The TAPS Project. 3: Predicting the Community Costs of Closing Psychiatric Hospitals

1990 ◽  
Vol 157 (5) ◽  
pp. 661-670 ◽  
Author(s):  
Martin Knapp ◽  
Jeni Beecham ◽  
Jeremy Anderson ◽  
David Dayson ◽  
Julian Leff ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Hospital Costs ◽  
Psychiatric Hospitals ◽  
Prediction Equation ◽  
Behavioural Problems ◽  
Accurate Information ◽  
Term Care ◽  
Resource Requirements ◽  
Baseline Characteristics

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these ‘baseline’ characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.

The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care

1988 ◽  
Vol 152 (6) ◽  
pp. 783-792 ◽  
Author(s):  
K. Wooff ◽  
D. P. Goldberg ◽  
T. Fryers
Keyword(s):  
Mental Health ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Health Staff ◽  
Mental Health Staff ◽  
Term Care ◽  
Community Psychiatric ◽  
Wide Range

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

scholarly journals Antipsychotic Use in Dementia

2016 ◽  
Vol 62 (3) ◽  
pp. 170-181 ◽  
Author(s):  
Julia Kirkham ◽  
Chelsea Sherman ◽  
Clive Velkers ◽  
Colleen Maxwell ◽  
Sudeep Gill ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Care ◽  
Neuropsychiatric Symptoms ◽  
Mental Illnesses ◽  
Educational Outreach ◽  
Term Care ◽  
Inappropriate Use ◽  
Regulatory Changes ◽  
Current Controversy

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

scholarly journals Maintaining Resident Social Connections During COVID-19: Considerations for Long-Term Care

2020 ◽  
Vol 6 ◽  
pp. 233372142096266
Author(s):  
Carla Ickert ◽  
Heather Rozak ◽  
Jennifer Masek ◽  
Keeley Eigner ◽  
Sherry Schaefer
Keyword(s):  
Long Term Care ◽  
Significant Risk ◽  
Physical Space ◽  
Infection Prevention And Control ◽  
Social Connections ◽  
Continuing Care ◽  
Term Care ◽  
Resource Requirements ◽  
And Control

Worldwide, long-term care (LTC) homes have been heavily impacted by the coronavirus disease 2019 (COVID-19) pandemic. The significant risk of COVID-19 to LTC residents has resulted in major public health restrictions placed on LTC visitation. This article describes the important considerations for the facilitation of social connections between LTC residents and their loved ones during the COVID-19 pandemic, based on the experiences of 10 continuing care homes in Alberta, Canada. Important considerations include: technology, physical space, human resource requirements, scheduling and organization, and infection prevention and control. We describe some of the challenges encountered when implementing alternative visit approaches such as video and phone visits, window visits and outdoor in-person visits, and share several strategies and approaches to managing this new process within LTC.

Investing in a “Rehabilitation Model” to Improve the Decision-Making Process in Long-Term Care

2013 ◽  
pp. 37-47
Author(s):  
Connie D’Astolfo
Keyword(s):  
Decision Making ◽  
Health System ◽  
Chronic Diseases ◽  
Long Term Care ◽  
Hospital Costs ◽  
Cost Savings ◽  
System Transformation ◽  
Term Care ◽  
Rehabilitation Model

An aging population is a primary factor associated with escalating healthcare costs due to increased drug spending, chronic diseases and co-morbidities, physician visits, and hospital costs (TD Report, 2010). There has already been a marked increase in the number of Long-Term Care (LTC) residents with co-morbidities, and chronic diseases will be more prevalent in future years (Conference Board of Canada, 2011). The chapter explores the use of a rehabilitation model to improve the current decision-making processes that impact the health outcomes of seniors across the Ontario LTC continuum. Improved clinical management of this population through rehabilitation could result in not only enhanced quality of care but also significant cost savings for both the Long-Term Care (LTC) industry and the health system at large. The chapter highlights the need for the LTC sector to identify strategies for harnessing innovation to improve its own activities and outcomes and become a leader in health system transformation.

Children of Psychiatric in-Patients - Prevalence, Psychiatric Symptoms and Obstacles for Professional Support

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Koelch ◽  
M. Schmid ◽  
J.M. Fegert
Keyword(s):  
Psychiatric Disorders ◽  
Mentally Ill ◽  
Psychiatric Symptoms ◽  
Psychiatric Hospitals ◽  
Professional Support ◽  
Behavioural Problems ◽  
Professional Help ◽  
Number Of Children ◽  
Study Results ◽  
Mentally Ill Parents

Aims:Children of mentally ill parents are at high risk to develop psychiatric disorders. Psychiatric disorders often limit parenting skills and there are obstacles to accept professional help for the children. The study aimed to explore the prevalence of mentally ill parents in inpatient treatment, emotional and behavioural problems of their children, access to support for their children and obstacles for receiving support.Method:Inpatients of psychiatric hospitals of a county were examined by questionnaires (amongst other scales the Strengths and Difficulties Questionnaire (SDQ).Results:104 patients with children were detected, 81 patients with 165 children were enrolled. Most of the patients had more than one child and most of them had more than 3 prior inpatient treatments. Results in the SDQ indicated an up to fife fold increased number of children with emotional/behavioural problems compared to non-psychiatric samples. Even it 40% of the patients were dissatisfied with the care of their children during treatment, they seek seldom professional help. 51% have strong resentments against the youth welfare custodies. 55% quote that they cancelled or missed former inpatient treatments because of the inadequate nurturance of their children.Conclusion:Identification of children with need for professional support can be improved by using standardized questionnaires. Study results imply that psychiatrist should focus on parenthood of their patients and specialised offers of support are needed.

