Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory.

Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011-14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z=2.62, P=0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.

'Growing Old' in Shelters and 'On the Street': Experiences of Older Homeless People.

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

Impact of a fixed price system on the supply of institutional long-term care: a comparative study of Japanese and German metropolitan areas.

BACKGROUND: The need for institutional long-term care is increasing as the population ages and the pool of informal care givers declines. Care services are often limited when funding is controlled publicly. Fees for Japanese institutional care are publicly fixed and supply is short, particularly in expensive metropolitan areas. Those insured by universal long-term care insurance (LTCI) are faced with geographically inequitable access. The aim of this study was to examine the impact of a fixed price system on the supply of institutional care in terms of equity. METHODS: The data were derived from official statistics sources in both Japan and Germany, and a self-administered questionnaire was used in Japan in 2011. Cross-sectional multiple regression analyses were used to examine factors affecting bed supply of institutional/residential care in fixed price and free prices systems in Tokyo (Japan), and an individually-bargained price system in North Rhine-Westphalia (Germany). Variables relating to costs and needs were used to test hypotheses of cost-dependency and need-orientation of bed supply in each price system. Analyses were conducted using data both before and after the introduction of LTCI, and the results of each system were qualitatively compared. RESULTS: Total supply of institutional care in Tokyo under fixed pricing was found to be cost-dependent regarding capital costs and scale economies, and negatively related to need. These relationships have however weakened in recent years, possibly caused by political interventions under LTCI. Supply of residential care in Tokyo under free pricing was need-oriented and cost-dependent only regarding scale economies. Supply in North Rhine-Westphalia under individually bargained pricing was cost-independent and not negatively related to need. CONCLUSIONS: Findings suggest that publicly funded fixed prices have a negative impact on geographically equitable supply of institutional care. The contrasting results of the non-fixed-price systems for Japanese residential care and German institutional care provide further theoretical supports for this and indicate possible solutions against inequitable supply.

[Shared-housing arrangements for care-dependent persons. Legal frameworks and numbers in Germany]. / Ambulant betreute Wohngemeinschaften für Menschen mit Pflegebedarf. Versorgungsangebote und gesetzliche Rahmenbedingungen in Deutschland.

BACKGROUND: Since the mid-1990s, supervised shared-housing arrangements (SHA; assisted living facilities) have developed as a specific type of small-scale living facility for elderly care-dependent persons with dementia in Germany, offering services different than those in residential care. Neither a uniform and binding definition of SHA nor reliable estimates concerning numbers currently exist. Since January 2013, SHA have been promoted nationwide in Germany by law. MATERIALS AND METHODS: In a cross-sectional study funded by the National Association of Statutory Health Insurance Funds numbers as well as legal and financial frameworks of SHA in Germany were surveyed. RESULTS: As of February 2013, almost all German "Bundesländer" (federal states) have created special legal regulations for supervised SHA. The results of the present study show at least 1,420 SHA with 10,590 care places for adults in Germany. The regional distribution differs greatly. CONCLUSION: Supervised SHA are increasingly an established care offer among the various long-term care offers in Germany. Different care and support offers help ensure individualized and high quality care for elderly care-dependent persons with dementia.

[Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities].

OBJECTIVES: The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care. METHODS: The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home. RESULTS: The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff. CONCLUSION: It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.

Forced into exile: the traumatising impact of rural aged care service inaccessibility.

INTRODUCTION: The shortage of residential aged care places is especially acute in rural areas and this results in many older people who live in these areas being forced to leave their home communities to access care in distant communities. This article reports on one aspect of a larger study that explored family and caring community members' experiences when someone they cared for needed to access residential aged care away from their rural communities. METHODS: This qualitative research project, informed by phenomenology, was conducted in rural communities of New South Wales (NSW), Australia. Participants were recruited from media coverage of the proposed research. Indepth interviews were conducted, audiotaped and transcribed. Thematic analysis was undertaken by two researchers independently analysing the themes and then cross-checking these to ensure their strength. RESULTS: The 21 interviews conducted revealed that inaccessibility of residential aged care places caused many to experience loss, loneliness and a sense of social disconnectedness. The affected rural older person is exiled from their home community only to return to be buried. There are implications for the family and the rural community who are distanced by kilometres, transport and finances and, more significantly, by the emotional ties that bind families, friends and communities. CONCLUSION: The participants whose experiences were explored in this article described a sense of being in exile when residential aged care services are inaccessible in their local communities. The sense of exile is felt not only by the person moving away but also by their family, friends and neighbours. For this reason, rural residential aged care service delivery should be based on the identified needs of the older person and those who love and care for them.

