Modalidades de atención a domicilio del Sistema Único de Salud (SUS) articuladas a las Redes de Atención a la Salud / Modalidades de atendimento à domicilio do Sistema Único de Saúde (SUS) articuladas às Redes de Atenção à saúde / Modalities of Home service of the Unified Health System (SUS) articulated to Health Care Networks

El objetivo es conocer la literatura científica publicada desde 2008 hasta 2014 sobre las redes de atención a la salud y los procedimientos de atención a domicilio del Sistema Único de Salud. Se trata de una revisión integradora realizada vía on line a través de la Biblioteca Virtual en Salud en la base de datos de la Literatura Latino.Americana y del Caribe en Ciencias de la Salud (LILACS), el Banco de Datos de Enfermería (BDEnf) y Medical Literature Analysis and Retrieval System Online (MEDLINE), respetando los aspectos éticos en cuanto a la autoría de artículos. La muestra consistió en 06 artículos científicos completos seleccionados mediante la observación de los criterios de inclusión y exclusión. Se observó que a pesar de que las Redes de Atención Médica y las modalidades de atención a domicilio del Sistema Único de Salud están adquiriendo gran importancia en el ámbito de la salud, existen pocos artículos publicados relacionados con esta temática. Se concluye que los servicios implicados en las actividades de salud deben formar una red interdependiente, interrelacionada, utilizando como punto básico la complejidad de las necesidades del usuario a ser atendido. Se recomienda una profundización en este asunto para lograr una conciencia colectiva sobre el tema. Es preciso comprender la importancia real que la atención a domicilio en conjunción con las redes de atención a la salud es capaz de proporcionar para la vida de las personas, sin embargo, es necesario que los responsables, directa o indirectamente, de la coordinación de los servicios de salud consigan implementarlas en las redes interconectadas (AU)

Objetiva-se conhecer a produção científica publicada no período de 2008 à 2014, a respeito das Redes de atenção à saúde e as modalidades de atendimento à domicilio do Sistema Único de Saúde. Trata-se de uma revisão integrativa realizada via online na Biblioteca Virtual em Saúde na base de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Banco de dados da Enfermagem (BDEnf) e Medical Literature Analysis and Retrieval System Online (MEDLINE), respeitando os aspectos éticos em relação as autorias dos artigos. A amostra constituiu-se de 06 artigos científicos completos selecionados observando critérios de inclusão e exclusão. Observou-se que apesar das Redes de Atenção à Saúde e as modalidades de atendimento à domicilio do Sistema Único de Saúde estarem adquirindo grandes proporções no âmbito da saúde existe um número reduzido de artigos publicados relacionados à temática. Conclui-se que os serviços que integram as atividades de saúde deveriam constituir uma rede interdependente, inter-relacionada utilizando como ponto básico a complexidade das necessidades do usuário a ser atendido. Recomenda-se um aprofundamento desta temática para que haja uma sensibilização coletiva sobre o assunto. É preciso compreender a real importância que o atendimento à domicílio em articulação com às redes de atenção à saúde é capaz de proporcionar para a vida da população. Entretanto, é necessário que os responsáveis, direta ou indiretamente pela articulação dos serviços de saúde consigam implementá-los em redes inter-relacionadas (AU)

The objective is to know the scientific literature published from 2008 to 2014 about the health care networks and the procedures for compliance with the domicile of the Unified Health System. It is an integrative review conducted online via the Virtual Library Health in the Latin American database and Caribbean Health Sciences (LILACS), Bank of Nursing data (BDEnf) and Medical Literature Analysis and Retrieval System Online (MEDLINE), respecting the ethical aspects regarding the authorship of articles. The sample consisted of 06 full scientific papers selected by observing the inclusion and exclusion criteria. It was observed that despite the Networks of Health Care and terms of service to the domicile of the Unified Health System are acquiring major in health, there are few published articles related to the topic. It is concluded that the services involved in health activities should form an interdependent network, interrelated using as basic point the complexity of user needs being met. It recommends a deepening of this issue so that there is a collective awareness on the subject. You must understand the real importance of the domicile to the service in conjunction with the health care network is able to provide for people's lives, however, it is necessary that those responsible directly or indirectly for coordination of health services able to implement them in interconnected networks (AU)

[Activities of daily living and demand for care of the elderly with chronic conditions in Chengdu].

