[Activities of daily living and demand for care of the elderly with chronic conditions in Chengdu].

OBJECTIVE: To evaluate the activities of daily living and demand for care of the elderly with chronic conditions in Chengdu in order to develop appropriate care models. METHODS: Convenient sampling strategy was adopted to recruit participants in four communities in Chengdu. A total of 180 elderly respondents with chronic conditions completed a questionnaire survey, which evaluated the activities of daily living and demand for care of the respondents. RESULTS: More than 77% respondents suffered from two or more chronic conditions. Over 97% respondents followed medical advices of doctors in drug therapy, with 70% monitoring the effectiveness of the drug therapy by themselves. The chronic conditions of 61% of respondents were well controlled. More than 54% were able to perform activities of daily living; 38% needed assistance; and 8% were completely dependent on others. Age and numbers of conditions influenced the activities of daily living (P < 0.005). Over 98% respondents were aware of their care needs and 1% identified unmet needs. Care for elderly came mainly from families, followed by relatives, friends, neighbors and workmates. Demands for care depended on financial capacity, degree of independence and numbers of conditions. Demands for nursing care increased with numbers of conditions (P < 0.05). CONCLUSION: The ability of elderly performing activities of daily living decreases with age and chronic conditions. A multidimensional care model involving professional carers needs to be developed in responding to the increasing needs of aged care.

Medicaid State Plan personal care services: trends in programs and policies.

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.

Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid.

UNLABELLED: Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. DESIGN AND METHODS: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS. RESULTS: New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA). IMPLICATIONS: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.

Personal assistance in Sweden.

This article provides an overview of the Swedish personal assistance program for persons with severe impairments, introduced in 1994. The personal assistance program makes it financially possible for people with severe disabilities to appoint a personal assistant, by themselves or through a provider, to create support adapted to the individual and to optimize the person's influence over how the support is arranged. The article describes how the reform has increased the opportunity for people with severe disabilities to choose their own way of living. Overall, the personal assistance has enhanced the quality of life for people with severe disabilities and their families.

[Public social health services to demented persons living at home in Norway]. / Omsorgstilbud til hjemmeboende personer med demens.

BACKGROUND: About 50% of the 65,000 elderly with dementia in Norway live in their own homes, and are cared for by their families and social and health care personnel in the municipalities. According to governmental documents, the provision of help to demented patients should be predictable, continuous, individually tailored, and carried out by few helpers. The purpose of this study was to examine public social and health services provided to demented patients living at home. MATERIAL AND METHODS: Provision of public care to 460 patients from 24 municipalities, was recorded for seven consecutive days. The average patient age was 82 years (SD 7.1), 74% were women. Degree of dementia was assessed with the Clinical Dementia Rating scale (CDR). Functional status and need of help was assessed with the Rapid Disability Rating Scale-2 (RDRS 2). RESULTS AND INTERPRETATION: . Of the 460 patients, 54% had received a diagnosis by a physician. On average, 8 (SD 4) different people helped for 5.4 ( SD: 6.3) hours a week. Help was most frequently given to; take medicines, prepare food, carry out personal Activity of Daily Living (ADL) and to clean the house. Some did not receive enough help and a few received too much. Patients with a dementia diagnosis did not receive more help than those without. The results indicate that Norwegian municipalities provide a substantial amount of health services, but fail to tailor plans according to individual needs.

Private pay home care referrals: issues and challenges.

Assisting clients in determining the need for and choosing the type of private duty services can be confusing. This article provides: .An overview of the types of private duty home care services; . Key issues and challenges associated with each model; . Referral guidelines for quality private duty agencies; and . How the National Private Duty Association (NPDA) can assist in making quality referrals.

The current state of personal assistance services: implications for policy and future research.

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research.

Perspectives of elderly people receiving home help on health, care and quality of life.

