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.

scholarly journals “We just get paid for 12 hours a day, but we work 24”: home health aide restrictions and work related stress

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jillian L. Shotwell ◽  
Eve Wool ◽  
Andrzej Kozikowski ◽  
Renee Pekmezaris ◽  
Jill Slaboda ◽  
...  
Keyword(s):  
New York ◽  
Long Term Care ◽  
Care Program ◽  
Home Health ◽  
Term Care ◽  
Home Based ◽  
Primary Care Program ◽  
Related Stress ◽  
The Impact

Abstract Background Home-bound patients in New York State requiring long-term care services have seen significant changes to their benefits due to turmoil in the Managed Long Term Care (MLTC) market. While there has been research conducted regarding the effect of MLTC challenges on beneficiaries, the impact of MLTC regulatory changes on home health aides has not been explored. Methods Qualitative interviews were conducted with formal caregivers, defined as paid home health aides (HHAs) (n = 13) caring for patients in a home-based primary care program in the New York City metropolitan area. HHAs were asked about their satisfaction with the home based primary care program, their own job satisfaction, and whether HHA restrictions affect their work in any way. Interviews were audio-recorded, transcribed, and analyzed. Results Two main themes emerged: (1) Pay, benefits and hours worked and (2) Concerns about patient well-being afterhours. HHAs are working more hours than they are compensated for, experience wage stagnation and loss of benefits, and experience stress related to leaving frail clients alone after their shifts end. Conclusions HHAs experience significant job-related stress when caring for frail elderly patients at home, which may have implications for both patient care and HHA turnover. As government bodies contemplate new policy directions for long-term care programs which rely on HHAs the impact of these changes on this vulnerable workforce must be considered.

scholarly journals Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data

2020 ◽  
Vol 17 (23) ◽  
pp. 9078
Author(s):  
Sunjoo Boo ◽  
Jungah Lee ◽  
Hyunjin Oh
Keyword(s):  
Medical Care ◽  
Long Term Care ◽  
Claims Data ◽  
Medical Costs ◽  
Time Of Death ◽  
Term Care ◽  
Medical Care Use ◽  
Long Term Care Insurance ◽  
At Home

In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.

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.

Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

2020 ◽  
Author(s):  
Kyoung Ja Moon ◽  
Chang-Sik Son ◽  
Jong-Ha Lee ◽  
Mina Park
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Cloud System ◽  
Evidence Based ◽  
Methodological Study ◽  
Term Care ◽  
Web Based ◽  
Care Facilities ◽  
Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

The impact of ageing on hospital care and long-term care—the example of Germany

Health Policy ◽  
2004 ◽  
Vol 67 (1) ◽  
pp. 57-74 ◽  
Author(s):  
Erika Schulz ◽  
Reiner Leidl ◽  
Hans-Helmut König
Keyword(s):  
Hospital Care ◽  
Long Term Care ◽  
Term Care ◽  
The Impact

scholarly journals Public reporting of performance measures in long-term care in Canada: does it make a difference?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Poldrugovac ◽  
J E Amuah ◽  
H Wei-Randall ◽  
P Sidhom ◽  
K Morris ◽  
...  
Keyword(s):  
Performance Measures ◽  
Performance Indicators ◽  
Long Term Care ◽  
Public Reporting ◽  
Policy Implications ◽  
Term Care ◽  
Factors Affecting ◽  
Care Facilities ◽  
The Impact

Abstract Background Evidence of the impact of public reporting of healthcare performance on quality improvement is not yet sufficient to draw conclusions with certainty, despite the important policy implications. This study explored the impact of implementing public reporting of performance indicators of long-term care facilities in Canada. The objective was to analyse whether improvements can be observed in performance measures after publication. Methods We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, while the other 8 are privately reported. We analysed data from the Continuing Care Reporting System managed by the Canadian Institute for Health Information and based on information collection with RAI-MDS 2.0 © between the fiscal years 2011 and 2018. A multilevel model was developed to analyse time trends, before and after publication, which started in 2015. The analysis was also stratified by key sample characteristics, such as the facilities' jurisdiction, size, urban or rural location and performance prior to publication. Results Data from 1087 long-term care facilities were included. Among the 8 publicly reported indicators, the trend in the period after publication did not change significantly in 5 cases, improved in 2 cases and worsened in 1 case. Among the 8 privately reported indicators, no change was observed in 7, and worsening in 1 indicator. The stratification of the data suggests that for those indicators that were already improving prior to public reporting, there was either no change in trend or there was a decrease in the rate of improvement after publication. For those indicators that showed a worsening trend prior to public reporting, the contrary was observed. Conclusions Our findings suggest public reporting of performance data can support change. The trends of performance indicators prior to publication appear to have an impact on whether further change will occur after publication. Key messages Public reporting is likely one of the factors affecting change in performance in long-term care facilities. Public reporting of performance measures in long-term care facilities may support improvements in particular in cases where improvement was not observed before publication.

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