OBJECTIVE: To evaluate the activities of daily living and demand for care of the elderly with chronic conditions in Chengdu in order to develop appropriate care models. METHODS: Convenient sampling strategy was adopted to recruit participants in four communities in Chengdu. A total of 180 elderly respondents with chronic conditions completed a questionnaire survey, which evaluated the activities of daily living and demand for care of the respondents. RESULTS: More than 77% respondents suffered from two or more chronic conditions. Over 97% respondents followed medical advices of doctors in drug therapy, with 70% monitoring the effectiveness of the drug therapy by themselves. The chronic conditions of 61% of respondents were well controlled. More than 54% were able to perform activities of daily living; 38% needed assistance; and 8% were completely dependent on others. Age and numbers of conditions influenced the activities of daily living (P < 0.005). Over 98% respondents were aware of their care needs and 1% identified unmet needs. Care for elderly came mainly from families, followed by relatives, friends, neighbors and workmates. Demands for care depended on financial capacity, degree of independence and numbers of conditions. Demands for nursing care increased with numbers of conditions (P < 0.05). CONCLUSION: The ability of elderly performing activities of daily living decreases with age and chronic conditions. A multidimensional care model involving professional carers needs to be developed in responding to the increasing needs of aged care.

Medicaid State Plan personal care services: trends in programs and policies.

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.

Estimating the expense of a mandatory home-and community-based personal assistance services benefit under Medicaid.

UNLABELLED: Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability. DESIGN AND METHODS: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS. RESULTS: New expenditures for PAS are estimated to be $1.4-$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA). IMPLICATIONS: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.

Personal assistance in Sweden.

This article provides an overview of the Swedish personal assistance program for persons with severe impairments, introduced in 1994. The personal assistance program makes it financially possible for people with severe disabilities to appoint a personal assistant, by themselves or through a provider, to create support adapted to the individual and to optimize the person's influence over how the support is arranged. The article describes how the reform has increased the opportunity for people with severe disabilities to choose their own way of living. Overall, the personal assistance has enhanced the quality of life for people with severe disabilities and their families.

Evaluation of a consumer-personal assistant training project.

PURPOSE: This study evaluated a personal assistance services (PAS) training programme that aimed to improve the consumer and personal assistant relationship and increase consumer and personal assistant knowledge on health and wellness issues. METHOD: A total of 87 consumers and 53 personal assistants were enrolled in this longitudinal intervention study. Consumers and personal assistants in the intervention group participated in a six-hour in-person PAS training programme. RESULTS: Consumers and personal assistants who participated in the training had increased knowledge at both three and six months post-training compared to consumers and personal assistants who were in the non-treatment group. There were no differences in consumer/personal assistant relationship variables. CONCLUSIONS: Future studies should examine the impact of PAS training programmes on health behaviours needed to decrease secondary conditions.

[Public social health services to demented persons living at home in Norway]. / Omsorgstilbud til hjemmeboende personer med demens.

BACKGROUND: About 50% of the 65,000 elderly with dementia in Norway live in their own homes, and are cared for by their families and social and health care personnel in the municipalities. According to governmental documents, the provision of help to demented patients should be predictable, continuous, individually tailored, and carried out by few helpers. The purpose of this study was to examine public social and health services provided to demented patients living at home. MATERIAL AND METHODS: Provision of public care to 460 patients from 24 municipalities, was recorded for seven consecutive days. The average patient age was 82 years (SD 7.1), 74% were women. Degree of dementia was assessed with the Clinical Dementia Rating scale (CDR). Functional status and need of help was assessed with the Rapid Disability Rating Scale-2 (RDRS 2). RESULTS AND INTERPRETATION: . Of the 460 patients, 54% had received a diagnosis by a physician. On average, 8 (SD 4) different people helped for 5.4 ( SD: 6.3) hours a week. Help was most frequently given to; take medicines, prepare food, carry out personal Activity of Daily Living (ADL) and to clean the house. Some did not receive enough help and a few received too much. Patients with a dementia diagnosis did not receive more help than those without. The results indicate that Norwegian municipalities provide a substantial amount of health services, but fail to tailor plans according to individual needs.

Private pay home care referrals: issues and challenges.

Assisting clients in determining the need for and choosing the type of private duty services can be confusing. This article provides: .An overview of the types of private duty home care services; . Key issues and challenges associated with each model; . Referral guidelines for quality private duty agencies; and . How the National Private Duty Association (NPDA) can assist in making quality referrals.

