Advance Directives State Requirements, Center Practices, and Participant Prevalence in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.

OBJECTIVES: Adult day services centers (ADSCs) may serve as an entrée to advance care planning. This study examined state requirements for ADSCs to provide advance directives (ADs) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. About 80.8% of ADSCs provided AD information and 41.3% of participants had documented ADs. There were significant associations between state requirements, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health.

INTRODUCTION: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. OBJECTIVE: To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). METHOD: Review of mental health legislation from 1990 to 2014. RESULTS: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. CONCLUSION: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health / Hospital-dia e Centro de Atenção Psicossocial: ampliando o debate da internação parcial em saúde mental

Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Resumo Introdução: desde a segunda metade do século XX, as discussões em torno da assistência ao doente mental revelam o debate, ainda inacabado, entre dois paradigmas de atenção à saúde: o paradigma biomédico/biopsicossocial e o paradigma psicossocial. A luta pela hegemonia sobre as formas do cuidado, sobre a melhor maneira de lidar com a experiência do adoecimento, subjaz a uma intencionalidade de reorganização dos saberes sobre o binômio saúde/doença, que se reflete nos modelos propostos para a execução das ações e serviços de promoção, prevenção, assistência e reabilitação da saúde humana. Objetivo: problematizar as diretrizes do cuidado do Hospital-dia em Saúde Mental (HDSM) em contraste com o Centro de Atenção Psicossocial tipo III (CAPS III). Método: revisão da legislação em saúde mental entre 1990-2014. Resultados: não foi encontradas a definição de projeto terapêutico e as atividades e técnicas que devem ser empregadas por esses serviços de saúde. Conclusão: o HDSM e o CAPS III são serviços substitutivos à internação hospitalar psiquiátrica que se caracterizam pela complementaridade na atenção ao doente mental. Pelos seus variados e distintos métodos de intervenção, em ação sinérgica, potencializam-se com as contribuições tanto de um modelo quanto do outro modelo de atenção. As discussões em torno do melhor modelo de atenção em saúde mental mostram-se polarizadas entre os paradigmas biomédico/biopsicossocial e psicossocial, condição que reflete a supremacia do segundo sobre o primeiro no discurso político-ideológico que circunscreve a reforma da assistência psiquiátrica, fato que pode prejudicar o desfecho clínico para o paciente e sua família.

Grants for States for construction or acquisition of State homes. Final rule.

This rule adopts as final, without change, an interim final rule amending the Department of Veterans Affairs (VA) regulations governing prioritization of State applications for VA grants for the construction or acquisition of State home facilities that furnish domiciliary, nursing home, or adult day health care to veterans. As amended, the regulation gives preference to State applications that would use grant funds solely or primarily (under certain circumstances) to remedy cited life or safety deficiencies. This rulemaking also makes certain necessary technical amendments to regulations governing State home grants.

[When you see the light of day at the hospital]. / Cuando el hospital se hace de día...

Day Hospital delivers complex treatments to patients with psychiatric illness such as psychosis and severe neurosis. Interdisciplinary work is necessarily required by this device. Our Day Hospital is organized in three sections: community area, clinical area and education and research. Our practice isn't exempt of hindrances, which relate not only to the clinical specifics we deal with, but also with the social, cultural and legal contexts it develops in. Since the approval of the Mental Health National Law (no. 26657) we believe the Day Hospital, our old resource, is given the opportunity to keep fulfilling a space as a proposal both fresh and institutional. The mentioned law states that Day Hospitals are to be promoted as a means for social, labor and community inclusion of patients. We have no doubt on the legal advance this represents but, on daily practice, issues will persist until a strong change decision is shown, implemented as public health policies aligned with the law.

Smoke-free policies in psychiatric services: identification of unmet needs.

INTRODUCTION: Smoke-free policies have been extended to enclosed workplaces in many countries; however, smoking continues to be commonly allowed on psychiatric premises. The aim of this study was to describe tobacco control strategies undertaken in psychiatric inpatient services and day centres in Spain. METHODS: This cross-sectional survey included all psychiatric service centres that offered public services in Catalonia, Spain (n=192). Managers responded to a questionnaire of 24 items that covered four dimensions, including clinical intervention, staff training and commitment, smoking area management and communication of smoke-free policies. RESULTS: A total of 186 managers (96.9%) completed the questionnaire. Results showed low tobacco control in psychiatric services: 41.0% usually intervened in patient tobacco use, 34.1% had interventional pharmacotherapy available and 38.9% had indoor smoking areas. Day centres showed the lowest implementation of tobacco control measures. Out of 186 managers, 47.3% stated that the staff had insufficient knowledge on smoking cessation interventions. CONCLUSIONS: The former Spanish partial law has not been sufficiently successful in promoting tobacco control in psychiatric services. There is room for improvement in tobacco control policies, specifically in smoking interventions, staff training and resource availability.

