Satisfaction with HMO Coverage: An Empirical Study of a Medical School's Faculty,Staff, and Administrators

With a growing elderly population, there is little argument that the healthcare system in the United States must understand the needs and wants of its elderly consumers. This is especially important in a rural community where services can be limited and access to these services is difficult for consumers. Marketing research is one way in which rural healthcare facilities can gain market information not only to enhance their product offerings, but also to ensure that proper and sufficient services are provided. This article presents a case study of a long-term healthcare facility using marketing research.     

The use of market research to design healthcare offerings. A case study of a senior citizen community

With a growing elderly population, there is little argument that the healthcare system in the United States must understand the needs and wants of its elderly consumers. This is especially important in a rural community where services can be limited and access to these services is difficult for consumers. Marketing research is one way in which rural healthcare facilities can gain market information not only to enhance their product offerings, but also to ensure that proper and sufficient services are provided. This article presents a case study of a long-term healthcare facility using marketing research.     

Cooperation in the care of the institutionalized elderly in a rural community

OBJECTIVE: To develop a method of addressing and minimizing the institutional, cultural, and regulatory barriers to the care of nursing facility residents in our community. METHODS: Nurses, administrators, and medical directors from all the nursing facilities in our community plus representatives from the community hospital participated in a monthly meeting where difficult issues in the care of nursing facility residents were discussed. The committee developed responses to these issues that were implemented throughout the community. RESULTS: This committee has provided an opportunity for the whole community to address problems in the care of the institutionalized elderly. Systems have been developed which have improved communication between nurses and physicians and between nursing facilities and the hospital. Community standards for the care of common problems in nursing facility residents have also been developed. Other unexpected benefits have included community discussion of regulatory concerns, nurse assistant education, and care at the end of life, as well as coordination of laboratory services in the nursing facilities. Other rural communities may find a similar approach useful.     

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed.     

Congregate retirement communities: exploring the importance of services and activities as viewed by residents, potential residents, and administrators.

Given the demographic trends, which indicate a need for facilities to accommodate a rapidly increasing and healthier elderly population, our study provides relevant and timely information for builders and health care administrators who are considering the initial construction of or addition to a congregate retirement facility. Though a congregate retirement facility must satisfy the demands of its residents for services and activities, cost considerations make it equally important for builders and administrators to offer only those services that are essential to meet those demands successfully. A multitude of services and activities may seem attractive to the general population and to investors as they formulate plans for new congregate facilities, but there is little need to provide or fund services and activities that are not used or demanded. Our findings show that the elderly target market for congregate facilities is primarily concerned with "necessity" services such as transportation, shopping, security, health care, and appearance, rather than the availability of a multitude of nonessential recreational and cultural activities. In summary, congregate facilities currently offer numerous activities and services that are not being used and are not important to residents or potential residents. Our exploratory research examines an area that has not been studied extensively and the findings are important in planning for the future. By using these findings, administrators and planners of congregate facilities should be able to determine effectively the types of services and activities that will satisfy the demands of the elderly during their retirement.     

The role of geriatric intermediate care facilities in long-term care for the elderly in Japan

Geriatric intermediate care facilities (GICFs) were first established in 1987 to help the hospitalized elderly return home within 3 months. Users of the GICFs are the elders who do not require hospitalization, but are mentally or physically impaired. Rather than providing unnecessary medical services, GICFs emphasize nursing care and rehabilitation so that users can carry out their daily tasks independently. Due to the limited supply of institutional and in-home services for the elderly in long-term care systems in Japan, only half of the discharged users were able to return home and a quarter stayed at GICFs for over 1 year, contrary to the initial purpose. This suggests that in addition to serving as an intermediate facility between institutions and private homes, GICFs should enlarge their role of home care supporting facilities in ways that would enable them to provide frail elderly patients at home with respite care and daycare services.     

Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: A seemingly unrelated regression approach

Producing services efficiently and equitably are important goals for health systems. Many countries pursue horizontal equity – providing people with the same illnesses equal access to health services – by locating facilities in remote areas. Staff are often paid incentives to work at such facilities. However, there is little evidence on how many fewer people are treated at remote facilities than facilities in more densely settled areas. This research explores if there is an association between the efficiency of health centers in Afghanistan and the remoteness of their location.Survey teams collected data on facility level inputs and outputs at a stratified random sample of 579 health centers in 2005. Quality of care was measured by observing staff interact with patients and determining if staff completed a set of normative patient care tasks. We used seemingly unrelated regression to determine if facilities in remote areas have fewer outpatient visits than other rural facilities. In this analysis, one equation compares the number of outpatient visits to facility inputs, while another compares quality of care to determinants of quality.The results indicate remote facilities have about 13% fewer outpatient visits than non-remote facilities, holding inputs constant. Our analysis suggests that facilities in remote areas are realizing horizontal equity since their clients are receiving comparable quality of care to those at non-remote facilities. However, we find the average labor cost for a visit at a remote facility is $1.44, but only $0.97 at other rural facilities, indicating that a visit in a remote facility would have to be ‘worth’ 1.49 times a visit at a rural facility for there to be no equity – efficiency trade-off. In determining where to build or staff health centers, this loss of efficiency may be offset by progress toward a social policy objective of providing services to disadvantaged rural populations.     

GP-BASED EMERGENCY RESPONSE IN RURAL AREAS: IS THERE A NEED?

Rural general practitioners (GPs) traditionally provide the initial care for the very ill and severely traumatised in small and medium-sized rural hospitals. It has been said that these patients would be better managed in a level 1 trauma centre. The present paper will test this hypothesis and shows that the benefits of the expertise available in the large centres may be outweighed by the loss of life in the prehospital phase, most of which occurs before the arrival of the ambulance. General practitioner involvement would enhance the current early retrieval system. Very ill and severe trauma should be assessed and stabilised in the most appropriate local facility. Routine by-passing of local emergency medical services should be avoided. A national standard for training rural GPs in emergency management skills is needed. Emergency facilities and equipment must be maintained and improved throughout rural Australia. These facilities and their staff must be accredited so that the ambulance service can more appropriately determine its transport priorities.     

Premature institutionalization among the rural elderly in Arizona

Rural areas of the United States, compared with urban areas, exhibit a scarcity of resources and programs designed to provide health and supportive services to impaired elderly persons living in the community. Furthermore, recent research has indicated that informal, familial support for the rural elderly has become increasingly attenuated because of such factors as outmigration of younger family members. Under these circumstances, there is reason for concern that a lack of available supportive services to help impaired rural elderly persons remain in the community may in effect drive them prematurely into nursing homes. In Arizona we have found that, consistent with such a process, elderly nursing home patients in rural areas tend on the average to be significantly less impaired in most areas of functional capacity, and younger at time of entry, than elderly nursing home patients in urban areas. This pattern remains when various possible confounding effects are statistically controlled.     

Factors promoting resident deaths at aged care facilities in Japan: a review

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end‐of‐life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual‐ and facility‐level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency‐level factors. The other 28 studies identified individual‐level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in‐facility resident deaths were associated with healthcare service provision, confirmation of resident/family end‐of‐life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities.     

Availability, distribution and use of emergency obstetric care in northern Tanzania

The objective of this study is to determine the availability, distribution and quality of facilities providing delivery services, as well as their use by pregnant women. The study is a survey of all facilities providing delivery services (n = 129) in six districts in northern Tanzania. The framework provided by the UNICEF/UNFPA/WHO (UN) Guidelines is applied. An attempt is made to answer the first three questions in this audit outline: are there enough emergency obstetric care (EmOC) facilities? Are they well distributed? And are enough women using them? The results show that there is a very low availability of basic emergency obstetric care (BEmOC) units (1.6/500,000), and a relatively high availability of comprehensive emergency obstetric care (CEmOC) units (4.6/500,000), both with large urban/rural variation. The percentage of expected deliveries in EmOC facilities is 36%, compared with the UN Guidelines minimum accepted threshold of 15%. Nevertheless, the distribution shows a much higher utilization in urban districts compared with rural, indicating that mothers have to travel long distances to receive adequate services when in need of them. The paper also discusses the provisional context of the services in terms of level of facilities providing them and their public/private mix. Most facility deliveries are conducted at CEmOC facilities. Pregnant women tend to utilize the services of voluntary agencies to a greater degree than government services in rural areas, while the government services have a higher burden of the workload in urban areas. A majority (86%) of the deliveries occurring in voluntary agency facilities occur in a qualified EmOC facility. Against a backdrop of a large availability of any facility regardless of their emergency obstetric care status (41.9/500,000), this paper argues that given the large number of potential BEmOC facilities, it seems more efficient to shift resources within the BEmOC level, compared with from CEmOC level down to BEmOC level, to improve access to quality services. There is a large potential for quality improvement, in particular at dispensary and health centre levels. We argue that the main barrier to access to quality care is not the mother's ignorance or their ability to get to a facility, but the actual quality of care meeting them at the facility.     

