Social participation in Australian residential aged care: A human rights perspective.

The Royal Commission into Aged Care Quality and Safety emphasised the critical need for a human rights-based approach to protect the rights of older people in the Australian aged care context, including 'the right to social participation'. This topic is important because of the widespread social isolation and loneliness in Australian residential aged care. This article demonstrates how a human rights-based framework can provide guidance to governments in approaching issues involving the protection of older people's need for social connection in aged care. In doing so, the article considers examples of how the Australian government can ensure choice of living arrangement, individualised support and access to community services and facilities in the residential aged care context to better protect the right to social participation.

Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations.

OBJECTIVES: Present analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). DESIGN: Review and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH-Serious Illness Care (SIC) model domains. SETTING AND PARTICIPANTS: The 155 PACE organizations operating in 32 states and the District of Columbia. METHODS: A multipronged search was conducted to identify official state and federal manuals guiding the implementation and functions of PACE organizations. The CMS PACE website was used to identify the federal PACE manual. State-level manuals for 32 states with PACE programs were identified through several sources, including official PACE websites, contacts through official websites, the National PACE Association (NPA), and public and academic search engines. The manuals were searched according to the BH-SIC model domains that pertain to integrating BH care with complex care individuals. RESULTS: According to the CMS Manual, the interdisciplinary team is responsible for holistic care of PACE enrollees, but a BH specialist is not a required member. The CMS Manual includes information on BH clinical functions, BH workforce, and structures for outcome measurement, quality, and accountability. Eight of 32 PACE-participating states offer publicly available state PACE manuals; of which 3 offer information on BH clinical functions. CONCLUSIONS AND IMPLICATIONS: Regarding BH, federal and state manual regulations establish limited guidance for comprehensive care service delivery at PACE organizations. The absence of clear directives weakens BH care delivery due to a limiting the ability to develop quality measures and accountability structures. This hinders incentivization and accountability to truly all-inclusive care. Clearer guidelines and regulatory parameters regarding BH care at federal and state levels may enable more PACE organizations to meet rising BH demands of aging communities.

Situación legal de la atención farmacéutica en residencias de ancianos en España / Legal Situation of Pharmaceutical Care in Nursing Homes in Spain

ntroducción: La mayor esperanza de vida está pro-duciendo un aumento de la población de personas mayores de 65 años. Este grupo de población se caracteriza por un elevado consumo de medica-mentos y de asistencia sanitaria, permaneciendo muchos de ellos en centros residenciales donde son cubiertas todas sus necesidades. El perfil farmacoterapéutico de estos pacientes suele ser complejo debido a la polimedicación y a las pato-logías crónicas que padecen. Es aquí donde entra en juego el papel del farmacéutico a través de servicios asistenciales. El objetivo de esta revisión es analizar la situación legal, a través del estudio de la normativa específica española que regula la atención farmacéutica en centros sociosanitarios.Método: Revisión de la situación legal de la aten-ción farmacéutica en centros sociosanitarios en EspañaResultados: En España, el marco legal básico se encuentra en el Real Decreto Ley 16/2012 que esta-blece la obligación de tener un servicio de farmacia para los centros sociosanitarios que tengan cien o más camas en régimen de asistidos, mientras que aquellos con menos camas tendrán que tener-lo vinculado a un hospital o a una farmacia. Sin embargo, cada Comunidad Autónoma establece un régimen propio de funcionamiento, a través de su normativa específica.Conclusiones: Existen diferencias en la regulación de los centros sociosanitarios en cuanto a presta-ciones, funciones y servicios farmacéuticos corres-pondiente a cada Comunidad Autónoma (AU)

