Inter-organizational networks on the Dutch home health care market

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost.     

A program of evaluation and research for hospital based home care

A program of evaluation and research has been developed and initiated in a large Hospital Based Home Care Program which principally serves chronically-ill, elderly veterans. Program evaluation is based on data from an automated home care information system developed for this purpose. The information system is based on the Long-Term Health Care Minimum Data Set, a nationally-recommended data set which describes patient demographics and physical and mental health status, and health services provided. Home care and related costs per visit and per patient day have been identified. A proposed, experimental research protocol identifies health status outcomes and health care costs of home care and alternative modes of long-term health care.     

老年人居家和社区养老服务利用影响因素研究——基于CHARLS数据的实证分析

本文利用北京大学国家发展研究院(CCER)发布的中国健康与养老追踪调查数据(CHARLS),以安德森医疗服务利用行为模型为分析框架,实证研究了影响我国老年人居家和社区养老服务利用的因素。统计分析结果显示,我国老年人居家和社区养老服务的利用程度整体偏低,其中社区养老服务的利用程度高于居家养老服务;影响我国老年人居家和社区养老服务利用的因素有所交集,但不完全相同。为提高我国老年人居家和社区养老服务利用程度,促进我国养老照护事业发展,应加大政策宣传、提升认知程度,完善基层功能、提升服务质量,重视预防保健、强化精神慰藉,做好需求评估、实现精准供给。     

Dutch home care: towards a new organization?

As in all western countries the demand for home care in the Netherlands is rapidly growing. Reduced institutionalization in hospitals and nursing homes, combined with an increasing number of elderly people, have led to new groups of patients, with complex and diverse problems, to be cared for in their home settings. To meet this new demand, it is argued, comprehensive home care arrangements are needed. Development of such arrangements was the target of 12 demonstration projects that were part of the 'National Home Health Care Programme'. This article presents the results of an evaluation study of the Programme, with special attention to factors favouring the development of comprehensive home care arrangements and its effectiveness.     

Characteristics of elderly home health care users: data from the 1996 National Home and Hospice Care Survey

OBJECTIVE: This report presents demographic characteristics, service utilization, and primary admission diagnoses of elderly users of home health care services. Included are home health care services used by both current and discharged clients (called patients). These services are provided by home health care agencies and hospices. The focus of the report is on services used by both current patients and discharges aged 65 years and over. METHODS: The data used for this report are from the National Center for Health Statistics 1996 National Home and Hospice Care Survey's (NHHCS) sample of current patients and discharges. The 1996 NHHCS is the fourth survey of home health care agencies and hospices and their current patients and discharges. RESULTS: The overall results of the survey indicate that, as in previous years, the elderly current patients and discharges were predominantly women, 75-84 years old, white, non-Hispanic, widowed, and most often lived in a private residence with members of their family. For elderly men and women, the most commonly used home health care service was skilled nursing services and the primary admission diagnosis was diseases of the circulatory system, including heart disease.     

北京市失能老人社区照顾现状及需求分析

目的:通过研究北京市失能老人的社区照料现状与需求,为完善老人社区照顾体系提供建议。方法:利用北京市社区老人社会支持状况调查数据,运用描述性统计分析、单因素卡方检验及多元Logistic回归分析方法,对失能老人的社会照顾情况进行分析。结果:失能老人健康状况不容乐观,其对社区提供公益性医疗卫生服务和为老设施建设均有很高需求,对社区提供钟点工入户、日间照料、志愿者服务也有需求,但社区供给服务与设施建设不足。结论:我国失能老人基数大、增长快,但社区照顾供给不足,难以满足老人的需求,亟需完善社区医疗卫生服务建设与社区居家照顾体系。     

社区居家养老和机构养老老年人 长期照护需求Meta分析*

摘 要：目的：整合国内外社区居家养老和机构养老老年人长期照护需求的质性研究并进行对比分析,为不同养老方式 下老年人长期照护服务内容的设计与完善提供参考。方法：检索国内外数据库 PubMed、CRS核心论文数据库、Web of Sci⁃ ence、中国知网、万方数据库和维普期刊资源整合数据库中建库至2022年10月的文献,筛选与老年人长期照护需求相关的 质性研究。采用 《澳大利亚 JBI循证卫生保健中心质性研究质量评价标准》 对文献质量进行评价,对文献结果进行 Meta整 合。结果：共纳入8篇文献,提炼出42个主题,归纳成10个新类别,即基本生活照料、临床医疗服务、康复保健服务、精 神心理支持、社会环境与功能支持、政策支持、经济支持、信息支持、支持性服务和社会功能维持。结论：老年人长期照护 需求具有多样化、个性化的特点。社区应加强支持性服务,机构应重视对老年人的精神心理支持,满足老年人在不同养老方 式下的长期照护需求,健全多元化养老服务体系,进一步完善长期照护服务。     

