaita Zone, southern Ethiopia for ANC service. All women were interviewed twice: the first interview was done face-to-face in the health facility in which they were having ANC follow up to gather information about basic socio-demographic and obstetric characteristics; the second interview was done via telephone after they gave birth to get information about the place of birth. Epi-Data version 3.1 was used for data entry and the Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis.ResultsA total of 68 (13.5%; 95% Confidence Interval (CI): 10.5%-16.6%) women who were booked for ANC gave birth at home. Being uneducated (AOR = 2.46, 95% CI: [1.10-5.10]), starting ANC visit late (>16weeks) (AOR = 2.27, 95% CI: [1.14-4.50]), time taken to reach at health facility for ANC service (>30minutes) (AOR = 8.94, 95% CI: [4.50-17.72]), waiting time of greater than 30 minutes for ANC in health facilities (AOR = 1.18, 95% CI: [1.06-2.30]) and lack of knowledge about danger signs of pregnancy (AOR = 4.18, 95%CI: [1.80-9.70]) were significantly associated with home birth.ConclusionsHome birth among ANC booked women is low compared to other studies. Yet, giving attention to women with no education and those coming from far areas while providing advice on birth preparedness and pregnancy danger signs may be useful to further reduce the rate of home birth. Advising mothers to start ANC early and trying to reduce ANC waiting time could also be of importance.
| S-EPMC6128615 | biostudies-literature
Project description:The current aging service industry has problems in meeting the ever-increasing demand for the home-based elderly care service (HECS). Social organizations participating in HECS seems to be a promising way to address these problems but also raises new challenges, like uncoordinated cooperation among stakeholders, which could lead to low management efficiency and low service quality. However, Synergetic development can be promising to enhance the participation of social organizations and to improve social welfare. This study introduces a conceptual model to explore relationships between five determinants and synergetic development of social organizations participating in HECS. A structural equation model (SEM) based on questionnaire survey is used as a test methodology. The results indicated that stakeholder engagement plays a critical role in synergetic development in HECS, resource allocation can only be improved by institutional climate, and supervision capacity cannot facilitate information sharing. This study provides effective strategies and directions for the improvement of home-based elderly care services.
| S-EPMC7775099 | biostudies-literature
Project description:BackgroundThe policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fourth update of the original review.ObjectivesTo determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs, and caregivers, compared with inpatient hospital or hospice care.Search methodsWe searched the following databases until April 2015: Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE(R) (from 1950), EMBASE (from 1980), CINAHL (from 1982), and EconLit (from 1969). We checked the reference lists of potentially relevant articles identified and handsearched palliative care publications, clinical trials registries, and a database of systematic reviews for related trials (PDQ-Evidence 2015).Selection criteriaRandomised controlled trials, interrupted time series, or controlled before and after studies evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older.Data collection and analysisTwo review authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible, we reported the results from individual studies.Main resultsWe included four trials in this review and did not identify new studies from the search in April 2015. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (risk ratio (RR) 1.33, 95% confidence interval (CI) 1.14 to 1.55, P = 0.0002; Chi(2) = 1.72, df = 2, P = 0.42, I(2) = 0%; 3 trials; N = 652; high quality evidence). Admission to hospital while receiving home-based end-of-life care varied between trials, and this was reflected by a high level of statistical heterogeneity in this analysis (range RR 0.62 to RR 2.61; 4 trials; N = 823; moderate quality evidence). Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up and reduce it at six-month follow-up (2 trials; low quality evidence). The effect on caregivers is uncertain (2 trials; low quality evidence). The intervention may slightly reduce healthcare costs (2 trials, low quality evidence). No trial reported costs to patients and caregivers.Authors' conclusionsThe evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home, although the numbers of people admitted to hospital while receiving end-of-life care should be monitored. Future research should systematically assess the impact of home-based end-of-life care on caregivers.
| S-EPMC7111432 | biostudies-literature
Project description:Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to "abandon" many patients with depression. The authors call for incremental policy changes in several key areas.
| S-EPMC4167154 | biostudies-literature
Project description:The purpose of this paper is to analyse the extent to which length of residence in the country and country of origin are of importance to older immigrants' use of long-term care services compared to native older people. The analyses were conducted on a population of over 65s living in the Municipality of Copenhagen on 1st Jan 2007. Information was drawn from the administrative registers of the Municipality of Copenhagen on the population's use in 2007 of home care and of residential care in a nursing home. These data were combined by Statistics Denmark with demographic data, socio-economic data and data on the use of health services. It was found that older immigrants are less likely than ethnic Danes to use municipal long-term care services when other predisposing, enabling and need factors are controlled for. The difference is greatest between ethnic Danes and immigrants from non-western countries who have only lived in Denmark for a few years. The difference decreases the longer the immigrant has lived in the country. The findings may be explained, at least in part, by poorer language skills and poorer knowledge of the Danish welfare system among older immigrants and the fact that they are more likely to be cared for by relatives than ethnic Danes are. However, in the course of time language skills improve and knowledge of the system increases and life style with respect to care may approach that of older Danes.
| S-EPMC5549190 | biostudies-other
Project description:ObjectiveTo compare the costs of Community Nursing Homes (CNHs) to Medical Foster Homes (MFHs) at Veteran Health Administration (VHA) Medical Centers that established MFH programs.Data sourcesEpisode and costs data were derived from VA and Medicare files (inpatient, outpatient, emergency room, skilled nursing facility, dialysis, and hospice).Study designPropensity scores matched 354 MFH to 1693 CNH Veterans on demographics, clinical characteristics, health care utilization, and costs.Data extraction methodsData were retrieved for years 2010-2011 from the VA Corporate Data Warehouse, VA Health Data Repository, and the VA MFH Program through the VA Informatics and Computing Infrastructure (VINCI).Principal findingsAfter matching on unique characteristics of MFH Veterans, costs were $71.28 less per day alive compared to CNH care. Home-based and mental health care costs increased with savings largely attributable to avoiding CNH residential care. When average out-of-pocket payments by Veterans of $74/day are considered, MFH is at least cost neutral. Mortality was 12 percent higher among matched Veterans in CNHs.ConclusionsMFHs may serve as alternatives to traditional CNH care that do not increase total costs with mortality benefits. Future work should examine the differences for functional disability subgroups.
| S-EPMC6863232 | biostudies-literature