scholarly journals Risk of Venous Thromboembolism in Patients Nursed at Home or in Long-Term Care Residential Facilities

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Guido Arpaia ◽  
Federico Ambrogi ◽  
Maristella Penza ◽  
Aladar Bruno Ianes ◽  
Alessandra Serras ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Home Care ◽  
Residential Care ◽  
Long Term Care ◽  
Residential Facilities ◽  
Term Care ◽  
Reduced Mobility ◽  
At Home

Background. This study investigated the prevalence of and impact of risk factors for deep venous thrombosis (DVT) in patients with chronic diseases, bedridden or with greatly limited mobility, cared for at home or in long-term residential facilities.Methods. We enrolled 221 chronically ill patients, all over 18 years old, markedly or totally immobile, at home or in long-term care facilities. They were screened at the bedside by simplified compression ultrasound.Results. The prevalence of asymptomatic proximal DVT was 18% (95% CI 13–24%); there were no cases of symptomatic DVT or pulmonary embolism. The best model with at most four risk factors included: previous VTE, time of onset of reduced mobility, long-term residential care as opposed to home care and causes of reduced mobility. The risk of DVT for patients with reduced mobility due to cognitive impairment was about half that of patients with cognitive impairment/dementia.Conclusions. This is a first estimate of the prevalence of DVT among bedridden or low-mobility patients. Some of the risk factors that came to light, such as home care as opposed to long-term residential care and cognitive deficit as causes of reduced mobility, are not among those usually observed in acutely ill patients.

Comparing Changes and Transitions of Home Care Clients in Retirement Homes and Private Homes

2019 ◽  
Vol 39 (3) ◽  
pp. 421-431
Author(s):  
Jeffrey Poss ◽  
Chi-Ling Sinn ◽  
Galina Grinchenko ◽  
Lialoma Salam-White ◽  
John Hirdes
Keyword(s):  
Risk Factors ◽  
Home Care ◽  
Long Term Care ◽  
Local Health ◽  
Caregiver Distress ◽  
Retirement Home ◽  
Term Care ◽  
Home Residency ◽  
Private Homes

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.

A Comparative Analysis of Costs to Government for Home Care and Long-term Residential Care Services, Standardized for Client Care Needs

2007 ◽  
Vol 26 (S1) ◽  
pp. 149-161 ◽  
Author(s):  
Marcus J. Hollander ◽  
Neena L. Chappell
Keyword(s):  
Home Care ◽  
Residential Care ◽  
Long Term Care ◽  
Lower Cost ◽  
Level Of Care ◽  
Care Needs ◽  
Term Care ◽  
Care Services ◽  
Residential Long Term Care

ABSTRACTThis paper reports on the results of analyses using administrative data from British Columbia for 10 years from fiscal 1987/1988 to 1996/1997, inclusive, to examine the comparative costs to government of long-term home care and residential care services. The analyses used administrative data for hospital care, physician care, drugs, and home care and residential long-term care. Direct comparisons for cost and utilization data were possible, as the same care-level classification system is used in BC for home care and residential care clients. Given significant changes in the type and/or level of care of clients over time, a full-time equivalent client strategy was used to maximize the accuracy of comparisons. The findings suggest that, in general, home care can be a lower-cost alternative to residential care for clients with similar care needs. The difference in costs between home care and residential care services narrows considerably for those who change their type and/or level of care, and home care was found to be more costly than long-term institutional care for home care clients who died. The findings from this study indicate that with the appropriate substitution for residential care services, in a planned and targeted manner, home care services can be a lower-cost alternative to residential long-term care in integrated systems of care delivery that include both sets of services.

scholarly journals No Decision About Me Without Me: International Views on Providing Care Against Someone’s Will

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 664-664
Author(s):  
Michel Bleijlevens ◽  
Jan Hamers ◽  
Elizabeth Capezuti
Keyword(s):  
Cognitive Impairment ◽  
The Netherlands ◽  
Home Care ◽  
Psychotropic Medication ◽  
Long Term Care ◽  
Physical Restraint ◽  
Care Recipient ◽  
Term Care ◽  
Systems Research

Abstract People with cognitive impairment may experience the care provided by their caregiver(s) as unnecessary or undesirable, which is expressed by behaviors such as resisting the efforts of a caregiver or preventing the caregiver to perform or assist with ADL such as bathing, dressing and toileting. This can lead to stress, agitation and aggression for both the care recipient and the caregiver, and places the caregiver in a complex dilemma. Should the caregiver force hygiene or respect the person’s autonomy to refuse care? It is difficult for caregivers to find a balance between quality of care and safety, while accepting the person’s autonomy. Caregivers in long-term care often feel the necessity to provide care against the will of people with a cognitive impairment, including physical restraints, psychotropic medication, and non-consensual care. This symposium provides an international perspective with presenters from Belgium, Switzerland, Germany, and the Netherlands. The first presenter explores the use and factors associated with physical restraint, psychotropic medication, and non-consensual care in people with dementia receiving home care in the Netherlands and Belgium. Second, a presenter from Switzerland focuses on the prevalence of restraint use in nursing homes. The third presenter introduces an Advance Care Planning intervention from Germany that aims to ensure that personal wishes in home care are followed. The last presenter assesses the feasibility of an approach to prevent and reduce care against a person’s will in the Netherlands. To conclude, our discussant will integrate these insights and draw conclusion for policy, practice and further research. Systems Research in Long-Term Care Interest Group Sponsored Symposium

Older couples and long-term care: the financial implications of one spouse entering private or voluntary residential or nursing home care