From a nursing perspective it is important to have information about the type of care needed, the reasons care is needed and quality of life among the most elderly people living in their own homes, in order to support their independence and maximise their quality of life. Thus a study was performed to investigate people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases, and complaints in relation to quality of life as perceived by themselves. The sample (n = 448) comprised those who, in an age-stratified randomised sample of adults living in their own homes, responded that they were dependent on help from others. The questionnaire covered sex, age, living conditions, civil status and number of children and cohabitation, respondents' health, diseases, quality of life, help from another person, and the type and amount of help received. The number of elderly persons dependent on help ranged from 18.5 to 79.1% in the different age groups. The help came mainly from informal carers (84.1%), and, in 53.1% of cases, from the home help service and home nursing care. Help from formal caregivers was given in combination with that from a next of kin in 38.8% of the cases. More next of kin than formal carers helped in all Instrumental Activities of Daily Living (IADL) and Personal Activities of Daily Living (PADL) tasks, with the exception of cleaning the house and providing a bath/shower. Although the respondents received help themselves, they also helped another person in 6.5% of cases. The elderly reported a median of three diseases and ten different complaints of which pain and impaired mobility were the most frequent. Between 20 and 40% of the respondents in the different age groups reported restricted ability to be alone and one third of them reported low or very low quality of life. Multiple linear regression analysis showed the number of complaints, restricted ability to be alone, living alone and age to have a significant relationship on low quality of life.

State Medicaid programs offering personal care services.

Two Medicaid programs offer personal care services: (1) the Title XIX Personal Care Services (PCS) optional State plan benefit; and (2) the 1915(c) home and community-based services (HCBS) waivers. By 1998-1999, 26 States offered the PCS optional State plan benefit; 45 offered personal care services via a waiver(s). Nationwide, the former program was larger. The latter was the more popular administrative mechanism, possibly because it more reliably controls growth. States vary dramatically in terms of Medicaid personal care. Medicaid personal care participants per 1,000 State population ranged from 7.33 to 0.04. Per capita expenditures ranged from $91.21 to $0.02.

Using supportive services to manage cost while improving quality.

Supportive services have traditionally been viewed as secondary to the skilled services in home care. Yet increasingly these supportive services can be more important to clients than many organizations recognize--and more important in managing costs as well.

The work of visiting homemakers in the context of cost cutting in long-term care.

Policy making and service organization in long term care for frail elderly people are dominated by concern with reducing institutional costs and increasing the use of relatively inexpensive home care services. Little attention has been focussed on the implications of cost cutting for those at the point of home care service delivery. A qualitative study of visiting homemakers sought to explore these implications. A sample of visiting homemakers working in southern Ontario took part in semi-structured interviews about their work experiences. Analysis of interview transcripts revealed the exploitative potential and tensions introduced by funding restraint, and suggested that home care workers' ability to deliver high quality, personalized care is compromised by organizational practices that speed up and intensify their work. Further research on home care providers and their elderly clients is needed to document the outcomes of economically driven public policies for those who deliver and receive them.

Bridging the gaps in geriatric care. Volunteers help meet the elderly's nonmedical needs.

Concerned about the paucity of services for elderly who need care but prefer to live at home, Our Lady of Lourdes Medical Center, Camden, NJ, embarked on an effort to obtain grant funds while seeking creative ways to meet the elderly's nonmedical needs. One of the first programs developed was a Senior Companion Program. This federally funded program recruits low-income elderly citizens, trains them, and places them in the homes of seniors who need nonmedical services to remain in the community. The program's success led to the establishment of Helping Hands in the Community, which recruits volunteers of all ages and incomes to serve as companions for seniors. An extension of this program, Helping Hands in Business, sought to help employers reduce the costs associated with lost productivity because of employees' responsibilities as care givers for elderly family members. Finally, the Camden Senior Community Support Program uses aggressive case management in the emergency room and the hospital to determine whether the elderly need to be admitted to the hospital or can receive support from family or others to remain in the community.

The shared aide program. The cluster care experience.

Traditional home care services use a one-on-one caregiver-to-client approach in time blocks. In urban setting caregivers may cross each other's paths as aides from several agencies each visit several patients in one building. Cluster care services use a team approach by tasks, consolidating visits and providing a more coordinated, cost-effective approach to services.

Networking the rural community.

A branch network of affiliate hospitals has been providing home care services to rural North Dakota residents successfully for a decade. Here's how this effective system meets the special challenges that a rural environment poses for hiring, training, scheduling, and supporting home care aides.

The reform and redirection of long-term care in Ontario.

In Ontario, the current fragmented health services system cannot respond to projected demands. Several government reports recommend a shift of focus from institutionalization to community-based services--one-stop shopping--to integrate services.