Care for people with dementia in Slovenia.

The number of patients with dementia in Slovenia will increase 33% in the next ten years. Unfortunately, networks offering different activities for demented patients are still insufficiently developed, although in the last ten years a significant improvement has been observed in all areas of care (diagnosis, treatment, day care centres, nursing homes, and non-governmental organizations). The article provides a short overview of developing care for persons with dementia in Slovenia.

The importance of assessing the environment to determine the most suitable location for seniors' residences so as to adjust the supply to the needs.

Seniors' residences must be located in areas that foster the well-being of both residents and staff. This study is unprecedented in France. It uses the multi-criteria decision-making method to classify the environmental targets in priority order, according to the importance they are given by the people living or working on the premises as related to their proximity to the residence. The results are then integrated into a mapping of areas in which the targets are geolocalized, thus highlighting the most suitable zones. The data collected from interviews and from the mapping vary from one residence to another. Nevertheless they all clearly point to the importance of a territorial approach before planning the building of such residences.

Ownership form and consumer welfare: evidence from the nursing home industry.

This paper compares the likely consumer benefits of higher quality with the potentially greater production costs that result from increased not-for-profit activity in a nursing home services market area. The comparison of consumer benefits and costs is made possible by observing empirically how an increased market penetration of not-for-profit facilities affects the use of private-pay nursing home care. Increased (decreased) use of nursing home care suggests that the consumer benefits associated with additional not-for-profit nursing homes are greater (less) than consumer costs. The empirical results indicate that, from a consumer's perspective, too few not-for-profit nursing homes may exist in the typical market area of the United States. The policy implication is that more quality of care per dollar might be obtained by attracting a greater percentage of not-for-profit nursing homes into many market areas.

Study of American and Chinese family members' evaluations on institutionalized care for their older parents: potential development in the future.

The evaluations on institutionalized care facilities from family members, after their loved ones moved into such services, are very different from culture to culture, family to family and person to person. According to a recent survey in the United States and China, it is found that different cultures and the different health conditions of the residents strongly influence family member's viewpoints on institutionalized care services. It is also found that the availability of the institutionalized care facilities plays a significant role, which strongly affects family members' evaluations on nursing home services.

Geospatial panorama of long-term care facilities in Brazil: a portrait of territorial inequalities / Panorama geoespacial das Instituições de Longa Permanência para Idosos no Brasil: um retrato das desigualdades territoriais

OBJECTIVES: To map the number and geospatial distribution of Brazilian long-term care facilities (LTCFs) for older adults. Additionally, we sought to highlight the relationship between these findings and the number of older people in the country's 27 Federation Units, demonstrating the growth of these facilities in the last decade. METHODS: This is a descriptive observational study, using secondary data, which was performed in 3 stages: 1) searching and consolidating national and subnational data from different sources and mapping LTCFs; 2) preparing a geospatial map using Brazilian postal codes; and 3) triangulating the number of facilities and of older people in each state and all 5 Brazilian regions. RESULTS: We found 7029 LTCFs in the country, mostly in the Southeast and South regions: São Paulo, Minas Gerais and Rio Grande do Sul had the highest numbers of facilities while states in the North region represented only 1.12% of Brazilian LTCFs. Geospatial mapping highlighted that 64% of the 5 570 Brazilian municipalities did not have any LTCFs for older adults. CONCLUSIONS: We observed a large difference between Brazilian regions regarding the provision of long-term care.

OBJETIVOS: Mapeamento do número e distribuição geoespacial das Instituições de Longa Permanência para idosos (ILPI) brasileiras. Além disso, procuramos destacar a relação entre estes resultados e o número de pessoas idosas nas 27 unidades de da federação, exibindo o crescimento dessas instalações na última década. METODOLOGIA: Estudo observacional descritivo, a partir de dados secundários, realizado em 3 etapas: 1) pesquisa e consolidação de dados nacionais e subnacionais de diferentes fontes e mapeamento de ILPI; 2) elaboração de mapa geoespacial utilizando o código de endereço postal do Brasil, e 3) triangulação do número de instituições com dados sobre o número dos idosos em cada estado e nas cinco regiões brasileiras. RESULTADOS: Encontramos 7.029 ILPI no país, principalmente nas regiões Sudeste e Sul: São Paulo, Minas Gerais e Rio Grande do Sul tiveram o maior número de instalações, enquanto os estados da região Norte representavam apenas 1,12% das ILPI brasileiras. O mapeamento geoespacial destacou que 64% dos 5 570 municípios brasileiros não possuem ILPI para os idosos. CONCLUSÕES: Observamos uma grande diferença no Brasil em relação à prestação de cuidados de longa duração.

