New Long-Term Care Policies in Latin America: The National System of Care in Uruguay.

BACKGROUND: Uruguay is the Latin American country with the largest share of elderly population and it has the greatest pressure for formal long-term care services in the region. For this reason, last year the government approved a law creating a National System of Care. OBJECTIVE: This article describes and analyzes the long-term care policy in the recently created National System of Care of Uruguay. METHOD: The Director of the National System of Care was asked to complete a questionnaire with a description and management of long-term care programs. This information was completed with official information and peer-reviewed articles of long-term care in Uruguay. RESULTS: The National System of Care includes long-term care services. The main services are carried out through a cash-for-care system for home-based services, but in the future the benefits will expand to day centers and residential and nursing homes. CONCLUSION: The system follows international trends in terms of universality, services, and regulations dealing with care. However, the current and future financing is low, and this condition could undermine its development capacity.

Manual Administrativo Financiero para la Organización y Funcionamiento de las Casas Maternas / Financial Administrative manual for the Organization and Operation of the Maternal Houses

El presente documento constituye el Manual Administrativo Financiero para la Organización y Funcionamiento de las Casas Maternas que reciben financiamiento subsidiario del Ministerio de Salud (MINSA-FONSALUD. En el mismo se describen las normas y procedimientos administrativos y financieros que deben utilizar las Casas Maternas para asegurar el control interno de los recursos económicos. Este Manual pretende ser un instrumento que contribuya a la Administración eficiente de los recursos financieros en las Casas Maternas (CAM) asegurando el uso racional y eficiente de los mismo. Facilita el registro y control de las operaciones administrativas financieras, que realizan las Casas Maternas; estandariza las normas y los procedimientos administrativos financieros utilizados por las Casas Maternas para la administración de los desembolsos que reciben del MINSA-FONSALUD.

Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.

The influence of nurse wage differentials on nursing home staffing and resident care decisions.

This study examines the extent to which nursing homes adjust staffing and care practices relative to local market conditions. Weighted two-stage least squares regression results suggest that facilities employ more nonprofessional nursing staff in markets in which professional nurse wages are higher. RN staffing levels are higher in markets with a higher percentage of self-pay nursing home residents and a lower percentage of for-profit nursing homes. Controlling for resident characteristics, the use of labor-saving practices is higher in markets with higher average nursing home wages, suggesting that there are economic incentives to hire fewer nursing personnel.

Successful rehabilitation program rests on service utilization.

An effective rehabilitation strategy is built upon three fundamentals: translating resident needs into delivered services, managing occupancy and marketing programs, and utilizing existing reimbursement mechanisms to ensure profitability of the venture.