In vitro metabolism of cyanohydroxybutene: formation of a glutathione-S-transferase catalyzed product

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.     

Nursing homes--structure and selected characteristics, 1987 and 1996

This paper briefly describes changes in the nursing home market over a nine-year period, 1987 to 1996. Estimates are based on the "Institutional Population Component" of the 1987 National Medical Expenditure Survey (NMES) and the "Nursing Home Component" of the 1996 Medical Expenditure Panel Survey (MEPS). Both surveys were sponsored by the Agency for Health Care Policy and Research. On January 1, 1996, approximately 1.56 million residents were receiving care in 16,840 nursing homes with 1.76 million beds. This compares to 1.36 million residents in 14,050 nursing homes with 1.48 million beds in 1987, increases of 15, 20 and 19 percent, respectively. The average size of a nursing home remained constant. The occupancy rate decreased from 92 percent in 1987 to 89 percent in 1996, in spite of the growth of the elderly population, both in relative and absolute terms. There was also a significant drop in the supply of nursing home beds relative to the elderly population; this decrease was observed in all four regions of the country, with the greatest drop being in the West. In 1987 only 28 percent of nursing homes were certified by both Medicare and Medicaid (dually certified), while this proportion increased to 73 percent in 1996. Conversely, while only 17 percent of nursing homes were certified by only Medicaid in 1996, a full 50 percent were certified as such in 1987. By far the most common type of nursing home in both 1987 and 1996 was the nursing home with only nursing home beds. Such nursing homes represented 87 percent of the market in 1987 but just 77 percent in 1996. The remaining were either hospital-based or nursing homes with personal care and/or independent living beds in addition to nursing home beds or were part of a continuing care retirement community.     

Management of moderate to severe hypertension and proteinuria by nifedipine retard and perindopril after renal transplantation

The following analysis describes selected aspects of Saxonian social and medical care for people in need of help and elderly, via "community social service units". Almost 16% of people are older than 65 years in Saxonia, whereas the number of women is twice the number of men. To secure the social and medical care "community social service units" were founded partly from former municipal nursing stations of the former GDR and partly from newly founded institutions. Basic and medical care is an essential part of the supply in "community social service units". To approximate an all-embracing social and medical care, so-called "other tasks" complete the general service from a qualitative point of view.     

Probability of particle and salbutamol deposition in the respiratory tract: comparison between MDI and Autohaler

QOL for children with chronic neurological diseases (CND) depends mainly on the supporting system of children's development and respite measurements of their families. For supporting children's development with CND and for alleviating the burden on the family members, various staffs are needed such as pediatricians, nurses, psychologists, OT, PT, home helpers, etc. Especially children with CND are living at home needs in-home services supplied by these supporting staffs. An in-home care service center is desirable to be established in their living area. According to the maternal and child health law and child welfare law, several measures have been adopted, but these services are not available for children with CND and their family, without registration as handicapped children. All these children should be treated because they have the same problems as physically or mentally handicapped children. The capability of the medical and social service supply has been influenced by recent decrease of the birth rate and improvement of the level in the maternal and child health. The number of facilities, such as pediatric clinics or nursing homes for physically handicapped children, is decreasing because of poor profit. These trends will be continued if appropriate measurements are not introduced. The final estimation of need and supply must be made at the local community level.     

Randomised trial of impact of model of integrated care and case management for older people living in the community

OBJECTIVE: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. DESIGN: Randomised study with 1 year follow up. SETTING: Town in northern Italy (Rovereto). SUBJECTS: 200 older people already receiving conventional community care services. INTERVENTION: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. MAIN OUTCOME MEASURES: Admission to an institution, use and costs of health services, variations in functional status. RESULTS: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of 1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). CONCLUSION: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.     