Homes for the aged: a study of a health region in Rio Grande do Sul, Brazil / Lares para idosos: um estudo em uma região de saúde do Rio Grande do Sul, Brasil

INTRODUCTION: With the aging of the population, the demand for Homes for the Aged (HFAs) grows. OBJECTIVE: To analyze resources and population of HFAs and to check the fulfillment of the criteria from the national regulations. METHODS: Descriptive quantitative study including 11 philanthropic HFAs in the state of Rio Grande do Sul, Brazil. Data was collected through a questionnaire applied to the responsible for the facility. RESULTS: The study comprised 318 workers and 522 elders. HFAs presented: some accommodations without private bathrooms (100%); external area and administrative office (72.7%); cafeteria and support room (54.5%); ecumenical room (36.4%); rooms with more than four beds (45.5%). The prevailing reasons for admission were brought by family member (69.2%); social vulnerability (36.4%). Death was the main reason for leaving the facility. The average age of elders was 76.8 years, 58.4% were women. The dependence grade was I for 31.1%; II for 33.9%; and III for 35%. Leisure and cultural activities occurred in 72.7% of HFAs. In 27.3% there were records of visits. Only 9.1% had cooperation from families. Available human resources were nurses (72.7%); physicians and nursing assistants (63.3%); physical therapists (45.5%); psychologists (36.4%); caregivers (27.3%); occupational therapists (9.1%). In 63.3% of facilities, workers carried out mixed activities. The costs were covered by retirement pensions, partnerships, and donations. The main obstacles were financial resources or dependence on donations and rigorous health surveillance or compliance with standards. CONCLUSION: The HFAs partially fulfill the national criteria, impairing the quality of care provided to elders.

INTRODUÇÃO: Com o aumento do envelhecimento, cresce a procura por Instituições de Longa Permanência para Idosos (HFAs). OBJETIVO: Analisar recursos e população de HFAs, verificando-se o cumprimento dos critérios da RDC nº 283/2005 da Anvisa. MÉTODOS: Pesquisa descritiva e quantitativa com 11 HFAs filantrópicas no estado do Rio Grande do Sul, Brasil. A coleta de dados foi realizada por questionário aplicado ao responsável pela unidade. RESULTADOS: O estudo envolveu 318 trabalhadores e 522 idosos. As HFAs apresentaram: alguns quartos sem banheiro (100%); área externa e sala administrativa (72,7%); refeitório e sala de apoio (54,5%); sala ecumênica (36,4%); quartos com mais de quatro leitos (45,5%). As razões de admissão prevalentes foram: idosos trazidos por familiares (69,2%) e vulnerabilidade social (36,4%). A morte foi a principal razão de saída. A idade média dos idosos foi 76,8 anos e 58,4% eram mulheres. O grau de dependência foi I para 31.1%; II para 33,9% e III para 35%. Atividades de lazer e cultura ocorrem em 72,7% das HFAs. Em 27,3% há registro de visitas. Somente 9,1% atuam junto às famílias. Os recursos humanos disponíveis foram enfermeiro (72,7%), médico e técnico de enfermagem (63,3%), fisioterapeuta (45,5%), psicólogo (36,4%) e cuidador (27,3%). Em 63,3% das unidades, trabalhadores realizam atividades mistas. Os custos são cobertos por aposentadorias, parcerias e doações. As principais dificuldades foram recursos financeiros ou dependência de doações e rigor da vigilância sanitária ou cumprimento de normas. CONCLUSÃO: As HFAs cumprem parcialmente aos critérios da Resolução, prejudicando a qualidade do atendimento aos idosos.

The Untold Story of Being Designated an Alternate Level of Care Patient.