Variations in Nursing Home Discharge Rates for Urban and Rural Nursing Facility Residents With Hip Fracture

CONTEXT: The more limited availability and use of community-based long-term care services in rural areas may be a factor in higher rates of nursing home use among rural residents. PURPOSE: This study examined differences in the rates of nursing home discharge for older adults receiving posthospital care in a nursing facility. METHODS: The study sample was comprised of a cohort of rural and urban residents newly admitted to nursing home care in Maine following surgery for hip fracture. FINDINGS: The results indicated that rural residents who were hospitalized for hip fracture and subsequently admitted to a nursing facility for rehabilitation were significantly less likely than urban residents to be discharged within the first 30 days of their admission. Rural residents who stayed in the nursing facility beyond 30 days were also less likely to be discharged in the first 6 months. These geographic differences were not explained by service use and resident characteristics such as age, health, or functional status. CONCLUSIONS: The finding of lower discharge rates among rural nursing facility residents appears to be consistent with previous studies demonstrating higher rates of nursing home use among rural residents. There continues to be a need for a better understanding of the role that service supply and accessibility and other factors play in the patterns and outcomes of rural long-term care.     

Care services for elderly people with dementia in rural China: a case study

Objective

To determine the state of the health and supportive services available to elderly people with dementia – and their families – in rural Lanxi county, in the province of Zhejiang, China.

Methods

In November 2014 and January 2015, we interviewed 14 key informants on dementia care face-to-face, using a semi-structured questionnaire. The informants included three rural physicians, an urban geriatrician, seven directors of institutions for the care of the elderly and three officials of the civil affairs bureau. We also completed in-depth interviews with five family caregivers of elderly people with dementia.

Findings

The interviewees indicated that there was a lack of specialized services designed specifically to address the needs of individuals with dementia and their family members. Non-psychiatric medical services and the available facilities for long-term care appeared to be ill-equipped to manage these needs. They lacked both clinical staff and standardized, evidence-based practices for the diagnosis, care, treatment and rehabilitation of patients with dementia. As care facilities often refused to admit elderly people with dementia, families were generally forced to care for elderly relatives with dementia at home.

Conclusion

In Lanxi county – and probably in much of rural China – more public resources are needed to support family caregivers and to improve the capacity of care facilities for the elderly to care for individuals with dementia.     

Rural and remote mental health placements for nursing students

Clinical placements can be instrumental in encouraging nursing students to consider a future career in rural Australia. Twenty nursing students from a metropolitan university were provided with the opportunity to undertake a clinical placement in mental health in a rural or remote setting. The majority of placements were between 2 and 4 weeks in length. They took place in community health centres and rehabilitation centres in New South Wales and in hospital inpatient facilities, remote areas and community health services in the Northern Territory. On return from the placement, students completed an open-question pro forma giving their views and impressions of their experiences and contrasting this with clinical experience gained in urban settings. The content of the students' responses was analysed and presented under the following themes: scale relating to urban and rural differences in population; geographical and health facility size; staffing matters; the environment; the students' perception of the clients; and professional interaction. Additional material relating to remote area placements is presented. Questions are raised about the maintenance of students' interest and the development of rural careers.     

农村养老院老人医养结合服务需求现状及影响因素分析

目的了解农村养老院老人的医养结合服务需求,并分析其影响因素,为采取针对性干预措施提供科学依据。方法采用自行设计并经过信效度检验的《农村养老院老人医养结合服务需求问卷》,便利选取河南省部分地区农村养老院470名老人进行问卷调查。结果农村养老院老人医养结合服务需求总得分为(111.18±13.06)分,平均得分为(3.97±0.47)分,处于较高水平,其中各维度平均得分为:精神文化娱乐(4.75±0.38)、健康指导服务(4.09±0.52)、日常生活照料(3.93±0.69)、医疗康复护理(3.74±0.56)、后勤保障服务(3.73±0.77),多元回归分析结果得自理情况、经济来源、每月医疗费用、每月养老费用、入住时长是影响农村养老院老人医养结合需求的因素(P<0.05)。结论农村养老院老人医养结合服务需求较大,尤其在精神文化娱乐及健康指导服务方面,亟待整合多方优质医疗资源、建立家庭社会支持网络等,以全面推行农村医养结合。     