Spending-down to Medicaid in the nursing home and in the community. A longitudinal study from Monroe County, New York

Medicaid spend-down continues to be of considerable interest in public policy discussions regarding long-term care financing reforms. Yet, "measuring" of spend-down has been difficult because of data limitations. This study focuses on patterns of spend-down affecting those who become Medicaid eligible both in nursing homes and in the community. The study uses a longitudinal, person-specific, merged Medicare and Medicaid claims and eligibility file constructed for Monroe County, New York. The analyses show that 27% of those who enter nursing homes as private pay can be expected to spend-down to Medicaid while in a nursing home. The spend-downers remain in nursing homes for a prolonged time, with 63% staying for more than 3 years. On admission, spend-downers appear somewhat more likely than those who remained private pay or Medicaid throughout to have been less disabled in terms of activities of daily living (ADL). The community-based spend-down group is larger, younger, and more heavily represented by those who are poor or marginally poor, than the nursing home-based spend-down population. Their spend-down to Medicaid appears to have been triggered principally by the cost of acute medical care not covered by Medicare or another third-party payer. It is this population of the elderly that would have been the principal beneficiary of the short-lived 1989 Medicare Catastrophic Coverage Act. The results of this study indicate that neither the existing private long-term care insurance policies nor the currently circulating public coverage proposals alone are sufficient to protect older persons, at risk of spend-down to Medicaid, from impoverishment. Effective long-term care financing reform will need to create partnerships between public and private insurance, rather than look at them as competing options.     

Alterations in cyclin-dependent kinase 2 function during differentiation of primary human keratinocytes

Long-term care for the elderly has recently become an area of great interest for practicing social workers because of the increasing number of aged persons and the important role of government in financing and regulating their care. Therefore, the purpose of this study was to provide a set of estimates on patterns in long-term care service use among older Americans over an eight-year period. This study applied multinomial logistic regression to analyzing the data from the National Long-Term Care Survey of 1982-1989 (NLTCS). The results of this study showed a number of differences from the results with cross-sectional studies. Of the 6,393 sample persons, more than half (56.5%) died over the eight years from 1982 to 1989. The rate of entering nursing homes (12.6%) was low. The rate of using community-based care services was fairly low. About 10.4 percent of the sample received care from helping professional personnel or paid helpers. As expected, the number receiving care from kin and other informal support was high. Long-term care services in the United States were distributed very unequally among various social groups. The indicator of need was not the only determinant of service utilization. Other variables such as number of household members, race, age and education were also important for service utilization. The predictors of deceased versus informal help were need, age, number of household member, gender and marital status. The predictors of nursing home care versus informal help were need, age, number of household members, education, attitude toward nursing home and race. The predictors of community-based help care versus informal help were need, number of household members, and education.     

New challenges in ageing: home care

Most nations are undergoing two fundamental demographic changes: concentration of their population in cities and accelerated pace of population ageing. The fastest-growing population is that 85 years and over. Morbidity increases with advancing age, functional capacities decrease; this results in decreased performance of activities of daily liver and need for services. The challenge is particularly strong in urban areas. Modern societies seek solutions in maintaining the elderly in their homes through home care programmes for those who are functionally impaired, homebound, and need support in home-making and home nursing. Home care is firmly established in programmes for the elderly. In order to become a scientific discipline home care has to define its boundaries, identify clients by careful multidisciplinary assessment, provide answers regarding its cost-effectiveness, evaluate outcomes of home caring develop indicators of high-quality care and advise appropriate home care technology, which is affordable and accessible. Home care for the elderly population living in remote rural areas is one of the future challenges.     

Levonorgestrel levels in serum and uterine flushings in women bearing LNG-Cu-IUD

This article describes how abuse and neglect of the elderly was made an issue for research in a Nordic perspective. The Council of Nordic Ministers funded a cooperation between Nordic researchers on the issue of abuse of the elderly, based on a Norwegian initiative in 1988. The aim was to establish a base of knowledge in order to recommend social and political measures for each country. The researchers were chosen from the disciplines of social work, social anthropology, sociology, nursing sciences and medicine. Interested researchers were hard to find in Iceland and Denmark. Important results are on a theoretical level the discussion and perspectives on the definition of "family", "violence" and "elderly". On the practical level the results reveal that between 8% and 17% of a random population sample in Denmark, Sweden and Finland knew about elderly people being abused in their homes. Between 1 and 8% of elderly people living in their homes are being abused by their close kin, according to either the old people themselves or as reported by home nurses. In one of the Swedish projects 12% of close family members, being responsible for the care of a demented, mostly spouse or parent, admitted abuse towards the demented person. Swedish home nurses described the difficulties in intervening into the abusive families.     

The perils of knowing

As we await the government White Paper on social services, the authors examine; in the first of two articles, the current two-tier service which means that elderly people are often moved unnecessarily between residential and nursing homes when their health needs change. The Royal College of Nursing's proposals for single registration care homes is explained on pages 32 and 33 in this issue. The second article will appear next week.     