The current state of personal assistance services: implications for policy and future research.

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research.

Personal & supportive care services: an international perspective on workforce issues.

Familiehulp, the largest home care organization in Flanders, Belgium, has 40,000 clients and 7,400 employees. Believing its staff is its most valuable capital, Familiehulp has instituted the concept of self-steering teams. The United Kingdom's home care was unregulated until April 2003. A major objective of that country is to get the disabled back to work. In the United States, the average tenure of home care aides for this presenter's agency is eight years. He shares his secrets for recruiting and retaining the best.

Culture and long-term care: the bath as social service in Japan.

A central feature of Japan's approach to community-based care of the elderly, including long-term home health care, is the emphasis on providing bath facilities. For mobile elders, senior centers typically provide a public bathing facility in which people can enjoy a relaxing soak along with friends who also visit the centers. In terms of in-home long-term care, visiting bath services are provided to assist family care providers with the difflcult task of bathing a frail or disabled elder--a task made more problematic as a result of the Japanese style of bathing. I argue that the bath, as social service, is a culturally shaped solution to a specific problem of elder care that arises in the Japanese context as a result of the importance of the bath in everyday life for Japanese. While the services may be considered specific to Japan, some aspects of bathing services, particularly the mobile bath service, may also have applicability in the United States.

Management of respite and personal assistance services in a consumer-directed family support programme.

BACKGROUND: The present study explores the management of respite and personal assistance services by families with relatives with developmental disability (DD). It focuses on the control of families over recruiting, hiring, training, scheduling, directing and negotiating wages of the staff they hire to provide services. METHODS: Surveys from 97 families using paid respite or personal assistance services were used to test associations between: 1) level of control of services and outcome variables; 2) hiring relatives to provide services and outcome variables. RESULTS: More control by families in the management of their respite/personal assistance services was associated with increased service satisfaction, increased community involvement of individuals with DD and increased employment of mothers. Families tended to hire friends, neighbours, and to a great extent, other family members. Hiring of other relatives to provide services was associated with the increased community involvement of individuals with DD. CONCLUSIONS: The present study supports the idea that there are benefits for both caregivers and individuals with DD with increased control of respite and personal assistance services. The study also supports benefits associated with hiring relatives and recommends additional research in this area to guide policies.

Perspectives of elderly people receiving home help on health, care and quality of life.

From a nursing perspective it is important to have information about the type of care needed, the reasons care is needed and quality of life among the most elderly people living in their own homes, in order to support their independence and maximise their quality of life. Thus a study was performed to investigate people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases, and complaints in relation to quality of life as perceived by themselves. The sample (n = 448) comprised those who, in an age-stratified randomised sample of adults living in their own homes, responded that they were dependent on help from others. The questionnaire covered sex, age, living conditions, civil status and number of children and cohabitation, respondents' health, diseases, quality of life, help from another person, and the type and amount of help received. The number of elderly persons dependent on help ranged from 18.5 to 79.1% in the different age groups. The help came mainly from informal carers (84.1%), and, in 53.1% of cases, from the home help service and home nursing care. Help from formal caregivers was given in combination with that from a next of kin in 38.8% of the cases. More next of kin than formal carers helped in all Instrumental Activities of Daily Living (IADL) and Personal Activities of Daily Living (PADL) tasks, with the exception of cleaning the house and providing a bath/shower. Although the respondents received help themselves, they also helped another person in 6.5% of cases. The elderly reported a median of three diseases and ten different complaints of which pain and impaired mobility were the most frequent. Between 20 and 40% of the respondents in the different age groups reported restricted ability to be alone and one third of them reported low or very low quality of life. Multiple linear regression analysis showed the number of complaints, restricted ability to be alone, living alone and age to have a significant relationship on low quality of life.

State Medicaid programs offering personal care services.

Two Medicaid programs offer personal care services: (1) the Title XIX Personal Care Services (PCS) optional State plan benefit; and (2) the 1915(c) home and community-based services (HCBS) waivers. By 1998-1999, 26 States offered the PCS optional State plan benefit; 45 offered personal care services via a waiver(s). Nationwide, the former program was larger. The latter was the more popular administrative mechanism, possibly because it more reliably controls growth. States vary dramatically in terms of Medicaid personal care. Medicaid personal care participants per 1,000 State population ranged from 7.33 to 0.04. Per capita expenditures ranged from $91.21 to $0.02.