INTRODUCTION: Much of the research and policy reports on Alternate Level of Care (ALC) in Canada have focused on the impact ALC has on acute care services. To date, the experiences and opinions of those who must wait in hospital for alternate services have been largely absent from discussions. METHOD: A qualitative study was conducted with patients and families designated as ALC in one urban and two rural hospitals in Atlantic Canada. Data were analyzed using content analysis. RESULTS: Three themes emerged from the data: a perception of normalcy, being old but not sick and anticipating relocation to another facility. CONCLUSIONS: ALC is an important issue for patients and their families. Policy directives aimed at addressing the causes and impacts of ALC, identification and provision of appropriate supportive care in the community and sensitivity to the impact of ALC for individuals designated as ALC are needed.

Analysis of nursing home use and bed supply: Wisconsin, 1983.

This article presents evidence that in 1983 excess demand was a prevailing characteristic of nursing home care markets in Wisconsin, a state with one of the highest bed to elderly population ratios. It further shows that excess demand is the source of at least three types of error in use-based estimates of the determinants of the need for nursing home care. First, if excess demand is present, estimates of the determinants of Medicaid use may simply represent a crowding out of Medicaid patients, driven by the determinants of private use. As a result, factors associated with greater overall need in an area will be correlated with fewer Medicaid patients in nursing homes, ceteris paribus. Second, estimates of the substitutability of home health care for nursing home care may be misleadingly insignificant if they are based on the bed supply-constrained behavior of Medicaid-eligible subjects. Third, because the determinants of bed supply become the determinants of overall use under excess-demand conditions, the determinants of use will reflect, to some extent, the nursing home's desire for profits. Because profitability considerations are reflected in use based estimates of need, these estimates are likely to be misleading.

Specialized dementia programs in residential care settings.

The authors conducted a telephone survey in 7 states to determine the prevalence of residential care specialized dementia programs (RC-SDPs) and to identify a sample of homes (n = 56) for more detailed study. The 56 homes were site visited, and data were gathered on facility administration, therapeutic environment, and characteristics of 259 randomly selected residents. Comparison data from 138 nursing home Special Care Units (NH-SCUs) and 1,340 of their residents were obtained from 4 studies conducted in the same 7 states. RC-SDPs were smaller, provided a more homelike environment, and had a higher proportion of residents paying privately, compared with NH-SCUs. Mean levels of cognitive and physical impairment among residents were higher in NH-SCUs; prevalences of psychotropic medication use and problem behaviors were similar. Among RC facilities, small homes were more homelike, provided fewer structured activities, and charged less than larger facilities. RC-SDPs include 5 types: small, independently operated homes; multiple small homes with joint administration; larger, all-dementia facilities; SDPs operated within larger, exclusively RC facilities; and RC-SDPs in multilevel facilities.

The changing availability of residential aged care in Australia.

Australian aged care services have undergone a series of substantial reforms in recent years under the rubric of the Aged Care Reform Strategy. Overall, there has been a progressive refinement of the targeting of available services on those most in need, defined in terms of both disability levels and financial resources. A key component of this process has been a deliberate reduction in the relative emphasis accorded to nursing home care within the aged care system. This has been accompanied by increases in the resources directed toward less intensive forms of residential care (hostels) and community based services. This paper explores the actual consequences of these intentional policy changes in terms of the availability of nursing home and hostel care, and the changing characteristics of nursing home residents. The results suggest that a more substantial reduction has occurred in the availability of nursing home care than has hitherto been suggested, with consequent decreases in the proportion of aged persons in nursing homes. The effect has been particularly marked amongst women and the very old. These findings raise policy questions about the appropriateness of current and planned future levels of provision.

Understanding the effects of PPS on Medicare home health use.

This study examines changes between 1983 and 1985 in the use of Medicare home health services. The key finding is that while overall increases in the proportion of Medicare enrollees who use home health services and the average number of visits received were relatively small, they were much greater than they would have been without the Prospective Payment System. The introduction of prospective payment for Medicare hospital services appears to have increased Medicare outlays for home health by an estimated 25%. In an effort to reduce patient stays, it appears that hospitals discharged more patients to home health and that home health users were discharged earlier, thus increasing both the number of users and the number of visits received per user. The study also found that changes in nursing home bed supplies and Medicaid reimbursement rates appear to bring about changes in home health use. These results have implications for understanding the impacts on home health services of changes in Medicare and Medicaid policies in other sectors.