Prevalence and severity of the dementia syndrome in homes for the aged and nursing homes. A study in elderly from a rural area near Zwolle

In the Netherlands both nursing homes and homes for the aged serve as a residence for demented elderly. Although these institutions differ considerably regarding financing and care facilities, specific functions of each institute concerning demented elderly have not been clearly defined. In order to know to what extent residential facilities serve demented elderly, the prevalence and severity of dementia among residents aged 65 and over was studied as part of a prevalence study among elderly people in a rural area of the Netherlands. The target population existed of all persons aged 65 and over who were registered in eight general practices. Patients who had to leave the practice on account of ill-health and were admitted to nursing homes were included in the study. In a two stage study the MMSE was applied as a screening instrument. Based on MMSE-score a non-proportional stratified random sample was drawn for the second, diagnostic stage, which existed of the CAMDEX. Prevalence estimates for DSM-III-R-dementia were 21% among residents of homes for the aged, 48% among residents of somatic wards of nursing homes and 100% among those admitted to psychogeriatric wards of nursing homes. Severity of dementia was highest among residents of psychogeriatric wards of nursing homes and lowest among those living in homes for the aged. Prevalence of dementia among residents of homes for the aged can be fully attributed to the age-distribution. The high frequency of dementia among residents of somatic nursing home wards can be explained in several ways: First, admission can be necessary due to a combination of dementia and somatic illness.(ABSTRACT TRUNCATED AT 250 WORDS)     

Physician's attitudes toward the ill aged and nursing homes

A survey of physicians in private practice (exclusive of pediatricians) was conducted in a medium sized suburban city in the New York metropolitan area, to determine whether physicians' attitudes toward the ill aged and nursing homes were predictors of the quality of medical care available to area nursing home patients. Questionnaires were circulated to 302 practitioners. Of the 28 percent who responded, 32 percent were psychiatrists, 15 percent primary care physicians and 8 percent orthopedists. Physicians felt competent to manage the ill aged, although 50 percent had had no significant degree of exposure to geriatric medicine in their medical education, and 70 percent of the primary care group had had none. Primary care and older physicians were more likely to treat patients in nursing homes. Almost 40 percent viewed the nursing home as a place to die. Although 85 percent studied that physicians should be involved in the nursing home displacement process, only 21 percent believed that they continued to be in charge of their patients after placement. The findings demonstrate generalized medical disinterest in the care of ill aged patients in institutions. The persons responsible for awarding government grants and those involved in planning medical school curricula should pay more attention to the needs of the chronically ill aged.     

Nursing homes as a setting for psychological practice: Public policy perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The persistence of race and ethnicity in the use of long-term care

We examine the use of nursing homes, formal personal care, informal Activities of Daily Living (ADL) assistance, and no care to identify racial differences in their use. Using the 1987 National Medical Expenditure Survey of both nursing homes and the community, multinominal logistic regressions controlled for predisposing, enabling, and need variables as well as other types of service use. Additional state-level variables make few changes in race/ethnicity parameters, indicating that race/ethnicity are not simply proxies for state-level variables. Older African Americans are less likely to use nursing homes than similar whites, with the lower institutionalization replaced by a higher use of paid home care, informal-only care, and no care. This suggests that formal in-home community care is not fully compensating for the racial differences in nursing home use. Persistent effects of race/ethnicity could be the result of culture, class, and/or discrimination that may impair equitable access to services.     

Characterizations of elderly recipient of home-care and their caregivers. A questionnaire survey of elderly members of a health insurance union

The characteristics of elderly being cared for at home and their caregivers were analyzed based on a questionnaire about health and care for the elderly. We also assessed the problems of home care in view of activities of daily living (ADL) of the home-care recipient. Subjects were members of a health insurance union or their families and ages were more than 65 years old. Results were as follows; 1. The total number of released questionnaires was 5,472, of which responses totally 2,567 (46.9%) were received. Frequencies of the elderly at home without care, at home with care, and in hospitals or nursing home were 86.3%, 9.6% and 4.1%, respectively. 2. We categorized the home care recipient according to their ADL and analyzed their status. The frequency of using health care equipment for home care was significantly higher in the low ADL groups than in the high ADL groups. Caregivers in low ADL groups felt much more care burden than those in high ADL groups. 3. There was a tendency for differences in the use of community welfare services such as visiting nurses or short-stay between the home care recipient with dementia (group D) and the bedfast home care recipient (group C). Approximately 30% of caregivers in group D wanted to transfer the care of the elderly to hospitals or nursing home. 4. In Tokyo and nearby prefectures, there was a highly frequency that main caregivers were recipients' children. In the rural prefecture it was more frequent that the main caregiver was recipients' wife or husband only.     