Meeting the Health Care Needs of Rural Elderly: Client Satisfaction with a University-Sponsored Nursing Center

Responding to health care needs of the elderly has presented great challenges for health care professionals. These problems are compounded in rural communities by physical and social isolation, increased poverty, and lack of transportation. An innovative approach to meeting health needs of rural elderly is through nursing centers. Through an emphasis on health promotion and maintenance of optimal level of functioning, these primary health care facilities can foster independence and self-care for this targeted population. In addition, nursing centers serve as clinical sites for student learning experiences and settings for nursing research. This article focuses on a nursing center established at Edinboro University of Pennsylvania (EUP), which tailors its services to the elderly living in Edinboro. Results of a client satisfaction survey, based on the Risser Patient Satisfaction Instrument, are described in addition to patterns of nursing center usage, general categories of care, teaching interventions, referrals, counseling, and frequency of visits. Findings from the survey indicated a general high client satisfaction level with nursing care received at the center. Discussion also includes plans to expand services to elderly in the community through home visits.     

Denmark: changes in health and social services for the elderly and comparative observations

In Denmark, legislation having the aim to help the elderly to be active as long as possible and prevent or delay institutionalization, is responsible for a number of innovative programs for this segment of the population. It is now the law that no more nursing homes will be constructed in Denmark. Free home nursing and permanent home help and night patrols for home nursing and help is a strategy to delay or prevent institutionalization. In the municipality of Skaevinge, a nursing home was converted to sheltered housing for the same patients and others from the community. Emphasis is on self care and autonomy in decision making. There are no fixed routines or schedules as found in the traditional nursing home. Examples of programs in facilities are given that have health professionals jointly planning and coordinating the delivery of their services that reduce fragmentation and duplication.     

A little help, a lot of independence. Retirement community advances the cause of aging with dignity

Sometimes the elderly need only a little extra help to make it on their own. When this is the case, it behooves providers of healthcare and social services to meet those needs and allow these individuals to maintain the dignity of independent living as they age. At Resurrection Retirement Community, an independent living facility on Chicago's northwest side, the Garden Annex fills this niche in a unique model of independent living with additional services. Services include three meals a day in the common dining room, laundry service for household linen, and weekly maid service. Residents enjoy varied activities, exercise sessions, and socialization with friends and neighbors. They also have access to such amenities as daily religious services, a library, a beauty salon, and banking facilities. To live in the Garden Annex, prospective residents must meet certain physical and mental criteria and be able to function somewhat independently. In contrast to assisted living facilities, the Garden Annex does not provide nursing care or assistance with personal care. However, residents may take advantage of the continuum of care offered by Resurrection Health Care Corporation. They are afforded access to a medical center, a long-term care facility, and physicians' services.     

Assisted Living in Rural America: Results From a National Survey

CONTEXT: Expanding the availability of long-term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that has been growing in popularity is assisted-living facilities (ALFs). PURPOSE AND METHODS: This paper describes rural ALFs and compares them with metropolitan ALFs. Data were collected using a multistage sample design that yielded a nationally representative sample of ALFs. Telephone interviews were completed with administrators of 1,251 ALFs in 1998. FINDINGS: Nationwide, assisted living was largely administered by private payment, and there was an undersupply in rural areas. Compared with metropolitan ALFs, rural ALFs were smaller and less likely to offer the types of services and accommodations associated with the philosophy of assisted living. They were more likely to offer accommodations with little privacy, and while similar in the services they offered, rural ALFs were less likely to have nurses on staff, particularly licensed practical nurses. Moreover, they were less likely to offer a combination of high services and high privacy. Finally, rural ALFs charged lower prices than urban ALFs; however, the average price was still unaffordable for most elderly rural residents. CONCLUSIONS: These findings suggest that assisted living, as currently structured, will make only a marginal contribution to meeting the needs of frail elders in rural areas.