scholarly journals Modelling the cost-effectiveness of impact-absorbing flooring in Swedish residential care facilities

2015 ◽  
Vol 26 (3) ◽  
pp. 407-411 ◽  
Author(s):  
Linda Ryen ◽  
Mikael Svensson
2021 ◽  
Vol 25 (39) ◽  
pp. 1-74
Author(s):  
Matt Stevenson ◽  
Andrew Metry ◽  
Michael Messenger

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. Objective The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. Perspective/setting The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. Methods A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. Results Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. Limitations There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. Conclusions SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. Future work More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. Funding This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.


2020 ◽  
Vol 36 (3) ◽  
pp. 24-36
Author(s):  
Caz Hales ◽  
◽  
Isaac Amankwaa ◽  
Lesley Gray ◽  
Helen Rook ◽  
...  

Little is known about the level of service demand and preparedness of Aotearoa New Zealand’s aged residential care facilities to care for older adults with extreme obesity. The aim of this study was to assess the current state of bariatric (extreme obesity) services within aged residential care. An environmental scan was conducted to identify bariatric resident needs and gaps in service provision to inform the development of policy and service provision. Observational and interview data from three facilities in Aotearoa New Zealand was collected along with a retrospective review of national resident admissions over a three-year period. Poor environmental design that included infrastructure deficiencies and financial barriers impacted on the ability to deliver safe and equitable care for this population. Specifically, equipment procurement and safe staffing ratios were of concern to the sector. There is an increasing need for bariatric level support within aged care, necessitating more equipment and staff, adaptation of physical care environments, and enhanced funding. Significant investment is required to address care concerns of older adults with extreme obesity at government and organisational levels.


Diabetes Care ◽  
2013 ◽  
Vol 36 (3) ◽  
pp. e37-e37 ◽  
Author(s):  
H. E. Resnick ◽  
G. L. Foster

2021 ◽  
Vol 15 (2) ◽  
pp. 253-273
Author(s):  
Virginia Miller ◽  
Seumas Miller ◽  
Bruce Stevens

Abstract The issues of elder sexual abuse and sexual freedom in residential care facilities are complicated by the existence of many residents with cognitive impairments of a kind that compromise their ability to make decisions based on informed consent. The issues of elder sexual abuse and sexual freedom in faith-based residential care facilities, in particular, are further complicated by restrictive, theologically based, ethical principles pertaining to sexual activity – for instance, prohibitions on extra-marital sex and the use of prostitutes by residents. The tension that arises must necessarily deal with the integrity of faith-based aged-care facilities and current legislation that promotes the rights of age-care residents to sexual freedoms. In the midst of much public concern about the level and quality of institutional age care this particular aspect seldom attracts notice. It nevertheless exposes a quandary to do with how ought public theology and ethics respond.


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