"Psychological services provided within Veterans Administration nursing homes": Correction to Kupke.

Reports an error in "Psychological services provided within Veterans Administration nursing homes" by Thomas Kupke (Professional Psychology: Research and Practice, 1986[Jun], Vol 17[3], 185-190). In this article, the copyright information was incorrect. The correct copyright information is included in the erratum. (The following abstract of the original article appeared in record 1986-28163-001.) Surveyed the nature and scope of psychological services provided within 67 Veterans Administration nursing facilities to examine the emerging professional domain of the nursing home psychologist. Data regarding service delivery models, use of time, assessment and treatment services, multidisciplinary team activities, staff and student training, and research are provided. The profile of the ideal nursing-home psychologist that emerges from this survey is that of a well-rounded psychologist capable of rendering a full range of assessment, treatment, and consultative services while also functioning as a treatment team member, a teacher, a program developer, and a researcher. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comprehensive functional assessment of the elderly in institutions, particularly in terms of social life

The purpose of this study was to clarify aspects of social life in a comprehensive functional assessment of 160 elderly subjects, over 60 years of age, in institutions for the elderly. Five items were assessed: economic conditions, marital status, family conditions, family relationships and group behavior. The institutions were of 4 types: a geriatric hospital, a special nursing home for the aged, a home for the elderly and a home with moderate fees. The assessment of social life demonstrated significant correlation between the revised version of Hasegawa's Dementia Scale, activity of daily living and physical conditions. Inter-institution comparisons revealed significant differences in terms of economic conditions for the home for the elderly, family conditions for the home with moderate fees, and family relationships and group behavior for the geriatric hospital. Total grades across the 5 items were significantly lower for the geriatric hospital cases. This assessment proved useful to illuminate aspects of social life of the elderly in institutions.     

p21WAF1 induces permanent growth arrest and enhances differentiation, but does not alter apoptosis in PC12 cells

Art. 9 of the Polish Mental Health Act provides two forms of community-based social support--specialist social help services and community self-help houses for persons who, due a to serious mental illness or severe mental retardation, face considerable difficulties in their daily life, especially with respect to interpersonal relations, employment and welfare matters. The first form could only be implemented after coming into force of the suitable regulation of the Ministry of Labour and Social Policy of December 18, 1996 (Dz. U. z 1997 r., nr. 2, poz. 12). Hence, it may be understood that information on these services is exceptionally scarce. The author presents: a draft of legal evolution of the specialist services, from the vague idea of "community care" provided by psychiatric care facilities to the present regulation of community specialist social help services run by social help agencies in consultation with psychiatric facilities, main guidelines for staff to be observed in performing community specialist social help services (training in maintenance and development of basic skills necessary to independent living and others), the first promising experiences of a team rendering community specialist social help services in one of the communes in Warsaw.     

The home health aide as a member of the home healthcare team

Individuals of all ages are discharged from acute-care facilities with a variety of medical and nursing diagnoses. Many of these individuals require home health aides services in addition to their skilled care. In the changing healthcare environment of the 1990s, home healthcare professionals are being challenged to provide effective, skilled care that is the most cost-effective and appropriate for patients. It is important that all professional home healthcare personnel work as a team with home health aides to accomplish these goals. The home health aide is an important member of the home care team.     

Multiple perceptions of discharge planning in one urban hospital

Since the advent of diagnosis-related groups (DRGs), advocacy groups have claimed that although hospital discharge planners perceive the discharge planning process as helpful, elderly patients and their families do not. This article explores how the discharge planning process was perceived by 40 discharge planners and 40 family caregivers. Planners greatly overrated caregiver influence and the amount adequacy of information shared about posthospital health care, choice of discharge to home or nursing home, and time to decide. Caregivers perceived that nursing homes were forced on patients by social workers and physicians. DRGs, physicians, and hospital administrators appeared to pressure social workers to coerce mentally competent patients into nursing homes. Excessive concern by hospital staff about patient safety after discharge may override patients' rights to autonomy and self-determination, violating the NASW Code of Ethics. Implications for practice, policy, and future research are discussed.