Institutional care in the community: from chaos to integration of health and social care?

1997 ◽  
Vol 7 (3) ◽  
pp. 189-191
Author(s):  
Clive E Bowman
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Social Services ◽  
Long Term Care ◽  
Social Care ◽  
Institutional Care ◽  
Nursing Home Care ◽  
Term Care ◽  
The Uk

Distinguishing between health and social aspects of institutional care for frail elderly people remains confusing and contentious in the UK, even though health and community care reforms specifically sought to avoid such problems. Nursing home care in the UK has developed rapidly to 170 000 nursing home beds. Nursing home care now costs significantly more than the total committed to primary care. Some health authorities maintain a large commitment to long-term care provision in hospitals and contract nursing home beds; others have divested themselves of providing long-term care, becoming dependent on means-tested nursing home care provided by social services. Where 'free' health service contract nursing home beds are adjacent to social services means-tested placements the inconsistencies become even more perverse. Distinguishing between health and social patients/clients/supplicants on the basis of health or social care need is often impossible. Health Service responsibilities to support care home residents will become more onerous as cost pressures define the limits of social care for individuals and social services producers alike. There is, in addition, an unresolved tension between the professions associated with the care of elderly patients, who are seeking clear standards, and the hostile purchasing environment which fails to value the cost benefit, let alone the health gain of planned care management in deference to the Mammonism of treatment episodes.

scholarly journals Municipalities’ Decision to Care: At Home or in a Nursing Home

2020 ◽  
Vol 26 (4) ◽  
pp. 327-342
Author(s):  
Theis Theisen
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Empirical Literature ◽  
Term Care ◽  
Scant Attention ◽  
Insurance Mechanism ◽  
Using Data

AbstractAn almost ideal demand system for long-term care is estimated using data from Norway, where the split of long-term care between home care and care in nursing homes is determined by municipalities. Previous literature has barely addressed what determines municipalities’ or other organizations’ allocations of resources to the sub-sectors of long-term care. The results show that home care is a luxury, while nursing home care is a necessity with respect to total expenditures on long-term care. Municipalities respond to high unit costs for home care by reducing that type of care. Municipalities are highly responsive to variations in the need for the two types of care and seem to provide a well-functioning insurance mechanism for long-term care. In the previous empirical literature, municipalities’ role as providers of insurance against the consequences of disabilities and frailty has received scant attention.

Physical Health and Cognitive Ability Among Married Long-Term-Care Patients and Among Their Spouses—A Comparison Between Home Care and Nursing Home Care

1993 ◽  
Vol 5 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Ann-Christine Löfgren ◽  
Gösta Bucht ◽  
Sture Eriksson ◽  
Tage Lundström
Keyword(s):  
Nursing Home ◽  
Cognitive Function ◽  
Nursing Homes ◽  
Home Care ◽  
Physical Health ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Nursing Home Patients

The purpose of this study was to establish whether physical health and cognitive function in married long-term patients or in their spouses determines why some patients are cared for in home care while others reside in nursing homes. Out of 38 married couples with a sick spouse cared for in a nursing home, 23 couples were studied; out of 34 couples with a sick spouse cared for in home care, 22 patients and 25 spouses were studied. The results showed no significant differences in physical health score either between the two groups of patients, or between the two groups of spouses. Both home-care patients and nursing home patients had low cognitive function scores, but nursing home patients had significantly lower scores. A multivariate analysis showed that physical health and cognitive function explained only 20% of patients' residence. Between the two groups of spouses there was no difference in cognitive function score. The conclusion is that physical health status and cognitive function explain only to a small extent why married long-term care patients are cared for in nursing homes or in home care.

scholarly journals Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

2016 ◽  
Vol 8 (3) ◽  
pp. 329-343
Author(s):  
Jingping Xing ◽  
Dana B. Mukamel ◽  
Laurent G. Glance ◽  
Ning Zhang ◽  
Helena Temkin-Greener
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Medicaid Reimbursement ◽  
Quality Of Nursing

Effizienzreserven in der stationären Pflege in Deutschland: Versuch einer Quantifizierung und Implikationen für die Reform der Gesetzlichen Pflegeversicherung

2008 ◽  
Vol 57 (1) ◽  
Author(s):  
Jasmin Häcker ◽  
Birgit König ◽  
Bernd Raffelhüschen ◽  
Matthias Wernicke ◽  
Jürgen Wettke
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Consumer Sovereignty ◽  
Incentive Problem ◽  
Relationship Of

AbstractThe design of the German statutory long-term care insurance (LTCI) is deficient in many respects. One of the major flaws in nursing home care is the inherent incentive problem concerning the relationship of the insured, the insurers and the nursing homes: For one, there is no competition amongst the insurers which influences the negotiation behaviour towards the nursing homes concerning the fixing of the daily payment rates. The nursing homes in turn are more or less unrestricted at setting the daily payment rate as the insured are mostly not in a position to fully practice their consumer sovereignty in case of the need of long-term care treatment. In the framework of this paper we try to quantify the efficiency reserve behind these disincentives in nursing home care and try to assess to what extent the contribution rate to LTCI could be reduced, if the efficieny reserves were exhausted.

