The use of preventable hospitalization for monitoring the performance of local health authorities in long-term care

ABSTRACTLong-stay home care clients mostly reside in private homes or retirement homes, and the type of residence may influence risk factors for long-term care placement. This multi-state analytic study uses RAI-Home Care and administrative data from the Hamilton Niagara Haldimand Brant Local Health Integration Network to model conceptualized states of risk at baseline through a 13-month follow-up period. Modifiable risk factors in these states were client loneliness or depressive symptoms, and caregiver distress. A higher adjusted likelihood of being discharged deceased was found for the lowest-risk clients in retirement homes. Adjusting for client, service, and caregiver characteristics, retirement home residency was associated with higher likelihood of placement in a long-term care home; reduced caregiver distress; and increased client loneliness/depression. As an alternative to private home settings as the location for aging in place among these long-stay home care clients, retirement home residency represents some trade-offs between client and informal caregiver.

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NHS indemnity for medical negligence: its implications

Psychiatric Bulletin ◽

10.1192/pb.15.2.79 ◽

1991 ◽

Vol 15 (2) ◽

pp. 79-80 ◽

Cited By ~ 1

Author(s):

Ram Seth

Keyword(s):

Major Change ◽

Health Department ◽

Local Health Authority ◽

Local Health ◽

Medical Practitioners ◽

Health Authorities ◽

Dental Practitioners ◽

Local Health Authorities ◽

Medical Defence

From 1 January 1990 medical and dental practitioners employed by health authorities were no longer required under the terms of their contracts to subscribe to a medical defence organisation. The health department, however, advised practitioners (DHSS circular) to “maintain their defence body membership in order to ensure they are covered for any work which does not fall within the scope of the indemnity scheme”. The expediency with which the scheme was introduced enabled little discussion on the consequences of such change and surprised medical practitioners and defence organisations alike. This major change in medical indemnity since 1954 will have long-term implications for practitioners, medical defence organisations, local health authorities and most importantly, the quality and quantity of health care which can be delivered. A meeting held on 9 April 1990 at Charter Nightingale Hospital was convened to discuss the implications of the NHS indemnity scheme between senior registrars in psychiatry and representatives from the Medical Defence Union, Medical Protection Society, British Medical Association and the local health authority.

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Attending Nurse Practitioners in Long-Term Care Homes Evaluation

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.965 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Danielle Fearon ◽

Refik Saskin ◽

Lisa Ishiguro ◽

Erin Graves

Keyword(s):

Nurse Practitioners ◽

Long Term Care ◽

Hospital Admissions ◽

Research Question ◽

Emergency Department Visits ◽

Fiscal Year ◽

Local Health ◽

Term Care ◽

The Impact

IntroductionIn 2014, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced funding for 75 nurse practitioners (NPs) over three years in long-term care (LTC) homes. This evaluation was approved by ICES’ Applied Health Research Question (AHRQ) team, a portfolio which answers questions from stakeholders having impact on healthcare policy. Objectives and ApproachThe purpose of this project is to evaluate the impact of the first thirty NPs hired. Changes will be evaluated using key outcome measures of resident care (e.g., early hospital discharge, emergency room bed days) identified through a literature review conducted by the MOHLTC. LTC home residents were identified using all individuals with claims in OHIP during the 2016-17 fiscal year with a location of a LTC home. LTC homes with a hired NP were considered to be cases and all other LTC homes were considered to be controls. ResultsFor part one of this evaluation, case and control LTC homes were stratified by bed size, Case Mix Index, rurality and Local Health Integration Network. Hospitalization records and emergency visits (from Discharge Abstract Database and National Ambulatory Care Reporting System) were determined for LTCH residents 6 months before and after the NP hire date of October 1, 2016. Overall, the rate of hospital admissions (per 100 residents) increased by 3.44% (8.51% to 11.94%) following the NP hire date; whereas, the rate of hospital admissions increased by 2.29% (6.55% to 8.83%) among controls. Following the NP hire date, the rate of emergency department visits also increased by 3.15% among cases (16.62% to 19.77%) in comparison to a 2.31% increase among controls (12.55% to 14.86%). Conclusion/ImplicationsThe findings from this evaluation will inform further implementation strategies of the NP program and guide decision-making of future funding opportunities. In summary, the results will inform policies to strengthen care of LTC homes and improve the quality of care of residents.

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Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012

Eurosurveillance ◽

10.2807/1560-7917.es2014.19.29.20859 ◽

2014 ◽

Vol 19 (29) ◽

Cited By ~ 17

Author(s):

A S Barret ◽

N Jourdan-da Silva ◽

K Ambert-Balay ◽

G Delmas ◽

A Bone ◽

...

