上海市老年人家庭护理服务需求及支付意愿的质性研究

目的探讨上海市居家老年人家庭护理服务需求及支付意愿。方法采用质性研究中的现象学研究法,对10名居家老年人进行半结构式访谈,并运用Claizzi分析程序进行资料分析。结果居家老年人主要希望得到基础护理、康复护理、健康教育、家庭病床等专业化家庭护理服务和家政转介服务、精神慰藉等非专业化家庭护理服务,并存在一定支付意愿,但总体意愿支付值偏低,其中希望以项目形式进行收费者居多。结论老年人对家庭护理服务存在一定的需求及支付意愿,应大力拓展家庭护理服务,适当收费,促进卫生资源的合理分配及家庭护理的可持续发展。     

Home health care in the continuum: a review

An aging population, financial and technical changes, and consumer preference will drive the increase in the types and volume of service clients receive at home. Financial and technical changes will influence the structure of home care services, but home health agencies will continue to partner with primary, acute, and long-term institutional care to provide a continuum of services. However, the health care system will need to allocate sufficient resources to home health if it is to serve an increasing number of more frail and unstable clients. Lacking such resources, home care may not able to contribute appropriately to the continuum of care, and the effectiveness of the overall health care system may be compromised. Challenges to home health agencies' successful operations include decreased resources, changing payment methods, staff shortages, and structural changes in health care systems that fragment care of decrease attention to home health. Home health care's traditional goals of serving clients and caregivers directly and educating them toward health and independence can continue if these problems are resolved.     

The changes involved in patient-centered medical home transformation

In 2007, the major primary care professional societies collaboratively introduced a new model of primary care: the patient-centered medical home (PCMH). The published document outlines the basic attributes and expectations of a PCMH but not with the specificity needed to help interested clinicians and administrators make the necessary changes to their practice. To identify the specific changes required to become a medical home, the authors reviewed literature and sought the opinions of two multi-stakeholder groups. This article describes the eight consensus change concepts and 32 key changes that emerged from this process, and the evidence supporting their inclusion.     

Home care nursing: professional and political issues

Concern for quality, cost, and access dominate the health care system in the eighties. State and national actions, demographic changes, and technological advances are converging to create many changes in the home care delivery system. Knowledgeable nurses can influence the evolution of home care services to assure that patients receive appropriate acute and long term home care services. Concern for quality care, changing patient needs, and availability of care are the major issues facing home care nursing in the eighties, and will continue to be into the nineties. Reimbursement policies of third party payers, medicare/medicaid regulations, state licensing, employer benefit programs, state health programs, home health care providers, professional/trade associations, and consumer advocacy groups are some of the key forces reshaping the practice of home health nurses. Knowledge of these factors will enable nurses to influence effectively the design of institutional and governmental policies which affect the care nurses deliver to patients at home.     

Rising to the challenge of home health care

The managed care concept has had a major impact on most health care delivery systems (from the hospital to home) and the professional practice of the people within those systems. It is important that all types of providers who are involved in an individual's care have a basic understanding of the challenges they each face. Sharing information may contribute to a more efficient transfer of the client's care from one provider to another and improve continuity of care and cost containment. This article presents some of the challenges that the Visiting Nurse Association of Chicago (VNAC), a home care provider, has faced as a participant in managed care.     

2001-2002 Joint Commission Home Care Manual: what's new? Part 1

The changes in the format of the 2001-2002 CAMHC are tremendously helpful for organizations that provide multiple types of home care programs. At last, reviewing the common and service-specific standards can identify the applicable standards. The most significant change is the change in the aggregation methodology that places home care and hospice organizations at higher risk for type 1 recommendation(s). The next Accreditation Strategies column will review the changes in the standards in the 2001-2002 CAMHC from the chapter entitled "Improving Organizational Performance" through the chapter entitled "Surveillance, Prevention and Control of Infection".     

Home care for persons with AIDS

Home care for PWAs is now available. This paper addresses some of the treatments and problems that may be a part of care at home. It is intended to be a basic review of principles and procedures associated with the care of PWAs at home.     