Developing home health care services in rural areas--a case study of decision points

Although Illinois is considered an urban industrial state it has many rural areas with scant medical, social and public health services. The need to improve these services has been recognized as a priority by the Health Systems Agency and by citizens of those areas. One method of beginning to meet those needs is to extend Home Health Services from a nearby county where Medicare-certified services are already well developed. This article is to share the methodology used by Peoria City/County Health Department in developing a plan to meet the Home Health Care needs of Marshall and Putnam Counties. The presentation will be made in a case study format with identification of decision points within the process. The objective in identifying decision points is to assist home health agencies contemplating expansion into adjoining counties with the process of program development. The goal of the process is to provide Home Health Services to an underserved area.     

居家养老医疗关爱服务模式浅析

居家养老服务是指政府和社会力量依托社区,为居家的老年人提供生活照料、家政服务、康复护理和精神慰藉等方面服务的一种服务形式。它是对传统家庭养老模式的补充与更新,是我国发展社区服务,建立养老服务体系的一项重要内容[1]。文章阐述了目前我国居家养老医疗关爱服务的现状,详细分析了建立居家养老医疗关爱服务体系的必要性和可行性,并针对现阶段居家养老医疗关爱服务中存在的问题,提出了提升我国居家养老医疗关爱服务水平的设想,阐明居家养老医疗关爱服务是我国现阶段养老模式医疗服务的最佳选择。     

Acute health care service use among elderly home care clients

Utilization of acute health care services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute health care services; i.e., hospital admissions, emergency room visits. Clients with nutritional problems were 2.58 times more likely to have used acute health care services than clients without nutritional problems. Among clients with a poor social support system, those with nutrition problems were 5.95 times as likely to have used acute health care services. Poor self-rated health, and greater functional dependency were also signif- icantly associated with acute health care use. This study provides a profile of elderly home care clients who are at risk of using acute health care services, which may facilitate targeted efforts to prevent unplanned acute health care use.     

Employers, home support workers and elderly clients: identifying key issues in delivery and receipt of home support

The Nexus Home Care Project examines the experiences of employers, home support workers and elderly clients and their family members in the delivery and receipt of home support services. The primary purpose of this research is to identify salient issues in the delivery and receipt of home support services to elderly individuals from the perspective of employers, home support workers and clients. The data for this study, funded by the Canadian Institutes of Health Research, are derived from in-depth interviews with home support employers (n=11), home support workers (n=32) and elderly clients (n=14) in British Columbia. Employers emphasized recruitment and retention and the increasing complexity of client needs, and raised questions regarding the appropriateness of home support as a part of the healthcare continuum. Home support workers stressed scheduling and time demands, the tension in providing intimate ongoing care at an emotional distance and the balance between tasks outlined in the care plan and the needs and wants of elderly clients. Elderly clients indicated an ongoing need to prepare for and manage services and expressed a need for companionship. Findings are discussed as they inform and extend our understanding of the key tensions in home support. Strategies for addressing these tensions are also identified.     

社区居家养老意愿下居住方式和子女支持对老年人基层卫生服务需求的影响

目的:探讨居住方式和子女支持对老年人基层卫生服务需求的影响,使基层卫生服务更具针对性,以满足不同居家类型老年人的卫生服务需求.方法:利用2016年中国老年社会追踪调查数据,采用负二项Hurdle回归模型(NBH模型)分析.结果:与子女同住会显著提高城乡居家老年人对基层卫生服务的需求(P<0.05),子女经济支持则会显著...     

Client demands and the allocation of home care in the Netherlands. A multinomial logit model of client types,care needs and referrals

The purpose of this paper is to estimate the volume and composition of referrals to home care on the basis of applicant characteristics. The relationships between the background and care needs of applicant groups on the one hand and the referral of home care packages on the other, are studied by means of a multinomial logit model. The model is estimated on the basis of more than 7000 requests for home care in the northern part of the Netherlands. Home health care institutions have to deal with clients who arrive from many different branches of the health care system. As a result the services or products provided by home health care institutions are characterized by wide variation. In the modeling emphasis has, therefore, been placed on the differentiation of clients and products. We find for instance that elderly chronically ill applicants have a greater chance of being referred for domestic help only, while applicants with psychosocial disorders are more liable to be offered packages that include social support. Patients discharged from hospital have a greater chance of a referral to domestic help only when they are slightly disabled, and are more likely to be offered packages including physical care when they are more disabled. The model has a range of policy applications in assessing the impact of changes in the health care system on the volume and structure of the demand for home care services. Examples are presented of the consequences of the ageing population and earlier discharge from hospitals on demand for home care packages.     

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.     