Technical revisions to conform to the Caregivers and Veterans Omnibus Health Services Act of 2010. Final rule.

This final rule amends Department of Veterans Affairs (VA) medical regulations to incorporate statutory amendments. Certain statutes authorizing VA health care benefits were amended by the Caregivers and Veterans Omnibus Health Services Act of 2010. The statutory amendments affect enrollment in certain health care priority categories and exempt catastrophically disabled veterans from copayment requirements.

[Heterogeneity of the Departments of Mental Health in the Veneto Region ten years after the National Plan 1994-96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project]. / Eterogeneità dei DSM veneti a dieci anni dal Progetto Obiettivo "Tutela Salute Mentale 1994-96". Quali implicazioni per la pratica clinica? Indagine sui servizi partecipanti al Progetto PICOS-Veneto.

AIMS: This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health ("Progetto Obiettivo 1994-1996") ten years after its launch. METHODS: The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. RESULTS: CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. CONCLUSIONS: A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

Self-esteem among elderly people receiving care insurance at home and at day centers for the elderly.

BACKGROUND: Implementation of the Long-term Care Insurance Law of 1988 in Israel has made it possible to provide services to frail elderly people in the community. This study compares two specific services that are offered to elderly people as part of the law: (1) help offered to elderly people by homecare workers, and (2) help offered in day-care centers. METHODS: The study sought to analyze the impact of the two social service approaches on the self-esteem of the care seekers, and included 300 elderly women (150 of whom received services at home and 150 at day-care centers). RESULTS: The findings showed that the self-esteem of elderly women receiving services in a day-care center was higher than that of elderly women receiving the same services at home. CONCLUSIONS: The study shows that the provision of services in a social context is important in giving elderly people proper attention which increases their self-esteem, self-evaluation and sense of mastery.

A comparison of offenders with intellectual disability across three levels of security.

BACKGROUND: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. METHOD: A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). RESULTS: Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

[Effects of nursing insurance on caregiving daughters--the role of professional nursing care]. / Auswirkungen der Pflegeversicherung auf die Situation pflegender Töchter--Die Rolle der professionellen Pflegedienste.

In view of the demographic development the topic of "Nursing of elderly relatives" is gaining more and more importance within nursing research. The object of the investigation described in this paper was to assess the measures of the Pflegeversicherung [Long Term Care Insurance] with regard to its effects on care-giving daughters. This publication assesses one of the questions of the study--what part professional services play in the support of care-giving daughters. The data was collected by individual biographic-narrative interviews in the private household of care-giving daughters. The data was then evaluated according to the method of biographical case reconstruction developed by Gabriele Rosenthal. This way we were able to gain a deeper insight into the situation of care-giving daughters and analyse the consequences of the Pflegeversicherungsgesetz [Long Term Care Insurance Law] from an "inner perspective". The results of the study point to both the positive effects of the Pflegeversicherungsgesetz and its limits. We were able to show that the expansion of out patient services leads to an enhanced nursing infrastructure. In view of the part that professional nursing services play, however, the biographical access also made it clear that the Pflegeversicherung will not lead to far-reaching changes in nursing arrangements. In spite of Pflegeversicherung caregiving relatives still suffer from personal and emotional strain. Also the legal requirements are too narrow and allow hardly enough space for the consideration of the family environment and the history of life of relationship between daughter and mother.

[The reform of psychiatric care in Poland--2001]. / Reforma psychiatrycznej opieki zdrowotnej w Polsce--2001.

Both positive and negative effects of the reform of the health care financing system are noted. Low prices offered by Sickness Funds for particular services (a bed-day, a visit) should be regarded as a negative effect of the reform. Particularly insufficient were the prices of services in some specialised psychiatric wards and in outpatient clinics. Prices in many community-based psychiatric facilities were also considerably underestimated. Undoubtedly, the reform has led to positive changes in the organization of inpatient care. These changes include: further reduction of beds in large hospitals organisational structure as well as a marked increase in the number of psychiatric wards at general hospitals, which should be the key units of psychiatric inpatient care. Increase in the number of day hospitals is another positive effect of the reform. The programme of psychiatric care transformation is presented mostly in the Mental Health Programme. The main goal of this programme is to ensure appropriate care for the mentally disordered people, namely comprehensive and accessible health care as well as other forms of help and and support necessary for living in family and in society. This goal will be accomplished by health care and other forms of help mentioned in the Mental Health Act and in the Social Help Act. Community-based model of psychiatric care is the key element of this system. Also, the Programme states desired accessibility rates for staff, number of beds and number of particular forms of psychiatric and alcohol treatment care. Separate rates for adult and children/youth population have been elaborated.

State legislation to support family caregivers. Opportunities for partnerships abound.

This article focuses on three examples of state legislation that can improve the quality of life of family caregivers while enhancing the role of home care agencies.