Introduction: Longer life expectancy is producing an increase among the population of people over the age of 65. This population group is charac-terized by a high consumption of medicines and healthcare, living many of them in residential facili-ties where all their needs are covered.The pharmacotherapeutic profile of these patients is usually complex due to their polymedication and the chronic pathologies they suffer. Here is where the role of the pharmacist comes into play with healthcare services. The aim of this review is to analyze the legal situation by studying the specific Spanish regulations that rule the pharmaceutical care in social and health care centers.Method: Review of the legal situation of pharma-ceutical care in social-health centers in Spain.Results: In Spain, the basic legal framework is found in Royal Decree Law 16/2012, which estab-lishes the obligation to have a pharmacy service for social care centers with one hundred beds or more in assisted care, while those with fewer beds must be linked to a hospital or pharmacy. However, each Autonomous Community establishes its own oper-ating regime through its specific regulations.Conclusions: There are differences in the regula-tion of social and healthcare centers in terms of benefits, functions and pharmaceutical services corresponding to each Autonomous Community (AU)

VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation.

BACKGROUND: Interdisciplinary team (IDT) care is central to home-based primary care (HBPC) of frail elders. Traditionally, all HBPC disciplines managed a patient (Full IDT), a costly approach to maintain. The recent PACE (Program of All-inclusive Care for the Elderly) regulation provides for a flexible approach of annual assessments from a core team with involvement of additional disciplines dependent upon patient needs (Core+). Current Department of Veterans Affairs (VA) HBPC guidance specifies Full IDTs care for medically complex and functionally impaired Veterans similar to PACE participants. We evaluated whether VA HBPC has adopted the flexible structure of the PACE regulation, aligned to Veteran needs. DESIGN: Cross-sectional analysis. SETTING: All 139 VA HBPC programs administered across 379 sites. PARTICIPANTS: About 55,173 Veterans enrolled in HBPC during fiscal year 2018. MEASUREMENTS: Patients' HBPC physician, nurse, psychologist/psychiatrist, social worker, therapist, dietitian, and pharmacist visits were grouped into interdisciplinary team types. Patient frailty was classified using VA HNHR v2 (High-Need High-Risk version 2, a measure of high, medium, and low risk of long-term institutionalization). Medical complexity was measured by clusters of impairment in the JEN frailty index (JFI). JFI clusters were validated by VA's Nosos measure to project cost and Care Assessment Need (CAN) measure of hospitalization and mortality risk. RESULTS: HBPC provided Full IDT care to 21%, Core+ care to 54%, and Home Health+ (HHA+) care (skilled home health services plus additional disciplines, without primary care) to 16% of Veterans. Team type was associated with medical complexity (X2 2863.5 [66 df], p < 0.0001). High-risk Veterans (72% of sample) were more likely to receive Full IDT care (X2 62.9, 1 df), p < 0.0001), while low-risk Veterans (28%) were more likely to receive HHA+ care (X2 314.8, 1 df, p < 0.0001). CONCLUSION: There is a strong association between HBPC team patterns and patient frailty, indicating tailoring of care to match Veteran needs.

WebPalestra: Políticas Públicas de Atenção à Saúde da pessoa idosa

A saúde do idoso no contexto do SUS: o lado formal da moeda. Política Nacional do Idoso (1994). Estatuto do Idoso (2003). Política Nacional de Saúde da Pessoa Idosa (2006). As políticas de saúde no cotidiano do idoso: o lado real da moeda.

Webconferência: a violência contra a pessoa Idosa - Telessaúde ES 24/06/2014

Webconferência: prevenção de violência contra as pessoas Idosas - Telessaúde ES 30/06/2015

Webconferência: importância da caderneta de saúde da pessoa idosa - Telessaúde ES 05/04/2016

WebPalestra: direitos da pessoa idosa

Direito a saúde; Direito à alimentação e assistência social; Direito à habitação; Direito à profissionalização e ao trabalho; Direito à aposentadoria e pensão; Direito ao transporte e à acessibilidade; Direito à educação, cultura, esporte e lazer; Direito de acesso à justiça.

COVID-19 in the Long-Term Care Setting: The CMS Perspective.

Safeguarding the health and promoting the well-being and quality of life of the most vulnerable and fragile citizens is a top priority for the Centers for Medicare & Medicaid Services (CMS). In response to the Coronavirus Disease 2019 (COVID-19) pandemic, numerous regulatory policies and 1,135 waivers of federal requirements have been implemented by CMS to give long-term care providers and professionals flexibility to meet the demands of resident and patient care needs during this public health emergency. Goals for these policies and waivers are increasing capacity, enhancing workforce and capability, improving oversight and transparency, preventing COVID-19 transmission, and reducing provider burden. J Am Geriatr Soc 68:1366-1369, 2020.

Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans.

BACKGROUND: One of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement. AIM: This study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa. SETTING: Eighteen community health centres (CHCs) formed the sampling frame for the study. METHODS: This study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health. RESULTS: Several national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management. CONCLUSION: This article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions.

How provider organisations interpret regulation in the context of residential dementia aged care.

OBJECTIVE: To explore how Australian residential dementia aged care providers respond to regulation via organisational culture, level, processes and interpretation. METHODS: Observation took place in three provider organisations. Qualitative, semi-structured in-depth interviews were conducted with aged care staff (n = 60) at three different levels of each organisation: senior management from three head offices (n = 17), facility management (n = 13) and personal care workers (n = 30) from eight residential care facilities. RESULTS: Orientations towards regulation included the following: "above and beyond;" "pushing back;" and "engineering out." Regulation was interpreted differently depending on the level of authority within an organisation where boundaries were managed according to strategic, operational and interactional priorities. DISCUSSION: Examining regulation within an organisational context and at different staff levels suggests ways to balance dementia care with regulatory control. Both generate stress, mitigated by culture and interdependent role differentiation.

An examination of organisational policies for healthcare and lifestyle decision-making among Australian aged care providers.

OBJECTIVE: Examine policies of aged care organisations relating to healthcare and lifestyle decision-making. METHODS: Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) "Decision-Making Principles" as a framework. Senior staff (N = 9) with policy development roles participated in follow-up interviews. RESULTS: The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision-making; however, the nature of this support was often unclear. Interview themes included factors relating to "organisational contexts" "policy development and implementation" and "ethical challenges." An overarching theme among high-performing organisations was "proactive response aimed at pre-empting decision-making dilemmas". We provide recommendations for policy development, including a self-assessment audit tool. CONCLUSION: Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision-making to meet current best practice principles.

What you say and what I want: Priorities for public health campaigning and initiatives in relation to dementia.

OBJECTIVE: To examine the overlap between priorities expressed by representatives from national and local campaigning organisations and the views of key voices in relation to dementia. METHODS: Semi-structured, in-depth telephone interviews were conducted with 19 representatives from campaigning organisations, including nine countries and six local community initiatives in Australia. Responses were categorised into nine priorities. Views were compared to the voices of people with dementia (n = 19), carers (n = 28), and health-care (n = 21), social work (n = 23) and service professionals (n = 20). RESULTS: Local groups prioritised user-led decision-making and community normalising agendas. National groups were influenced by service frameworks and increasing public awareness. Professional and carer groups focused on increasing understanding and communication skills while people with dementia valued being a normal part of society. CONCLUSION: Future campaigning should use both national and local approaches to changing social relations, through interpersonal connections, advocacy and social mobilisation, to promote a normalising approach to attitude change.

The impact of Dependency Act benefits on employment.

OBJECTIVE: To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. METHODS: The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. RESULTS: The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. CONCLUSIONS: Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits.

Progress and Policy Opportunities in Family Caregiver Assessment: Results From a National Survey.

Family caregivers play an essential role in long-term services and supports (LTSS). Despite numerous calls for robust caregiver assessment policies to determine needs and treat them as partners in care planning, there has been limited information about whether or how states assess caregiver needs and strengths, or use caregiver information. Using cross-sectional survey data from the 2015 Process Evaluation of the Older Americans Act National Family Caregiver Support Program (NFCSP), this study analyzes caregiver assessment policies and practices in 54 State Units on Aging, 619 Area Agencies on Aging, and 642 local service providers. It examines whether and for what purposes caregiver assessments are used, what domains are included, and how well current policies conform to recommended practice. It also recommends that policy makers who influence NFCSP and other LTSS programs develop caregiver assessment practices using a multidimensional framework including more caregiver-focused domains and utilizing assessment data to measure program outcomes.