Persons with brain injury and employment supports: Long-term employment outcomes and use of community-based services

Brain Injury ◽  
2017 ◽  
Vol 31 (5) ◽  
pp. 607-619 ◽  
Author(s):  
Alisa Grigorovich ◽  
Mary Stergiou-Kita ◽  
Thecla Damianakis ◽  
Guylaine Le Dorze ◽  
Carolyn Lemsky ◽  
...  
Keyword(s):  
Brain Injury ◽  
Employment Outcomes ◽  
Community Based ◽  
Employment Supports ◽  
Community Based Services

Community-Based Services for People With Brain Injury: A National Analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 123-138 ◽  
Author(s):  
Carli Friedman ◽  
Laura VanPuymbrouck
Keyword(s):  
Brain Injury ◽  
Underserved Populations ◽  
Fiscal Year ◽  
Community Based ◽  
Institutional Settings ◽  
Services And Supports ◽  
National Analysis ◽  
Community Based Services

Purpose:Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.Method:This study examined how states utilized waivers to provide for people with BI.Results:Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.Conclusions:Of those waivers for people with BI, there were vast differences across states and services.

scholarly journals Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041569
Author(s):  
Lucina Rolewicz ◽  
Eilís Keeble ◽  
Charlotte Paddison ◽  
Sarah Scobie
Keyword(s):  
General Practice ◽  
Unmet Need ◽  
Patient Survey ◽  
Secondary Outcome ◽  
Community Based ◽  
Long Term Conditions ◽  
Local Services ◽  
Community Based Services ◽  
Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

scholarly journals Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

2020 ◽  
Vol 17 (8) ◽  
pp. 2649
Author(s):  
Chia-Mei Shih ◽  
Yu-Hua Wang ◽  
Li-Fan Liu ◽  
Jung-Hua Wu
Keyword(s):  
Low Income ◽  
Long Term Care ◽  
Common Factor ◽  
Behavioral Model ◽  
Care Needs ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Community Based Services

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

scholarly journals EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Home Based ◽  
Number Of Visits ◽  
Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

Functional independence 6 months to 5 years after traumatic brain injury: Opportunities for recreational therapy

2018 ◽  
Vol 17 (1) ◽  
pp. 29
Author(s):  
Donna L. Gregory, MBA, CTRS ◽  
Brent L. Hawkins, PhD, LRT/CTRS ◽  
Leighton Chan, MD, MPH
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Psychosocial Adjustment ◽  
Social Skill ◽  
Functional Independence ◽  
Recreational Therapy ◽  
Community Based ◽  
Social Skill Development ◽  
Compensatory Strategies

Traumatic brain injury (TBI) can have a lasting and devastating impact on individuals and their families. The effects of TBI are complex and may impair cognitive and psychosocial function. The purpose of this study was to identify impairments 6 months to 5 years after TBI and to recognize opportunities for recreational therapy (RT) to address functional needs. Results indicated that psychosocial adjustment and cognitive improvements occurred between 90 and 180 days after injury. However, impairment in several cognitive and psychosocial adjustment subscales persisted 1 to 5 years after injury. Community-based RT interventions focused on cognitive compensatory strategies, environmental adaptation, and social skill development may help individuals experiencing long-term impairments.

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

2015 ◽  
pp. 150527102958001 ◽  
Author(s):  
Andrea Wysocki ◽  
Mary Butler ◽  
Robert L. Kane ◽  
Rosalie A. Kane ◽  
Tetyana Shippee ◽  
...  
Keyword(s):  
Older Adults ◽  
Institutional Care ◽  
Community Based ◽  
Services And Supports ◽  
Community Based Services

The Use of Community-Based Services in Long-term Care by Older Minority Persons

1979 ◽  
Vol 19 (4) ◽  
pp. 389-397 ◽  
Author(s):  
D. Holmes ◽  
M. Holmes ◽  
L. Steinbach ◽  
T. Hausner ◽  
B. Rocheleau
Keyword(s):  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Community Based Services

scholarly journals Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

2020 ◽  
pp. 073346482094136
Author(s):  
Sangeeta C. Ahluwalia ◽  
Esther Friedman ◽  
Daniel Siconolfi ◽  
Debra Saliba ◽  
Jessica Phillips ◽  
...  
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Service Agency ◽  
Community Based ◽  
Incentive Program ◽  
Services And Supports ◽  
Consumer Advocates ◽  
Community Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

Long-Term Care Goes to Market: Managed Competition and Ontario's Reform of Community-Based Services

1999 ◽  
Vol 18 (2) ◽  
pp. 125-153 ◽  
Author(s):  
A. Paul Williams ◽  
Jan Barnsley ◽  
Sandra Leggat ◽  
Raisa Deber ◽  
Pat Baranek
Keyword(s):  
Nous Avons ◽  
Long Term Care ◽  
Managed Competition ◽  
Community Based ◽  
Term Care ◽  
Longue Duree ◽  
Longue Durée ◽  
Community Based Services

RÉSUMÉLa désinstitutionnalisation et le virage vers les ressources communautaires posent des défis importants aux décideurs et aux dispensateurs de services, le plus important étant sans nul doute le défi de fournir un volume de services communautaires de haute qualité suffisant à répondre aux besoins de la clientèle. Ce défi est particulièrement évident dans les soins de longue durée (SLD), en raison de la complexité et de la diversité de ce champs d'action, de la vulnérabilité de la clientèle et de l'accroissement de la demande consécutive aux compressions dans le système hospitalier. Dans ce contexte, la dernière réforme des soins de longue durée en Ontario est particulièrement intéressante parce que, comme l'exprime le mot d'ordre gouvernemental «meilleure qualité au meilleur prix,» elle promet la coüt-efficacité tout en assurant le maintien ou l'amélioration de la qualité. Pour y arriver, on a recours à un modèle de «gestion de la concurrence» dans lequel les fournisseurs sans but lucratif et à but lucratif entrent en concurrence pour des contrats de services attribués par des Centres d'accès aux soins communautaires locaux, gérés par un conseil de bénévoles. Dans cette communication, nous avons utilisé les commentaires de hauts fonctionnaires et de représentants de fournisseurs de soins, ainsi que des documents du domaine public, pour mettre en lumière les questions et les problèmes soulevés par cette plus récente réforme provinciale. Nous soumettons que le modèle de gestion de la concurrence pourra entraîner la subordination de la qualité des services et du choix du consommateur aux impératifs de limitation des coûts, particulièrement dans le contexte actuel de budgets fermés et d'augmentation de la demande.

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