scholarly journals A joint hierarchical model for the number of cases and deaths due to COVID-19 across the boroughs of Montreal

2021 ◽  
Author(s):  
Victoire Michal ◽  
Leo Vanciu ◽  
Alexandra M. Schmidt
Keyword(s):  
Fixed Effects ◽  
Hierarchical Bayesian Models ◽  
Spatial Effects ◽  
Term Care ◽  
Spatial Confounding ◽  
Spatial Approach ◽  
Latent Effects ◽  
Conditional Autoregressive ◽  
Set Up

AbstractMontreal is the epicentre of the COVID-19 pandemic in Canada with highest number of deaths. The cumulative numbers of cases and deaths in the 33 areas of Montreal are modelled through bivariate hierarchical Bayesian models using Poisson distributions. The Poisson means are decomposed in the log scale as the sums of fixed effects and latent effects. The areal median age, the educational level, and the number of beds in long-term care homes are included in the fixed effects. To explore the correlation between cases and deaths inside and across areas, three bivariate models are considered for the latent effects, namely an independent one, a conditional autoregressive model, and one that allows for both spatially structured and unstructured sources of variability. As the inclusion of spatial effects change some of the fixed effects, we extend the Spatial+ approach to a Bayesian areal set up to investigate the presence of spatial confounding.

scholarly journals Why are there long waits at English emergency departments?

2019 ◽  
Vol 21 (2) ◽  
pp. 209-218 ◽  
Author(s):  
James Gaughan ◽  
Panagiotis Kasteridis ◽  
Anne Mason ◽  
Andrew Street
Keyword(s):  
Emergency Departments ◽  
Fixed Effects ◽  
Waiting Times ◽  
Poisson Model ◽  
Bed Occupancy ◽  
Term Care ◽  
Delayed Discharges ◽  
A Minor ◽  
The Impact

Abstract A core performance target for the English National Health Service (NHS) concerns waiting times at Emergency Departments (EDs), with the aim of minimising long waits. We investigate the drivers of long waits. We analyse weekly data for all major EDs in England from April 2011 to March 2016. A Poisson model with ED fixed effects is used to explore the impact on long (> 4 h) waits of variations in demand (population need and patient case-mix) and supply (emergency physicians, introduction of a Minor Injury Unit (MIU), inpatient bed occupancy, delayed discharges and long-term care). We assess overall ED waits and waits on a trolley (gurney) before admission. We also investigate variation in performance among EDs. The rate of long overall waits is higher in EDs serving older patients (4.2%), where a higher proportion of attendees leave without being treated (15.1%), in EDs with a higher death rate (3.3%) and in those located in hospitals with greater bed occupancy (1.5%). These factors are also significantly associated with higher rates of long trolley waits. The introduction of a co-located MIU is significantly and positively associated with long overall waits, but not with trolley waits. There is substantial variation in waits among EDs that cannot be explained by observed demand and supply characteristics. The drivers of long waits are only partially understood but addressing them is likely to require a multi-faceted approach. EDs with high rates of unexplained long waits would repay further investigation to ascertain how they might improve.

scholarly journals Care support points of Mecklenburg-West Pomerania. Results of a scientific analysis / Pflegestützpunkte in Mecklenburg-Vorpommern. Ergebnisse einer wissenschaftliche Analyse

2016 ◽  
Vol 3 (2) ◽  
pp. 165-176 ◽  
Author(s):  
Stefan Schmidt ◽  
Steffi Kraehmer
Keyword(s):  
Case Management ◽  
Long Term Care ◽  
Demographic Data ◽  
General Information ◽  
Term Care ◽  
Support Points ◽  
Long Term Care Insurance ◽  
Set Up ◽  
Care Support

Abstract Background In the period 2011 – 2013, 13 care support points were set up in Mecklenburg-West Pomerania. They are the joint responsibility of all health and long-term care insurance funds and local government. Method Between July and November 2013, data on organisation and personnel were collected in respect of the care support points and their advisory staff. Questions were asked about reasons for visiting a care support point, the subject matter of any counselling and demographic data on the users. Data were collected using questionnaires and interviews. Descriptive statistics were used to analyse quantitative data, the interviews were evaluated by analysis of their content. Results The results show a heterogenic picture of adviser training. Most users made contact with the care support points by telephone. General information on long-term care insurance was frequently sought. In 2015, care support points were consulted much more frequently than in 2014. The partners describe the networking involved as time-consuming; any synergy effects to date were estimated to be limited. Conclusions More network structures need to be created if those in need of care and assistance as supplied by care counselling based on case management are to be reached in future. What is called for are firm, written contracts with no personal bias, assigning care support points with the role of central actors at the regional level, able to produce neutral, independent organization and coordination of the necessary assistance. A guarantee of continuity of provision would fulfill the requirements of the kind of procedure involved in case management. Regardless of the number of professional providers and informal carers participating.

