Using the long-term care information system for effective community care.

Obtaining appropriate long-term care is a problem common to individuals in need, community service providers, regulatory agencies, and fiscal intermediaries. The fragmented nature of the long-term care system precludes natural linkages among service programs. The Long-Term Care Information System Assessment Process was developed and demonstrated to be a communication link among programs and agencies concerned with long-term care. The use of its common language tools for decision making and program organization leads to the provision of appropriate long-term care, efficient use of resources, and effective community care.     

Outbreak of adenoviral infections in a long-term paediatric facility, New Jersey, 1986/87.

During an 8-week period in the winter of 1986-87, there were 11 deaths from an adenovirus infection (case fatality rate = 39%, 11/28) in a long-term care paediatric facility in southern New Jersey. Among the 61 resident children, all with severe congenital and/or acquired disabilities, 28 developed a febrile respiratory illness compatible with adenovirus infection [attack rate (AR) = 46%]. Patients with tracheostomies were three times as likely to become ill [relative risk (RR) = 3.2, 95% confidence intervals (CI) = 1.8-5.6]. Twenty-three members of the staff had a similar febrile illness (AR = 22%, 23/106); nurses were more likely to be ill than other staff (RR = 3.0, 95% CI = 1.1-11.4). Adenovirus 7 was isolated from four of the case patients and adenovirus 1 from one. The findings suggest prolonged transmission between patients and nursing staff with lack of cohorting of ill patients probably contributing to the prolongation of the outbreak. This investigation indicates that adenoviral outbreaks, although rare, can have a high mortality in severely disabled children, and that future outbreak investigations should examine the use of vaccines or antiviral agents to reduce mortality and for outbreak control.     

Physician and patient assessment of ambulatory care in a university facility

Physicians are a largely untapped resource for evaluating medical care delivery in an ambulatory care facility. This study includes the attitudes of physicians in assessing care at the Northwestern University Medical School Clinics (NUMSC). A self-administered questionnaire was mailed to all clinic chiefs, attending physicians, and resident physicians who had worked in the clinics during the summer of 1973. Using a similar questionnaire, personal interviews were conducted with a sample of patients in the clinics. Physicians were consistently more critical than patients in their responses to the battery of questions on satisfaction and on indices constructed from these responses. The findings indicate a negative relationship between the physician's position of authority in the organization and his report of satisfaction: clinic chiefs were consistently more critical than either attending physicians or resident physicians, while the comparisons between attendings and residents were more mixed. Further, salaried physicians were more critical than those who received no salary and non-AMA members were more critical than AMA members. Adding the assessment of physicians to those of patients introduces a useful complement and strengthens the utility of such evaluation instruments.     

Easing the strain. The physician and the long-term care facility should work together to improve patient care

Numerous regulations, inadequate reimbursement, and poor communication can strain the physician--long-term care facility relationship. Three major roles define the physician's responsibilities in the nursing home: care giver, communicator, and complier. Although the physician's roles in the nursing home may be similar to those in an office practice, they can be complicated by a number of factors. Many professionals, such as the nutritionist, social worker, and pharmacist, care for the nursing home resident. The physician thus loses some control over the patient's care. Communication barriers, such as the nursing home's misinterpretation of federal regulations, can frustrate both the physician and the facility's medical staff. This can lead to suboptimal patient care. Nursing homes must ensure that they keep physicians who treat residents abreast of facility regulations and federal and state guidelines. Although a physician may want to continue providing care to a patient who has entered a long-term care facility, he or she may find it necessary to transfer care to the medical director or house physician. Often the time and distance a physician must travel prohibit the physician from giving patients the high-quality care to which they are entitled.     

Expenditures for long-term care services by community elders.

Costs of care are presented for elderly persons in five community-based settings. These settings include elderly persons living in their own homes or in group housing and who do or do not receive case-managed home care. Expenditures for care ranged from a low of about $1,100 per year to a high of $4,025. The level of expenditure was directly related to risk of institutionalization and was higher for those receiving case-managed home care. As a majority of the elderly use a substantial amount of care even without case management, the potential for community care demonstration programs to yield significant cost savings appears quite limited.     

Holistic retreats. A New Jersey medical center responds to community needs

Through Lourdes Wellness Center, sponsored by Lourdes Medical Center, Camden, NJ, religious and laypersons from across the nation can experience holistic spirituality retreats. In holistic spirituality, a person reverences his or her whole self as an expression of and a way to God. Retreats offered through the Wholistic Retreat Program are geared to demonstrate the Christian and Franciscan perspective of the holiness of all creation. Some retreatants say the liturgies are the core of the holistic spirituality retreats, rich in their use of symbol, music, and word. Meals served at the retreats are a celebration of color, texture, and fragrance. Movement and exercise options are always available. Staff from Our Lady of Lourdes Medical Center often come to test retreatants' cholesterol levels, assess their life-styles and health, and provide information on health, fitness, and additional health screenings. Lourdes wellness retreats have a bright future as people increasingly turn to spirituality, preventive care, and alternative ways of healing in our high-stress society.     

Cost analysis and facility reimbursement in the long-term health care industry.

This article examines costs and develops a system of prospective reimbursement for the industry committed to long-term health care. Together with estimates of average cost functions--for purposes of determining those factors affecting the costs of long-term health care, the author examines in depth the cost effects of patient mix and facility quality. Policy implications are indicated. The article estimates cost savings and predicted improvements in facility performance resulting from adoption of a prospective reimbursement system.     

The changing hopes, worries, and community supports of individuals moving from a closing long-term care facility

This study examines client's hopes, worries, and social networks before, one year, and two years following release from a long-term care facility. More clients expressed hopes than worries before closure but, over time, hopes decreased and worries increased significantly. Before closing, independence was cited most often as a hope, followed by work and finances. Criminal opportunities headed up concerns, followed by mental health treatment, finances, living arrangements and independence. Over time, respondents were less excited about independence and living arrangements but more hopeful about social opportunities and everyday practicalities. Worries relating to family increased while concerns about deviance decreased. Respondents reported an average increase in network ties but the proportion of family members decreased while professional supports and ties with former CSH patients increased. The trends highlight particular vulnerability at the one-year point, the necessity of viewing movement into the community as a nonlinear process, and the importance of marking outcomes periodically.This article was presented at the 1997 annual meetings of the American Public Health Association in Indianapolis, Indiana.She is also Director of the Indiana Consortium for Mental Health Services Research in Bloomington.he is also with the Indiana Consortium for Mental Health Services Research in Bloomington.she is also with the Indiana Consortium for Mental Health Services Research in Bloomington.     

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.