Keyword(s):

Long Term Care ◽

Control Measures ◽

Infection Prevention And Control ◽

Term Care ◽

Health Authorities ◽

First Case ◽

Rapid Control ◽

Care Facilities ◽

And Control

This article describes outbreaks of gastroenteritis in elderly long-term care facilities (LTCF) in France from November 2010 to May 2012 reported through the surveillance system for gastroenteritis outbreaks in LTCF. A total of 1,072 outbreaks were reported, causing 26,551 episodes of illness and 60 deaths. The median attack rate (AR) among residents was 32%. Norovirus and person-to-person transmission were the most frequently reported aetiology and mode of transmission. Control measures were implemented in 1,054 (98%) outbreaks and for 928 outbreaks, the timing of such measures could be inferred. Of these, 799 (86%) had put control measures into effect within three days of the occurrence of the first case. Outbreaks of gastroenteritis in LTCF cause substantial morbidity and mortality among elderly people in France. LTCF are encouraged to develop infection prevention and control plans and to notify any gastroenteritis outbreak to health authorities to ensure rapid control.

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Multidimensional and nutritional evaluation in post-acute long-term care setting

Geriatric Care ◽

10.4081/gc.2017.6644 ◽

2017 ◽

Vol 3 (3) ◽

Author(s):

Antonio Uneddu ◽

Mauro Sotgia ◽

Valentina Spissu ◽

Marta Manzocco ◽

Alessandra Filippi

Keyword(s):

Care Setting ◽

Long Term Care ◽

Prognostic Index ◽

University Hospital ◽

Local Health ◽

Term Care ◽

Risk Of Mortality ◽

Local Health Care ◽

The University

Since 2011 the Unit of Post Acute Long-Term Care started the activity in Sassari, Sardinia region, initially as Local Health Care Public Service and currently integrated in the University Hospital. The purpose of this paper was to describe the main care methods based on a comprehensive geriatric approach and the multidimensional prognostic index to stratify the risk of mortality and other negative outcomes. With a strong emphasis on nutritional problems, we analyzed the correlations among malnutrition and motility, cognitive impairment, comorbidity and major diseases, and psychosocial determinants.

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The impact of COVID-19 on Long Term Care Facilities (LTCFs) of an Italian Province: a cohort study and a retrospective analysis of observed vs. expected mortality

10.1101/2020.10.21.20216705 ◽

2020 ◽

Author(s):

Andrea Tramarin ◽

Nicola Gennaro ◽

Giancarlo Dal Grande ◽

Luciana Bragagnolo ◽

Maria Rosa Carta ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Analysis ◽

Long Term Care ◽

Mitigation Measures ◽

Term Care ◽

Health Authorities ◽

Care Facilities ◽

Expected Mortality ◽

The Impact

AbstractIn Italy, as in other countries, Long Term Care Facilities (LTCFs) have seen a disproportionally high number of deaths during the COVID-19 pandemic. The Veneto region was one of the first areas of the country where the virus spread rapidly particularly in the LTCFs. As it became evident that LTCs were the epicenter of the pandemic, health authorities of the Vicenza province adopted a plan, which included an epidemiological investigation in a case study facility (CSF) and a retrospective analysis to estimate the impact of COVID-19 in terms of mortality. Combining retrospective data and a prospective cohort study in the CSF we provided a tentative estimate of the impact of COVID-19 on LTCFs. We found an age-gradient in all variables explored. An observed mortality higher 60% than 2019 was found in those LTCF reporting COVID-19 cases. Our findings suggest the need to adopt and maintain strict mitigation measures in LTCFs in the future dynamics of the epidemic.

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Augmenting Surveillance to Minimize the Burden of Norovirus-Like Illness in Ontario: Using TeleHealth Ontario Data to Detect the Onset of Community Activity

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v8i1.6538 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Stephanie L. Hughes ◽

Andrew Papadopoulos

Keyword(s):

Early Warning System ◽

Long Term Care ◽

Laboratory Data ◽

Warning System ◽

Term Care ◽

Health Authorities ◽

Lost Productivity ◽

Public Health Authorities ◽

The Common

Norovirus is the leading cause of gastroenteritis worldwide, resulting in millions of infections annually. In comparison to other viral illnesses, the total number of norovirus cases per year is second only to the common cold. While infection is relatively short-lived, the illness causes a high economic impact due to lost productivity and healthcare expenditures, thus requiring action to reduce the burden. In Ontario, surveillance is predominantly laboratory-based, leaving much room for improvement. This project will utilize syndromic surveillance to create an early warning system for early norovirus detection; TeleHealth Ontario call data will be analyzed to identify the beginning of the winter vomiting season in conjunction with laboratory data to confirm the season. From this, public health authorities can notify hospitals, long-term care homes, and other vulnerable populations of impending outbreaks.

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Working With Resistance and Encouraging Buy-In to New Programs

Perspectives on Gerontology ◽

10.1044/gero16.1.18 ◽

2011 ◽

Vol 16 (1) ◽

pp. 18-21

Author(s):

Sara Joffe

Keyword(s):

Long Term Care ◽

Term Care ◽

Optimal Outcomes ◽

Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

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