scholarly journals Does long-term care coverage shape the impact of informal care-giving on quality of life? A difference-in-difference approach

2018 ◽  
Vol 40 (6) ◽  
pp. 1291-1308 ◽  
Author(s):  
Thijs van den Broek ◽  
Emily Grundy
Keyword(s):  
Quality Of Life ◽  
Informal Care ◽  
Fixed Effects ◽  
Long Term Care ◽  
Difference In Difference ◽  
Term Care ◽  
Care Giving ◽  
The Impact

AbstractThe impact that providing care to ageing parents has on adult children's lives may depend on the long-term care (LTC) context. A common approach to test this is to compare whether the impact of care-giving varies between countries with different LTC coverage. However, this approach leaves considerable room for omitted variable bias. We use individual fixed-effects analyses to reduce bias in the estimates of the effects of informal care-giving on quality of life, and combine this with a difference-in-difference approach to reduce bias in the estimated moderating impact of LTC coverage on these effects. We draw on longitudinal data for Sweden and Denmark from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected between 2004 and 2015. Both countries traditionally had generous LTC coverage, but cutbacks were implemented at the end of the 20th century in Sweden and more recently in Denmark. We use this country difference in the timing of the cutbacks to shed light on effects of LTC coverage on the impact care-giving has on quality of life. Our analyses show that care-giving was more detrimental for quality of life in Sweden than in Denmark, and this difference weakened significantly when LTC coverage was reduced in Denmark, but not in Sweden. This suggests that LTC coverage shapes the impact of care-giving on quality of life.

scholarly journals Learning in Collaborative Moments

2019 ◽  
Vol 26 (3) ◽  
pp. 10-22
Author(s):  
Silke Hoppe ◽  
Laura Vermeulen ◽  
Annelieke Driessen ◽  
Els Roding ◽  
Marije de Groot ◽  
...  
Keyword(s):  
The Netherlands ◽  
Long Term Care ◽  
Research Collaboration ◽  
Research Projects ◽  
Term Care ◽  
Conventional Process ◽  
Set Up

In this article, we describe experiences with dialogue evenings within a research collaboration on long-term care and dementia in the Netherlands. What started as a conventional process of ‘reporting back’ to interlocutors transformed over the course of two years into learning and knowing together. We argue that learning took place in three different articulations. First, participants learnt to expand their notion of knowledge. Second, they learnt to relate differently to each other and, therewith, to dementia. And third, participants learnt how to generate knowledge with each other. We further argue that these processes did not happen continuously, but in moments. We suggest that a framework of collaborative moments can be helpful for research projects that are not set up collaboratively from the start. Furthermore, we point to the work required to facilitate these moments.

An Ethics Consult Team in Geriatric Long-Term Care

1995 ◽  
Vol 4 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Eileen R. Chichin ◽  
Ellen Olson
Keyword(s):  
Long Term Care ◽  
Ethics Committees ◽  
Case Review ◽  
Advocacy Groups ◽  
Term Care ◽  
Ethical Problems ◽  
Set Up ◽  
Patient Advocacy Groups ◽  
Geriatric Long Term Care

The increasing incidence of ethical dilemmas in long-term care settings, in concert with recommendations from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, has prompted long-term care institutions to develop mechanisms to address these concerns. Some facilities have chosen to set up an ethics committee, although estimates obtained in the past few years indicate that only between 2 and 27% of institutional long-term care settings have such committees. Ethics committees are responsible for assisting staff, residents, and families with the resolution of ethi- cal concerns, and typically engage in policy review and development, case review, and education. Such committees usually count among their membership representatives from a variety of disciplines, with family members, patients, and representatives from patient advocacy groups supplementing the professional component of the committee.

scholarly journals Local Nursing Home Prescribing Patterns and Psychoactive Prescribing in Assisted Living

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 707-707
Author(s):  
Kali Thomas ◽  
Christopher Wretman ◽  
Philip Sloane ◽  
Anna Beeber ◽  
Paula Carder ◽  
...  
Keyword(s):  
Nursing Home ◽  
Assisted Living ◽  
Fixed Effects ◽  
Linear Models ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Term Care ◽  
Separate Model ◽  
Medication Prescribing

Abstract Because prescribing practices in long-term care settings may reflect regional influences, we examined how potentially inappropriate antipsychotic and antianxiety medication prescribing in assisted living (AL) compared to prescribing in nursing homes (NHs) based on their proximity, using generalized linear models adjusting for facility characteristics and state fixed effects. Data were derived from a seven state sample of AL communities and data for the same seven states drawn from publicly available data reported on the Nursing Home Compare website. In adjusted analyses, AL rates of antipsychotic use were not associated with the rates in the nearest or farthest NHs. However, AL communities that were affiliated with a NH had lower rates of potentially inappropriate antipsychotic use (b=−0.27[95%CI=−0.50,−0.04]). In a separate model, antianxiety medication prescribing rates in AL were significantly associated with neighboring NHs’ rates of prescribing (b=2.65[95%CI=1.00,4.29]). Findings suggest efforts to change prescribing in NHs may influence prescribing in AL.