Clinical Software in Long-term Care Consultant Pharmacy Practice

1988 ◽  
Vol 1 (3) ◽  
pp. 218-224
Author(s):  
James A. Sherman
Keyword(s):  
Long Term Care ◽  
Pharmacy Practice ◽  
Human Memory ◽  
Drug Regimen ◽  
Accurate Information ◽  
Term Care ◽  
Drug Regimens ◽  
Computer Based ◽  
Software Programs

As evidenced in 1985, and confirmed through preliminary analysis of a 1988 survey, 96.3% of long-term care (LTC) providers were using computers in providing dispensing services. It is the challenge of using this current tecnhology to merge existing drug management (prescription processing) and clinical applications that identifies the frontier of computerized pharmacy practice. Software programs are currently available that enable the consultant to uniformly apply set indicator criteria without ommission or human memory lapse to all LTC resident drug regimens. It is the degree to which these drug regimen review software programs may be integrated with prescription processing software, and the extent that the programs exceed the indicators that may be used in evaluating their impact and value. This value may be reflected in decreased consultant pharmacist review time, patient benefit, physician response, perceived administrator/nursing home benefits, and the usefulness of reports and outcome statistics generated. The advantages, disadvantages, guidelines for software evaluation, and currently available clinical programs are presented in order to provide accurate information to those consultant pharmacists seeking to expand or implement new computer based clinical services.

scholarly journals Fall-Related Hospitalization and Facility Costs Among Residents of Institutions Providing Long-Term Care

2008 ◽  
Vol 48 (2) ◽  
pp. 213-222 ◽  
Author(s):  
Norman V. Carroll ◽  
Jeffrey C. Delafuente ◽  
Fred M. Cox ◽  
Siva Narayanan
Keyword(s):  
Propensity Scores ◽  
Long Term Care ◽  
Hospital Costs ◽  
Term Care ◽  
Data Set ◽  
Care Chain ◽  
Hospitalization Costs ◽  
The Difference ◽  
Post Period

Abstract Purpose:  The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers. We estimated residents' propensity to fall from demographics, comorbidities, and reimbursement in the pre-period. The matched sample included 1,130 fallers and 1,130 non-fallers who were residents of a large, multifacility long-term-care chain. Cost estimates were based on information in the Minimum Data Set and were defined as hospital and LTCF reimbursements. We estimated fall-related costs as the difference between changes in costs for fallers and non-fallers from the pre- to post-period. Results: Fallers were substantially more likely to suffer fractures and hospitalizations in the post-period than were non-fallers. Fall-related LTCF and hospital costs were $6,259 (95% confidence interval = $2,034–$10,484) per resident per year. About 60% of this amount was attributable to higher hospitalization costs. Fallers were more likely to be discharged to hospitals or to die. Implications: Falls in LTCFs are associated with costs of about $6,200 per resident per year. These results provide baseline estimates that one may use to estimate the cost-effectiveness of interventions to reduce fall rates.

Dementia Syndromes in Nursing Home Patients

1992 ◽  
Vol 4 (2) ◽  
pp. 241-252 ◽  
Author(s):  
M. Andersson ◽  
C. G. Gottfries
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Depressed Mood ◽  
Long Term Care ◽  
Psychiatric Symptoms ◽  
The Elderly ◽  
Minor Importance ◽  
Term Care ◽  
Nursing Home Patients

Patients (n = 191) living in four comparable somaic nursing homes (NH) (nursing homes for physical illness) were studied in order to evaluate dementia syndromes. Dementia and symptoms of depressed mood occurred frequently (72% and 63%, respectively). Dementia was often undiagnosed at admittance. Neither the length of time spent in institutions, nor marital status, age, or sex seemed to be of more than minor importance to the prevalence of dementia syndromes. Concerning functional impairment, convergence of findings across the societies studied indicates that psychiatric symptoms and psychopathology are intrinsic parts of long-term care of the elderly.

Attachment and Conduct Disorder: The Response Program

1993 ◽  
Vol 38 (6) ◽  
pp. 420-431 ◽  
Author(s):  
Roy Holland ◽  
Marlene M. Moretti ◽  
Vince Verlaan ◽  
Sherri Peterson
Keyword(s):  
Conduct Disorder ◽  
Peer Relations ◽  
Psychiatric Symptoms ◽  
Treatment Programs ◽  
Term Care ◽  
Common Diagnosis ◽  
Wide Range ◽  
Vocational Success

An increasing number of youths are being identified as suffering from behavioural problems that cause difficulties in their family and peer relations which in turn reduces their chances of academic and vocational success. There is growing concern regarding their level of aggressiveness. The common diagnosis given to these disaffiliated youths is conduct disorder. To date, most treatment programs for conduct disorder have been unsuccessful. A review of recent studies indicates that the disruption of attachment may be an important feature that underlies the wide range of symptoms that are typically found in youths with conduct disorder. A community-oriented program designed to ensure long term care for these youths is described in this paper, and the findings of a six month follow-up evaluation are presented. Results indicated that communities, caregivers, and youths responded positively to the program; caregivers reported significant reductions in a broad range of psychiatric symptoms in youths, and youths reported a significant reduction in symptoms of conduct disorder.

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