Strategies to alleviate shortages of nurses in adult social care.

A lack of investment in adult social care has led to major staffing problems in care homes, according to a new report from the National Audit Office, as Emeritus Professor Alan Glasper, University of Southampton, explains.

A systematic review of the unit costs of allied health and community services used by older people in Australia.

BACKGROUND: An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. METHOD: A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. RESULTS: The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. CONCLUSIONS: Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

Experiences of graduate Registered Nurses in aged care: a case study.

The number of Registered Nurses (RNs) working in aged care is declining, with few new RNs choosing aged care in their graduate year. This paper describes a study exploring 11 female graduate RNs' experiences of working in an aged care setting in Victoria, Australia to assist in informing recruitment and retention strategies in aged care. Semi-structured interviews were undertaken and thematically analysed using open coding. This paper presents findings related to the themes of 'free choice or allocated to aged care' 'reasons for graduate choices', 'nature of aged care: a match or mismatch for graduates', 'lack of professional support for graduate RNs in aged care' and 'role confusion'. Findings supported the recruitment of graduate RNs with an initial interest in aged care into the sector. A clearer definition of the new graduate RN's role in aged care and a standardised graduate program may assist in increasing retention of such nurses in the future.

Who cares and how much? The imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid caregivers providing care to the elderly.

Canadians provide significant amounts of unpaid care to elderly family members and friends with long-term health problems. While some information is available on the nature of the tasks unpaid caregivers perform, and the amounts of time they spend on these tasks, the contribution of unpaid caregivers is often hidden. (It is recognized that some caregiving may be for short periods of time or may entail matters better described as "help" or "assistance," such as providing transportation. However, we use caregiving to cover the full range of unpaid care provided from some basic help to personal care.) Aggregate estimates of the market costs to replace the unpaid care provided are important to governments for policy development as they provide a means to situate the contributions of unpaid caregivers within Canada's healthcare system. The purpose of this study was to obtain an assessment of the imputed costs of replacing the unpaid care provided by Canadians to the elderly. (Imputed costs is used to refer to costs that would be incurred if the care provided by an unpaid caregiver was, instead, provided by a paid caregiver, on a direct hour-for-hour substitution basis.) The economic value of unpaid care as understood in this study is defined as the cost to replace the services provided by unpaid caregivers at rates for paid care providers.

Regulating payment for home care companionship services: legal authority and public policy.

On June 11, 2007, the U.S. Supreme Court issued a ruling in the case of Long Island Care at Home Ltd. v. Coke that upheld a federal regulation exempting employees of third-party agencies who provide home-based "companionship services" to disabled persons from the protections of the minimum wage and overtime pay provisions of the Fair Labor Standards Act. This article discusses the legal issues argued in the case and the legal rationales for the court's decision. The article then identifies the important public policy questions involving the maintenance of a sufficient, competent home care workforce that were left unanswered by the legal ruling and outlines some of the pragmatic implications of potential responses to these public policy questions.

Employer-based health insurance and seniors: the case of Bermuda.

This article examines the importance of economic factors in physician and other health service utilization among older adults living in Bermuda. Using data drawn from a national survey of 500 Bermudian elders, the findings reveal economic factors to be unrelated to the use of physician services directly, but to be significant determinants of the use of other health services. Need plus non-need factors are related to the use of both physician and other health services. The employer-based system does seem to provide universal access, but factors in addition to need influence the receipt of care.

Issues affecting the health of older citizens: meeting the challenge.

The health of older Americans will become a critical national policy issue during this century. As the population of older adults increases dramatically, there are few signs that adequate resources are available to meet the challenge of providing health care and good quality of life for older adults and their families. A fundamental change in the values emphasized in the American culture, and in other cultures, will be required to change the present health care system from one which focuses on diagnosis and treatment of disease to a system that attends to the major issues that affect quality of life of older adults and their families. This article discusses four critical areas influencing the quality of life of older Americans: providing resources to individuals to help manage chronic medical conditions, assuring a sufficient number of primary health care providers educated in geriatrics and gerontology, removing financial barriers to accessing health care and medications, and changing the American cultural value system that emphasizes disease treatment over providing emotional, educational, and support resources. To make these profound changes in the formal health care system, health care providers, health care organizations, and policy makers must commit to embracing the importance of quality of life as an integral component of health care for older citizens.

Reducción de costes mediante un programa de coordinación entre médicos de urgencias y médicos de residencias / Cost reductions using a coordination program between emergency department and nursing home physicians

No disponible

Area agencies on aging: a community resource for patients and families.

This article presents an overview of the Older Americans Act (OAA) so that home health clinicians may become more knowledgeable about this healthcare legislation. The OAA was passed in 1965 and has evolved significantly over time. The purpose of the OAA is to help older adults maintain their highest level of functional activity to remain in their homes as long as possible. Embedded within the OAA are key programs and services for older adults called Area Agencies on Aging (AAAs). It is vital that home health clinicians understand how the AAAs can help their patients and families. This article educates clinicians about the available services that AAAs have to offer.