A Comparison between the Veteran Administration's Long-Term Nursing Home Care Program and Three Examples of Similar Care Outside of the V.A.

1981 ◽  
Vol 13 (1) ◽  
pp. 61-69 ◽  
Author(s):  
William M. Epstein
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Nursing Care ◽  
Long Term Care ◽  
Care Program ◽  
Nursing Home Care ◽  
National Academy Of Sciences ◽  
Term Care

In a study mandated by Congress, the National Academy of Sciences reviewed the quality of medical care in the Veteran's Administrations health care system. The study reported here summarizes the findings of the long-term care portion of the NAS' work as it relates to nursing home care. The quality of the long-term care in the VA's nursing home care units was compared to three quality standards of long-term nursing care outside of the VA. Staffing pattern, quality of services, quality of the environment, and patient needs were measured and compared; overall assessments of nursing home quality were made by site visitors. Generally, the results show VA care to be superior to the care provided in the benchmark institutions, suggesting perhaps that the public sector's direct provision of long-term nursing care may be an acceptable alternative to the support of private sector care.

Are Personal Budgets a Financially Sound Reform Option for the German Long-Term Care Insurance?

2010 ◽  
Vol 230 (4) ◽  
Author(s):  
Melanie Arntz ◽  
Stephan L. Thomsen
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Long Term Care ◽  
Cost Savings ◽  
Nursing Home Care ◽  
Term Care ◽  
Long Run ◽  
Long Term Care Insurance ◽  
The Stability

SummaryIn a long-run social experiment, personal budgets have been tested as an alternative home care program of the German long-term care insurance (LTCI). By granting the monetary value of in kind services in cash, personal budgets are considered to enable customized home care arrangements, thereby avoiding costly nursing home care and thus saving LTCI spending. However, personal budgets also compete with the already existing and less generous cash option of the LTCI. Any transition from the receipt of cash benefits to personal budgets thus challenges the view of personal budgets as a cost savings device, unless personal budgets sufficiently reduce the use of costly nursing home care to balance these extra costs.This paper therefore contrasts the short-term costs of implementing personal budgets with potential cost savings if personal budgets enhance the stability of home care and avoid costly nursing home care. For this purpose, the paper investigates the effects of personal budgets on the duration of home care until moving to a nursing home as well as the perceived stability of home care. Despite a positive effect of personal budgets on the stability of home care, LTCI spending is likely to increase in the short to medium run. In the long run, however, the expected transition to decreasing numbers of cash recipients favors the introduction of personal budgets.

Efficiency of Institutional Long Term Care and Annual Demands for Placement

1998 ◽  
Vol 11 (3) ◽  
pp. 26-32 ◽  
Author(s):  
Darla O'Reilly ◽  
Patrick S. Parfrey ◽  
Brendan Barrett ◽  
Jackie McDonald
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Resource Utilization ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Hospital Beds ◽  
Single Entry ◽  
Study Population

The objective of this study was to determine the efficiency of and annual demands for institutional long term care placement in the St. John's region. The study population comprised all applicants assessed for institutional long term care through the Community Health St. John's Region Single Entry System in 1995–96. The outcome measures used for the study included estimates of client resource utilization employing the RUGs III and Alberta Resident Classification System; hospital beds occupied; time to placement; and annual demands on long term care. The study concludes that objective criteria for admission to supervised care and nursing home care may help reduce the number of inappropriate placements (thus maximizing the use of existing nursing home beds) and decrease annual demands. Investment in alternatives to nursing home care for those with modest disability is suggested.

scholarly journals The Pandemic and Nursing Home Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 388-388
Author(s):  
Lori Smetanka
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Long Term Care ◽  
Elder Abuse ◽  
Nursing Home Care ◽  
Term Care ◽  
Care Facilities

Abstract This session will provide updates on how the pandemic led to horrific situations in long-term care facilities and how the pandemic influenced major federal efforts to address elder abuse, neglect, and exploitation.

Do Local Governments Respond to (Perverse) Financial Incentives in Long-Term Care Funding Schemes?

2013 ◽  
Vol 14 (2) ◽  
pp. 525-549 ◽  
Author(s):  
Henning Øien
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Financial Incentives ◽  
Local Governments ◽  
Long Term Care ◽  
Nursing Home Care ◽  
Term Care ◽  
Home Based ◽  
Home Based Care

Abstract A highlighted issue in long-term care (LTC) financing is the presence of unfortunate incentives in financing schemes. For instance, in Norway, a high share of high-income recipients provides financial incentives to the local governments (the agencies in charge of the LTC system) to increase reliance on nursing home care relative to community housing and home-based care. This article examines the effects of the Norwegian LTC funding system on the composition of LTC services at the local government level. I use a cross-section from 2009 of 391 local governments to estimate a fractional probit model using quasi-maximum likelihood estimation. Controlling for need and geographical variations in care costs, I find that the share of “rich” elderly has a significant association with three measures of the volume of nursing home care relative to home-based care.

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