Home care personnel's perspectives on successful discharge of elderly clients from hospital to home setting

The successful discharge of elderly patients from hospital to home care is a process requiring co-operation between health and social care personnel in addition to their commitment and skills. During the discharge process it is important that health and social care professionals have a shared view of the health and mental status and needs of the patient so that appropriate plans for meeting these needs can be made. The aim of the study was to investigate home care personnel's (health and social care workers) views of which practices between the discharging hospital and home care are associated with the successful discharge of clients. Home care personnel in 22 Finnish municipalities (n = 1890, response rate 63%) received a questionnaire in spring 2001. When the respondents' background factors were standardized, the best predictors of successful discharge from the home care personnel's point of view were adequate information received about the treatment of the patient's illnesses and their functional ability and cognitive potentials, timely information about the discharge, and good co-operation between the discharging hospital, and the home care, social care and health care workers working in home care. There were differences in the opinions of social care workers and health care workers working in home care. From the home care personnel's point of view the most important correlates of an elderly client's discharge from hospital to a home setting were factors associated with how they can best plan their work. Their perspective on the discharge process may diverge from clients and their informal care givers point of view. To ensure the successful discharge process we must take them all into account.     

The Community-Based Transitions Model: one agency's experience

Home care providers have more than a century of experience providing complex patient care and medication management, symptom management, and disease self-management. These requisite home care clinician skills are common to those described of the "health coach" in most contemporary care transition models. When home care clinicians are re-tooled with health coaching competencies such as motivational interviewing, their role as the "perfect" health coach can be readily demonstrated. The Community-Based Transitions Model? (CBTM) was developed by home care providers to equip clinicians with these additional skills and to address gaps in all care transitions along the chronic condition trajectory. This agency's experience with this model is described.     

The advent of high-tech home care in Germany

The purpose of this conceptual paper is to examine the current situation in which high-tech home care is going to materialize in Germany in the beginning of the new millennium. It will be shown that there have been long-standing efforts to bring about a corresponding expansion of home care as can be observed in other countries (e.g., United States). It is apparent, however, that these efforts are still crowned by only modest success. This especially applies to high-tech home care. The introduction of this special form of care is turning out to be a complicated process on a collision course with a great number of obstacles due to the peculiarities of Germany's health care system. If the nursing options related to high-tech home care are to be opened up and put into practice in the future, numerous prerequisites for their development will first have to be created. From a public health nursing viewpoint the three most pressing issues on the list of priorities relevant to high-tech home care are to: (1) increase awareness of the problems associated with this special form of care; (2) eliminate the present information deficits in society; and (3) initiate a debate in Germany about possibilities and limitations of technology-intensive home care, building on international exchange of experiences and ideas.     

Nursing home care: whodunit?

Aims and objectives. (1) To analyse and compare (changes and differences in) activity profiles of various types of nursing home care. (2) To assess the impact of integrated care on these activity profiles. Background. Because of an ongoing introduction of integrated nursing home care, caregivers increasingly have to co‐ordinate their activities, engage into interprofessional relationships and take over each other's tasks. Consequently, activity profiles [i.e. combinations of (contributions to) care activities and the roles that perform them] are expected to change. Design/methods. At three measurement points in the period 1999–2003, caregivers (in 18 different roles) recorded and listed direct and indirect care activities. A total of 41 335 lists were analysed to derive activity profiles of traditional, transitional and integrated nursing home care in the Netherlands. Results. Traditional, transitional and integrated care shared some comparable activity profiles. Integrated care differed from the other types with respect to the contribution of the geriatric nurse, recreational activities supervisor, nutrition assistant, household assistant and nursing assistant to activities such as extra care, handling food and club activities. Contrary to the other roles, the licensed practical nurse contributed to (almost) all activities in all types of care. Conclusions. Nursing home care has several recurring activity profiles. These profiles are the same in all types of nursing home care. The introduction of integrated care implies that particular profiles have to be added to these profiles. As a generalist, the licensed practical nurse seems to play a key role in all activity profiles. Relevance to clinical practice. Because of demographic and financial pressures, integrated care for older people becomes increasingly important. By addressing the impact of integrated care on activity profiles, this paper provides information on how new types of care can be delivered in the most effective manner.     

How home care agencies in Germany view the AIDS challenge: results of an exploratory study.

The purpose of this article is to examine the current state of home care services for people living with HIV/AIDS and other seriously ill patients in Germany. It is based on a research project promoted by the Federal Ministry for Labor that aimed to investigate the possibilities and problems related to home care of the critically ill and thus establish basic scientific principles that could be used to close a health care gap that has long been of concern. The article will initially offer a brief explanation of the causes underlying the current problems in the field of home care for seriously ill patients. The authors then present the implications for nursing qualification that will have to be addressed to develop a patient-oriented, priority-level home nursing care program for people with HIV/AIDS in Germany.     

