Privately practising nurse practitioners' provision of care subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme in Australia: results from a national survey.

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

Paid companions: a private care option for older adults.

Paid companions, operating either independently or through private home care agencies, perform a variety of services for financially secure older adults who can afford to pay for private support in their homes and in care facilities. Drawing on semi-structured, open-ended, in-person interviews and autodriven photo elicitation (whereby individuals take their own photos and discuss them later in the interviews) with 30 participants (15 companions, 8 clients, and 7 key informants), this study examined the work performed by paid companions. The findings revealed that, in many ways, the companion-provided services for clients living in their own homes resemble task-based home care work, but the work's emphasis is different. The social and emotional relationship with clients is the central focus of their work. Facility-based companions provide a unique role filling the care gap left by government cutbacks to staffing ratios which keeps elderly residents, often with dementia, involved and engaged in the world.

The increase in illegal private duty nurses in public Greek hospitals.

AIM: To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. BACKGROUND: Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. EVALUATION: Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. KEY ISSUES: Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. CONCLUSIONS: It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. IMPLICATIONS FOR NURSING MANAGEMENT: Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.

Private duty nurses in Greek hospitals: a literature review.

AIM: The study aims to provide an overview of the practice of private duty nurses in Greek hospitals. BACKGROUND: For several decades, it has been a necessity for some hospital patients to hire private duty nurses (PDNs) to counterbalance the inadequacies of hospital infrastructures. In the current economic crisis in Greece, the majority of patients will not be able to afford to pay for private nursing care. METHODS: Databases such as PubMed, CINAHL, ScienceDirect, Wiley Online Library, Google Scholar and national sources were searched for relevant literature through a range of keywords. Information gathered was evaluated for relevance and grouped on a thematic basis. FINDINGS: Five articles met the inclusion criteria. Nearly 90% of PDNs have secondary levels of education or below. Approximately 15% of patients use PDNs at night due to nurse shortages and inability of their families to stay with them. Fifty per cent of the relatives reported being very unsatisfied with PDN services, while the cost for the use of a PDN is rather high. CONCLUSION: The existence of private duty nursing has been largely responsible for protecting healthcare authorities from the need to develop effective care infrastructures. In the current economic climate, nursing and healthcare authorities must staff wards appropriately for safe, free and efficient care for all patients. Effective utilization of the national nursing and healthcare workforce--including PDNs with appropriate qualifications--and matching demand with the necessary skills is essential.

Concurrent care for the medically complex child: lessons of implementation.

After years of the palliative care community calling for more open access to hospice services, pediatric patients are now eligible to receive simultaneous hospice services and disease-directed therapy. We report on five types of challenges that our team has experienced when implementing concurrent care, illustrated through case studies of three medically complex pediatric patients.

The ever-evolving private pay model.

As more consumers choose to take part in directing their health care futures, our industry finds itself witnessing significant changes in the private pay model and playing a role in how that model evolves. Over the last two decades, we've watched the private pay industry mature and consumer interest increase. We've identified greater opportunities for growth, and more importantly, opportunities for providing the highest quality programs and services for clients. Our future insight can be best gained by a brief look at where this industry has been and where it is heading.

Financing of pediatric home health care. Committee on Child Health Financing, Section on Home Care, American Academy of Pediatrics.

In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.

Family and paid caregivers of hospitalized patients in Korea.

AIM: To examine patient need for family and paid caregivers during hospitalization and determine factors related to caregiver use and the economic burden for paid caregivers. BACKGROUND: Provision of nursing care is influenced by the characteristics of the society and its health care system. An influencing factor in Korea is the involvement of family caregivers in inpatient care. Korean society has preserved the strong tradition of family bonds and filial responsibility for caregiving. However, the ability of Korean families to assist hospitalized family members has decreased as the society becomes more industrialized. DESIGN: A cross-sectional study design was used, employing data from the Seoul Citizens' Health Survey, a community-based interview survey with 3,203 inpatients in Seoul, conducted in 2001. METHODS: Distributions of caregivers and related factors were explored by employing univariate comparisons and multivariate logistic regression analyses. RESULTS: During hospitalization, 87% of patients needed caregivers. A greater need for caregivers was found in children, women giving birth and patients with disability, longer length of stay and discharge from general hospitals. Family members were the primary caregivers while 3% of inpatients used private paid caregivers. Having paid caregivers was associated with being female, older, high household income, disability, longer stay and discharge from general hospitals. The average daily expense for paid caregiver was 38.5 US dollars (USD) and 73% of patients perceived it as burdensome. CONCLUSIONS: The demonstrated need for caregivers may suggest that patients rely on family and paid caregivers in receiving assistance and care during hospitalization. Therefore, implementation of policies to relieve the burden of caregivers is necessary at both institutional and national levels. Nursing services need to be redesigned in response to changing needs and expectations of patients and their family members.