Control of measles in a juvenile custodial setting in the wake of the recent US outbreak.

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Hospitals in Hurricane Katrina: challenges facing custodial institutions in a disaster.

In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.

The role of a rural sobering-up centre in managing alcohol-related harm to Aboriginal people in South Australia.

There is a paucity of literature on the topic of sobering-up centres (non-custodial safe overnight accommodation for the publicly intoxicated). This paper presents findings of a retrospective longitudinal case study of a sobering-up centre in regional South Australia over the ten years 1991 to 2000. There were 6,486 admissions during this period, 97.1% of which were of Aboriginal people. We collated and analysed primary data including demographic details of admissions and re-admissions, and qualitative and quantitative measures of intoxication. The findings from this case study, considered together with contextual understandings from a wider social study in this region by three of the authors, provide supporting evidence of the important role of sobering-up centres in averting the known harms of a custodial response to public drunkenness, as well as avoiding the potential harm of alcohol-related injury among vulnerable Aboriginal people.

Custodial nursing home care. Setting realistic goals.

Despite concerted effort to rehabilitate and return patients to their homes, the majority of nursing home patients are destined to spend the remainder of their days in institutional settings. These custodial care patients are elderly, have many functional disabilities, and are often demented. The traditional medical approach to care, which emphasizes diagnosis and treatment of specific diseases, is often not appropriate for these patients. Instead, physicians should focus their attention on functional assessment and treatment, nontechnologic management of acute problems, humane terminal care, and the development of an efficient caregiving system within the nursing home.

Senior assisted living: a hospital niche?

Nationwide demographic trends indicating a growing elderly population are creating interest in a number of senior related services, especially within the health care industry. A relatively new concept in senior care, assisted living, may well be the greatest area of growth in the senior housing industry today. Understanding assisted living, the factors which make it successful, and the role hospitals can play in development is critical to wise decision-making.

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.