Role of the wound ostomy continence nurse in the home care setting: a patient case study

The clinical and operational challenges in home care services are increasingly more acute. Quality patient care is the goal for all home care agencies. Wounds comprise over a third of all cases in home care. The most common wounds are surgical, pressure ulcers, and lower extremity vascular ulcers. The WOC Nurse can provide the expertise in wound management that promotes quality care and positive outcomes, both clinical and fiscal.     

Health care management of adults with Down syndrome

The family physician's holistic approach to patients forms the basis of good health care for adults with Down syndrome. Patients with Down syndrome are likely to have a variety of illnesses, including thyroid disease, diabetes, depression, obsessive-compulsive disorder, hearing loss, atlantoaxial subluxation and Alzheimer's disease. In addition to routine health screening, patients with Down syndrome should be screened for sleep apnea, hypothyroidism, signs and symptoms of spinal cord compression and dementia. Patients with Down syndrome may have an unusual presentation of an ordinary illness or condition, and behavior changes or a loss of function may be the only indication of medical illnesses. Plans for long-term living arrangements, estate planning and custody arrangements should be discussed with the parents or guardians. Because of improvements in health care and better education, and because more people with this condition are being raised at home, most adults with Down syndrome can expect to function well enough to live in a group home and hold a meaningful job.     

The impact of Medicare reimbursement changes on home healthcare: a nursing perspective

This article presents an overview of changes in Medicare's payment system and their effect on home healthcare from a nursing standpoint, and makes policy recommendations for nurses. Home health care utilization, the Balanced Budget Act 1997, the effect of changes in Medicare reimbursement (on beneficiaries and providers), and transition to the new PPS system are discussed. Suggested strategies agencies can use, and how home care nurses can get involved in policy recommendations are presented.     

Stoma care nursing: what the community nurse needs to know

The transition from hospital to home can be a worrying period of time for a patient with a newly formed stoma. It is well documented that community care is important, however this transition has been seen as a weak link in the care for a patient with a stoma (Allison 1996). In most cases following discharge from hospital, the nurse specialist in stoma care will visit the patient at home as a means of maintaining continuity of care. It is also important that the patient's GP, district nurse and other relevant community services are introduced to ensure a cohesive approach to the patients care at home (Taylor, 2003). This article therefore aims to offer the community nurse an overview of stoma care nursing in order to provide the continuity of care much needed by this group of patients.     

Predictors of home death in palliative care cancer patients

With recent changes in health care there is greater emphasis on providing care at home, including the support of families to enable more home deaths. Since a home death may not be practical or desirable in every family situation, there is a need for an objective way to assess the viability of a home death in each individual family situation. The purpose of this study was to describe the relative role of predictors of home death in a cohort of palliative care patients with advanced cancer. A questionnaire was created as a means of assessing the viability of a home death. Five questions were included. Ninety questionnaires were administered by home care coordinators. A follow-up questionnaire was administered to record the place of death. Of the 73 evaluable patients, 34 (47%) died at home and 39 (53%) died in hospital or hospice. The desire for a home death by both the patient and the caregiver, support of a family physician, and presence of more than one caregiver were all significantly associated with a home death. Logistic regression identified a desire for home death by both the patient and the caregiver as the main predictive factor for a home death. The presence of more than one caregiver was also predictive of home death. The questionnaire is simple and, if our results are confirmed, it can be used for predicting those who will not have a home death.     

End of life in an Icelandic nursing home: an ethnographic study

Aim: To examine care of the dying elderly in a nursing home in Iceland. Methods: An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Findings: Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. Conclusions: The findings suggest that RNs' professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.     

Connected health care: the future of health care and the role of the pharmacist

The population of the world is ageing. As a result, the incidence of chronic disease is projected to increase, there are predicted shortages in health care workforce and budget restraints; implications for future health care provision are serious. The current model of health care is not equipped to deal with these changes. Connected health care, via the use of health informatics, disease management and home telehealth technologies, has been suggested as an approach to ease the projected strain on future health care. Evidence to date suggests a positive impact of the use of connected health care model; however, the majority of studies have overlooked the involvement of the community pharmacist. As the most common point of contact with primary health services for most of the population, the community pharmacist may be well placed to provide connected health care. The research to date is promising with improvements in outcomes for cardiovascular patients noted; however, further work is required to investigate the potential role the community pharmacist can play in the future of connected health care.