我国居家老人对社区三类健康服务需求的影响因素分析

目的 综合分析我国居家老人对社区保健知识、精神蔚籍和上门看病送药三类健康服务需求的影响因素。方法 利用CLHLS2017—2018调查数据,运用SPSS 23.0软件进行统计分析,采用二元logistic回归分析方法,探寻我国居家老人对社区三类健康服务需求的影响因素。结果 我国居家老人社区三类健康服务（保健知识:χ2 = 935.263,P＜0.001;精神蔚籍:χ2 = 406.578,P＜0.001;上门看病送药:χ2 = 325.448,P＜0.001）的需求与供给差异显著;除居住地、退休前职业、地区和抑郁程度是影响居家老人对三类健康服务需求的共同因素之外,两周患病（否:OR = 1.282,95%CI:1.072～1.534,P = 0.007）、每年体检（是:OR = 1.19,95%CI:1.021～1.387,P = 0.026）以及高血压诊断（否:OR = 1.224,95%CI:1.045～1.433,P = 0.012）等也影响居家老人对保健知识的需求,居住方式（独居:OR = 1.321,95%CI:1.094～1.594,P = 0.004）也影响居家老人对精神蔚籍的需求,年龄（70～79岁:OR = 0.792,95%CI:0.649～0.966,P = 0.022）和每年体检（是:OR = 0.821,95%CI:0.716～0.941,P = 0.005）也影响居家老人对上门看病送药的需求。结论 建议社区卫生机构全方位开展对健康居家老人的保健知识宣传;重视对独居和抑郁居家老人的心理健康服务;权衡自身资源和居家老人的实际情况,逐步推进上门看病送药服务。     

Cancer Home Care in Montana

Availability of health care services in sparsely populated areas may be limited by fewer health care organizations and geographic separation. The purposes of this study were to identify unmet needs of individuals and families managing cancer in rural areas and examine cancer-related home care in rural areas. Issues of stalling, caseloads and service area for home health agencies (HHAs) and hospices were examined. HHAs registered with the Montana Association of Home Health Care Agencies and licensed hospices in Montana were mailed questionnaires with 92% of the HHAs and 90% of the hospices returning the questionnaires. Health providers identitied a variety of unmet needs including personal care and respite. Agencies were small with approximately four full-time equivalent registered nurses for HHAs and one full-time equivalent registered nurse for hospices. Similarly, caseloads were also small with an average of 50 clients per month for HHAs and 11 clients per month for hospices. HHAs and hospices had large service areas with two of the HHAs each serving seven counties. Implications of these fmdings for research and practice are discussed.     

Home Support Services in Australia:

This article describes the current provision of community and domiciliary health and welfare services in Australia focusing upon national programs and outlining how these have been interpreted and implemented by each of the six Statcs and two Territories which constitute the Australian Federation. The funding of home support services is described, particularly in relation to institutional services and State diffcrences. Changing emphases have bccn highlighted and considered relative to the needs of those requiring support to remain at home. The article prescnts an account of a medley of initatiatives and programs which are failing to meet ever increasing demand. The recent report of an Inquiry into Accommodation and Home Care for the Aged and the policy of the recently elected Australian Labor Party in relation to domiciliary care are examined.     

Cancer home care in Montana

Availability of health care services in sparsely populated areas may be limited by fewer health care organizations and geographic separation. The purposes of this study were to identify unmet needs of individuals and families managing cancer in rural areas and examine cancer-related home care in rural areas. Issues of staffing, caseloads and service area for home health agencies (HHAs) and hospices were examined. HHAs registered with the Montana Association of Home Health Care Agencies and licensed hospices in Montana were mailed questionnaires with 92% of the HHAs and 90% of the hospices returning the questionnaires. Health providers identified a variety of unmet needs including personal care and respite. Agencies were small with approximately four full-time equivalent registered nurses for HHAs and one full-time equivalent registered nurse for hospices. Similarly, caseloads were also small with an average of 50 clients per month for HHAs and 11 clients per month for hospices. HHAs and hospices had large service areas with two of the HHAs each serving seven counties. Implications of these findings for research and practice are discussed.     

Home support services in Australia: a confusion of intergovernmental responsibilities and provision.

This article describes the current provision of community and domiciliary health and welfare services in Australia focusing upon national programs and outlining how these have been interpreted and implemented by each of the six States and two Territories which constitute the Australian Federation. The funding of home support services is described, particularly in relation to institutional services and State differences. Changing emphases have been highlighted and considered relative to the needs of those requiring support to remain at home. The article presents an account of a medley of initiatives and programs which are failing to meet ever increasing demand. The recent report of an Inquiry into Accommodation and Home Care for the Aged and the policy of the recently elected Australian Labor Party in relation to domiciliary care are examined.