Non-profit and for-profit organizations in home care services: a comparative analysis

The paper analyzes differences in the organizational, structural and strategic behavior of Non-Profit Organizations and For-Profit Organizations in Israel which provide home care services for the frail elderly. In contrast to other studies which have analyzed differences between institutions delivering various social services in the profit and non-profit sectors, this paper focuses on those organizations supplying home care services in the community. The findings suggest that NPO's have qualitative and operational advantages over FPO's.     

Managing competition in the health care industry

Health-care decisions made by consumers are generally not made by informed choice. Hospitals, expanding their market beyond physician referrals, are discovering that consumers are interested in taking a more active role. Managed-competition programs may be one of the first concepts to fine-tune a new broad-based health-care system.     

Staff perceptions of end-of-life care in long-term care

OBJECTIVE: Although residential care/assisted living facilities and nursing homes have increasingly become a significant site of death for older Americans, little is known about staff perceptions of end-of-life care, perceived need for improvement in care, and differences by type of setting. DESIGN, SETTING, AND PARTICIPANTS: Ninety-nine staff provided their perceptions of end-of-life care for 99 decedents from 74 residential care/assisted living facilities and nursing homes in four states as part of a larger cohort study. Staff were interviewed retrospectively regarding care provided during residents' last month of life. MEASUREMENTS: Staff reported on 11 areas of end-of-life care, describing the importance of each area and the level of improvement they felt was indicated. Weighted "need for change" scores were calculated as the product of perceived importance and need for improvement. RESULTS: Both residential care/assisted living and nursing home staff reported a need for more staff education and nursing assistant time, as well as more use of volunteers. The two lowest ranked items for both facility types were involvement of hospice and encouragement for staff to attend funeral services. Nursing home staff perceived a greater need for improvement than residential care/assisted living staff in all 11 areas. CONCLUSION: Results underscore the staffing demands of end-of-life care across facility types, and staff desires to be able to provide quality care throughout the dying process.     

Telling the story: perceptions of hospice in long-term care

We used qualitative methods (13 homogenous focus groups of residents, bereaved family members, licensed staff, paraprofessional staff, and social workers) to examine the components of a good death in a long-term care (LTC). Hospice involvement as beneficial to end-of-life care emerged as a naturally occurring theme and hospice was deemed as expert in all groups. Participants indicated some barriers to hospice involvement as well as difficulties in collaboration between facility staff and hospice personnel. When viewed within the context of existing literature, these data suggest that a new model of hospice care in which hospice staff serve as expert consultants may be appropriate. This model that recognizes and optimizes the experience of both the facility staff and hospice personnel will benefit care recipients.     

农村卫生服务于新农村建设探讨

党和政府历来重视农村卫生工作，建国以来，农村卫生事业蓬勃发展，医疗预防保健网络覆盖广大农村，农村医疗卫生服务能力明显增强，农民的健康水平显著提高，我国曾经创造的合作医疗、农村三级卫生网络和卫生队伍三大法宝，被公认为国际的典范。但由于多种原因，我国农村卫生明显落后于其他社会事业，农村卫生服务体系不适应农民健康需求的问题仍相当突出，特别是中西部贫困地区农民看病难、看病贵，以及因病致贫、因病返贫问题突出，已成为新农村建设的巨大挑战。必须引起我们的高度重视，积极寻求对策。     

Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario

The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a "managed competition" model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario's managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms.     

Waiting for placement: Discharge from hospital to long-term care in Ontario

Great pressures are placed on hospitals to promptly discharge patients. This is especially true of patients deemed “alternate level of care,” often referred to pejoratively as “bed blockers.” To alleviate these pressures, hospitals enact policies, both formal and informal, to discharge alternate level of care patients who are awaiting placement into long-term care homes. In addition to being dangerous for some of the patients discharged, these discharge policies also leave the hospital, its employees, physicians, and Community Care Access Centres open to legal liability. In 2013, the Advocacy Centre for the Elderly received more than 300 individual requests for legal service in 2013 on behalf of patients, relating to conflict with hospital policies and the placement process. This article analyzes the legal requirements relating to discharge from hospital and admission to long-term care.     

Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives

This paper examines the extensive restructuring of community-based long-term care that was initiated in Ontario, Canada in 1996, and does so with particular reference to longstanding problems of provision in rural communities. Specifically, it draws on a case study focussed on two small rural towns to develop a 'situated understanding' of service-user and service-provider perspectives on service coordination issues and on service cuts, particularly as they affect the ability of elderly people reliant on publicly-funded community services to stay in their homes, to continue to 'age in place'. The general and specific antecedents of long-term care reform are considered prior to the presentation of the case study. General antecedents include the rapid aging of Canada's population and aggressive strategies to reduce government deficits, while specific antecedents flow from a decade of failed attempts to address longstanding issues of service coordination and from the ideologically-driven, free market stance of the provincial government elected in 1995. The analysis of interviews conducted with 14 community-service users and 17 providers suggests that the managed competition system introduced as the centerpiece of long-term care reform has resulted in increasing diversity and uncertainty on both sides of the service provision equation. Despite continued attempts by rural elderly people and their families to 'cut and paste' support packages, it seems that the restructuring of publicly-funded community services, combined with a substantial re-investment in long-term care facilities, will make some elderly people more vulnerable to institutionalization.     

Physician productivity in ambulatory care: for-profit and military primary care health clinics

In summary, by being aware of the characteristics of their physicians and patients, ambulatory care managers might be able to influence their physician productivity. Specifically, managers may wish to hire physicians who are board certified or foreign medical school graduates. Similarly, managers may seek to attract patients with acute, nonsevere, nonurgent conditions. Managers seeking to enhance physician productivity should consider these characteristics regardless of the reimbursement or proprietary nature of their ambulatory care organizations.     

Assessing the continuing education needs of long-term care administrators in Ontario: results of a survey

This article reports the results of a 1989 survey of the professional characteristics and educational needs of 429 managers and supervisors in long-term care institutions and community-based service agencies in greater metropolitan Toronto. The data identify important gaps in the professional training of these administrators: while two-thirds report attainment of postsecondary education credentials, the remaining third, including a quarter of senior managers, have no formal college or university training. Moreover, of those with postsecondary credentials, only a minority are trained in health or human services and administration--skills and knowledge areas key to establishing and managing a client-centered continuum of long-term care. The data also demonstrate that there is widespread support in principle and practice among current administrators in the Toronto region for programs of education which address the particular challenges of long-term care administration, and that specific credentials in the field are seen as a future requirement for promotion to management positions. Preferred modes of education program delivery are short, intensive seminars and night classes.     

Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario

Purpose  

To estimate health status utilities in long-term care (LTC) residents in Ontario, both with and without pressure ulcers (PUs), and to determine the impact of PU on health-related quality of life (HRQOL).     

Risk factors for falls and injuries in a long-term care facility in Ontario

OBJECTIVE: To identify risk factors for falls and injuries among seniors living in a long-term care facility. METHOD: Case-control study of 335 residents living at St. Joseph's Villa, Dundas, Ontario. Cases were defined as residents who fell between July 1, 1996 and June 30, 1997; controls were those who did not fall. To identify risk factors for injury, cases were defined as those with completed incident injury forms and controls as those without. RESULTS: The most important risk factors for falls included: having fallen in the past three months; residing in a secured unit; living in the facility for two or more years; having the potential to cause injury to others; and having an illness, disease or behaviour that may cause a fall. The most important risk factor for injury among those who fell was altered mental state. CONCLUSION: The risk factors identified may be helpful to those planning falls prevention initiatives within long-term care settings.     

Primary care physicians' perceptions of barriers to preventive reproductive health care in rural communities

CONTEXT: Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored. METHODS: In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health—contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach. RESULTS: Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care. CONCLUSIONS: Rural women’s low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.     

Financial consequences of rural hospital long-term care strategies

Data for 540 rural hospitals from 1982 to 1997 were analyzed to determine whether adoption of long-term-care (LTC) strategies improved hospital financial performance. Adoption of external and internal LTC strategies (other than swing-beds) was generally, but not unambiguously, associated with higher profits, increased occupancy, and/or lower costs.     

Managing biomedical waste in Ontario: a regional approach

The lack of landfill space, public perceptions, the escalating costs of disposal, and other factors have created a controversial environment for the disposal of healthcare waste. In the province of Ontario, a proposal has been made that aims to make Ontario self-sufficient in its management of healthcare waste through the use of regional incineration facilities. This article examines this proposal as well as other available options for Ontario's healthcare facilities.