1999 ◽  
Vol 19 (2) ◽  
pp. 209-237 ◽  
Author(s):  
RUTH HANCOCK ◽  
FAY WRIGHT
Keyword(s):  
Nursing Home ◽  
Home Care ◽  
Residential Care ◽  
Married Couples ◽  
Nursing Home Care ◽  
Local Authorities ◽  
Term Care ◽  
Care Costs ◽  
At Home

A minority of older people who move into long-term institutional care are married and have spouses who continue living in the community. The financial complexities and consequences for a couple in this situation deserve to be more widely recognised. Data from the Family Expenditure Survey on the incomes of older married couples are used to examine the financial implications for couples of one spouse entering residential or nursing home care, taking into account local authority procedures for assessing residents' contributions to charges and Income Support rules as they apply to both spouses. We look in particular at the consequences of alternative ways couples might share their incomes, and alternative treatments of such sharing by local authorities and the Department of Social Security. We demonstrate that wives remaining at home are more likely to have low incomes and have recourse to means-tested state benefits if their husbands enter residential care than husbands who remain at home when their wives enter care. Local authorities are likely to be able to require larger contributions to their care costs from husbands than wives. On average, wives whose husbands enter residential care are best off financially when their combined income and savings are shared equally, but this leaves husbands with the least money to contribute to their care costs. If it is the wife who enters care the situation is reversed.

scholarly journals The price of privilege: helping mom die at home

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 863-863
Author(s):  
Renee Beard
Keyword(s):  
Home Care ◽  
Social Services ◽  
Long Term Care ◽  
Organizational Factors ◽  
Care Organization ◽  
Term Care ◽  
Long Term Care Insurance ◽  
At Home

Abstract Americans overwhelmingly wish to age in place and many explicitly want to die at home. Yet, the anemic welfare state means that only the most fortunate among us are able to achieve that goal. A disproportionate burden of care falls squarely to families, which are smaller and more geographically spread out than ever before. Carers too often wind up in environments that are far from conducive, namely being older and perhaps frail themselves or younger and perhaps with small children of their own. Drawing on an autoethnographic study of my mother’s final years and a case study analysis of one innovative home care agency, this project examines the individual and organizational factors that allow one family to grant their family member’s wish to die at home. Grounded theory methods revealed facilitators including presence of a home-based long term care insurance policy, geographic mobility, and access to a democratically-oriented home care organization. Barriers, of course, include lack of access to long term care insurance and a daughter who lives in a progressive state with a waiver for Home and Community Based Services. While the privilege of access underscores the social determinants of aging, this case study reveals some important features that suggest how senior social services could be. Even for the “ideal type” presented here, the many trials and tribulations of aiding a loved one to die at home relate to the untenable nature of doing it all in a context whereby social services are fragmented and driven by financial incentives.

scholarly journals The Impact of Dementia and Extremity Injuries on the Plasticity of Long-term Care Demand: An Analysis of Counterfactual Projection Scenarios Based on German Health Insurance Routine Data

2019 ◽  
Vol 44 ◽  
Author(s):  
Alexander Barth
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Claims Data ◽  
Health Claims ◽  
Term Care ◽  
Home Based ◽  
Health Claims Data ◽  
The Impact ◽  
At Home

Although demand for long-term care (LTC) in Germany is expected to increase over the coming decades, the LTC sector will struggle to provide sufficient capacity. Evaluating the impact of different risk factors on future LTC demand is necessary in order to make informed policy decisions. With regard to LTC need, dementia and lower extremity injuries (LEI) are common risk factors. Both are used to demonstrate their maximum attainable efficacy in mitigating the future increase in overall LTC need, both at home and in nursing homes.We use a multi-state projection model for which the estimation of the underlying transition and mortality rates is based on longitudinal health claims data from AOK, Germany’s largest public health insurance provider, between 2004 and 2010. We project six different scenarios of LTC for ages 75+ in Germany for the period from 2014 to 2044, including counterfactual scenarios that remove the effects of LEI, dementia, or both. Our multi-state projections distinguish between home-based and institutional LTC.Removing the effect of LTC risk factors mitigates the increase in total LTC demand and postpones demand until a later age. Removing dementia markedly shifts future care demand from institutional LTC to LTC at home and even increases demand for LTC at home at older ages beyond the baseline projection due to the dual function of dementia as a risk factor for both LTC demand and mortality. Removing LEI has less of an effect on overall and sectoral LTC demand. Removing both risk factors at the same time results in the greatest impact, which is even more marked than that of both individual scenarios combined, thus indicating a synergistic relationship between dementia and LEI on LTC risk.The type of LTC demand (home-based or institutional) shows considerable plasticity when specific risk factors are removed. We demonstrate the degree to which LTC demand can be affected in favour of LTC at home, using dementia and LEI as examples of potentially modifiable risk factors, and thus show how the efficacy of potential intervention targets for policy-makers can be assessed.This study provides evidence on the degree of plasticity of future long-term care demand at home and in institutions that would hypothetically be attainable when completely removing specific cognitive or physical risk factors of care need (dementia or lower EI). It is based on large-scale health claims data, which contain longitudinal individual level data on morbidity and long-term care status. A close link exists between the cognitive risk factor of dementia and the type of LTC, as its absence shifts care demand to home-based care at older ages. The study also demonstrates the usefulness of counterfactual projections based on health claims data in assessing the hypothetical maximum efficacy of different intervention strategies.

Sign in / Sign up

Export Citation Format

Share Document