Older people's willingness to use home care nursing services

AIM: This paper reports a study exploring willingness to use home care nursing services among older people and discussing the implications for long-term and home care nursing policies. BACKGROUND: The proportion of older people is increasing in all societies across the world. Correspondingly, Korean society has experienced a rapid growth in its population of older people, and this is expected to increase from 7.2% in 2000 to 14.4% in 2019. The government is in the process of developing publicly-financed long-term care for older people, and home care nursing services are expected to be provided as an element of this care. Methods. A cross-sectional study design was used, employing data from a nationally representative interview survey with 1834 respondents conducted during May and July, 2001. Univariate and logistic regression analyses were conducted. RESULTS: Willingness to use home care nursing services differed according to whether co-payment was required. About half the respondents answered that they would not use the services; 43% expressed a willingness to use them without co-payment; and 5% were very willing to use them even with co-payment. People with lower incomes showed greater willingness to use the services with no co-payment, while the high income group showed the greatest willingness under co-payment. Sex, living with adult children, living area, activities of daily living, and chronic conditions were associated with willingness. Older people who had known about or used home care nursing services previously showed greater willingness. CONCLUSIONS: Co-payment guidelines for minimizing unmet needs are required, especially for older people with low incomes. A positive evaluation from those who knew about or had used such services is expected to contribute to the use of home care nursing services by older people.     

Reducing nursing home use through consumer-directed personal care services

CONTEXT: Personal care services (PCS) are intended to enable beneficiaries with physical or cognitive impairments to live safely at home rather than in nursing facilities. The quality and flexibility of these services, typically provided by home care agencies, may not be sufficient to allow some beneficiaries to continue living at home. OBJECTIVE: We sought to test whether consumer direction of PCS under Arkansas's Cash and Counseling demonstration reduces nursing facility use and expenditures, compared with traditional Medicaid PCS, and how it affects total Medicaid cost. DESIGN: Interested adult Medicaid beneficiaries in Arkansas who were eligible to receive Medicaid PCS were randomly assigned (1) to have the option to receive an allowance instead of PCS (the treatment group) or (2) to receive traditional PCS through an agency (the control group). Between December 1998 and April 2001, 2008 beneficiaries enrolled. MEASURES:: Nursing facility use and costs, PCS costs, and total Medicaid costs (according to Medicaid claims data). RESULTS: Nursing facility use was 18% lower for the treatment group than for the control group during the 3-year follow-up period. Among those who had received PCS before the demonstration, nursing facility savings, together with savings in other long-term care costs, fully offset the higher PCS costs. These savings did not offset the higher PCS costs of new PCS applicants, since the increase in the proportion receiving paid care was so large for this subgroup. CONCLUSIONS: Consumer-directed PCS in Arkansas reduces nursing facility use and costs more effectively than providing services in the traditional manner. This favorable reduction in nursing facility costs was much more pronounced in Arkansas than in the other 2 states (New Jersey and Florida) where the Cash and Counseling demonstration was carried out.     

Mexican American elders' use of skilled home care nursing services

Hispanic elders use skilled home care nursing (SHCN) services less often than Anglo elders. The purpose of this study was to identify factors that influence whether disabled Mexican American elders decide to use SHCN services. The research process included reviewing the historical context in one Mexican American community, interviewing key and primary informants, presenting a report to the community and getting feedback, and assessing whether the community perceived a need for increased use of SHCN services by their disabled elders. Seven barriers to the use of SHCN services were identified: expectations of discrimination, lack of knowledge about services, expectations embedded in familism, lack of sense of prevention, lack of health insurance, preference for traditional remedies, and neglect/abuse. A community advisory committee validated the barriers identified during interviews and the need for increased use of SHCN services. Results provide new insight into the sociopolitical and cultural complexities that influence health care utilization decisions by Mexican American elders and their families and uncover traditional, oversimplified beliefs and practices by mainstream professionals and policymakers. Interventions that decrease inequities in a southern Arizona community may be transferable to other vulnerable populations in the United States and globally.     

Weathering the storm: challenges to nurses providing care to nursing home residents during hurricanes

This article documents the experience of 291 Florida nursing homes during the 2004 hurricane season. Using quantitative and qualitative methods, the authors described and compared the challenges nurses encountered when evacuating residents with their experiences assisting residents of facilities that sheltered in place. The primary concerns for evacuating facilities were accessing appropriate evacuation sites for residents and having ambulance transportation contracts honored. The main issue for facilities that sheltered in place was the length of time it took for power to be restored. Barriers to maintaining resident health during disasters for those who evacuated or sheltered in place are identified.     

Cost analyses of home care and nursing home services in the southern Taiwan area

This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence.     

Measuring relative work values for home care nursing services in Japan

BACKGROUND: Japan's system of Home Visit Nursing Care Stations (Station) began in 1991. To maintain the quality of services in home health nursing provided by Stations, reimbursement needs to account not only for the number of home visits, but also for the time and intensity of nursing services. OBJECTIVES: This study aimed primarily to investigate the total work value and the three dimensions (time, mental effort, and physical effort) of actual visiting nursing services for the aged, and to quantify the contribution made by the three dimensions of nursing services to total work. The secondary purpose was to determine whether patient characteristics, nurse characteristics, and types of nursing services contributed to the variance in total work. Total work is defined as comprehensive work input of nursing services, with careful consideration given to both the intensity and duration of work. METHODS: Self-report questionnaires about actual visiting nursing services, based on the Resource-Based Relative Value Scale, were answered by 32 nurses from three Stations in urban Yokohama, Japan. RESULTS: Regression analysis showed that time and intensity (physical effort and mental effort) explained 96% the variance in total work. Time alone accounted for only 39% of the variance in total work. Patient characteristics, nurse characteristics, and service type accounted for less variance in total work than did time and intensity. CONCLUSIONS: The study findings indicate that reimbursement of nursing services should reflect not only the time required for each visit, but also the intensity of nursing services provided, including mental effort and physical effort.