Long-term care for elderly people in the UK

1999 ◽  
Vol 9 (4) ◽  
pp. 383-393 ◽  
Author(s):  
Norman J Vetter
Keyword(s):  
Elderly People ◽  
Long Term Care ◽  
Elderly Person ◽  
The Elderly ◽  
Royal Commission ◽  
Elderly Persons ◽  
Term Care ◽  
Set Up ◽  
The Uk

The recent Royal Commission report on funding long-term care was produced following more than 100 visits and evidence from 400 organizations. It was set up following concern at the costs of long-term care for elderly people and what was seen to be the anomalous position of elderly people cared for by the NHS in long-term beds, where all costs were found by the state, albeit that elderly persons themselves lost most of their benefits. This contrasted with those in the social or independent sector, where payment has to be made unless the elderly person is poor.

scholarly journals Insurance decisions under nonperformance risk and ambiguity

2021 ◽  
Author(s):  
Timo R. Lambregts ◽  
Paul van Bruggen ◽  
Han Bleichrodt
Keyword(s):  
Ambiguity Aversion ◽  
Decision Makers ◽  
Care Needs ◽  
Term Care ◽  
Demand For Insurance ◽  
Theoretical Predictions ◽  
Set Up ◽  
Insurance Decisions ◽  
Far Future

AbstractAn important societal problem is that people underinsure against risks that are unlikely or occur in the far future, such as natural disasters and long-term care needs. One explanation is that uncertainty about the risk of non-reimbursement induces ambiguity averse and risk prudent decision makers to take out less insurance. We set up an insurance experiment to test this explanation. Consistent with the theoretical predictions, we find that the demand for insurance is lower when the nonperformance risk is ambiguous than when it is known and when decision makers are risk prudent. We cannot attribute the lower take-up of insurance to our measure of ambiguity aversion, probably because ambiguity attitudes are richer than aversion alone.

scholarly journals Socioeconomic Inequalities in Home-Care Use Across Regional Long-term Care Systems in Europe

2020 ◽  
Vol 76 (1) ◽  
pp. 121-132 ◽  
Author(s):  
Ginevra Floridi ◽  
Ludovico Carrino ◽  
Karen Glaser
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Fixed Effects ◽  
Long Term Care ◽  
Multilevel Models ◽  
Later Life ◽  
Socioeconomic Inequalities ◽  
Term Care ◽  
Individual Level

Abstract Objectives We examine whether socioeconomic inequalities in home-care use among disabled older adults are related to the contextual characteristics of long-term care (LTC) systems. Specifically, we investigate how wealth and income gradients in the use of informal, formal, and mixed home-care vary according to the degree to which LTC systems offer alternatives to families as the main providers of care (“de-familization”). Method We use survey data from SHARE on disabled older adults from 136 administrative regions in 12 European countries and link them to a regional indicator of de-familization in LTC, measured by the number of available LTC beds in care homes. We use multinomial multilevel models, with and without country fixed-effects, to study home-care use as a function of individual-level and regional-level LTC characteristics. We interact financial wealth and income with the number of LTC beds to assess whether socioeconomic gradients in home-care use differ across regions according to the degree of de-familization in LTC. Results We find robust evidence that socioeconomic status inequalities in the use of mixed-care are lower in more de-familized LTC systems. Poorer people are more likely than the wealthier to combine informal and formal home-care use in regions with more LTC beds. SES inequalities in the exclusive use of informal or formal care do not differ by the level of de-familization. Discussion The results suggest that de-familization in LTC favors the combination of formal and informal home-care among the more socioeconomically disadvantaged, potentially mitigating health inequalities in later life.

scholarly journals State tax subsidies to bolster the long-term care insurance market

2014 ◽  
Vol 34 (3) ◽  
pp. 415-436 ◽  
Author(s):  
David C. Nixon
Keyword(s):  
Fixed Effects ◽  
Long Term Care ◽  
State Governments ◽  
Term Care ◽  
Sales Data ◽  
Insurance Policies ◽  
Tax Subsidies ◽  
State Income ◽  
Long Term Care Insurance

AbstractThis paper examines long-term care insurance sales to assess whether state income tax subsidies are effective in encouraging the private purchase of long-term care insurance. Drawing from the most comprehensive available sales data on long-term care insurance policies, cross-state and over-time variation in sales data during the late 1990s and early 2000s are analysed. This analysis uses a panel model with fixed effects controls for potential endogeneity between state provision of tax subsidies and actual sales of long-term care insurance policies. Income, health and family support factors are significant determinants in the sale of long-term care insurance, but the tax incentives provided by many state governments do not induce any more sales of long-term care insurance than could be expected without such incentives. These costly subsidies have not been prudent uses of public dollars, and have not helped states cope with the challenge of long-term care costs.

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