scholarly journals Drivers of Old-Age Dependence and Long-Term Care Usage in Switzerland—A Structural Equation Model Approach

Risks ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 92 ◽  
Author(s):  
Iegor Rudnytskyi ◽  
Joël Wagner
Keyword(s):  
Informal Care ◽  
Structural Equation ◽  
Long Term Care ◽  
Functional Limitations ◽  
Elderly Person ◽  
Individual Characteristics ◽  
Equation Modeling ◽  
Term Care ◽  
Swiss Health

Long-term care (LTC) encompasses a set of services provided to impaired and dependent elderly people. To assess the level of the dependence several scales are used, including activities of daily living (ADL), instrumental ADL (IADL) and functional limitations. Once an elderly person fails to perform these activities independently, he or she requires special assistance. Help can be provided as informal care by relatives and as formal care by professionals. The aim of this research is to study individual characteristics that relate to the demand of LTC and to analyze the relation between formal and informal care. We base our study on data from the Swiss Health Survey focusing on respondents aged over 65 years. Using the structural equation modeling technique, we develop a statistical model that considers the dependence concept as a latent variable. This hidden dependence variable combines three indices linked to the limitations in ADL, in IADL and functional limitations. Accounting for causality links between covariates enables us to include the indirect effect of pathologies on the receipt of LTC mediated via dependence. In our model, we do not assume a causal relationship between formal and informal care. From our results, we observe a significant impact of pathologies as well as of the socio-demographic factors on the demand for LTC. The relationship between formal and informal care is found to be of both a complementary and substitutional nature.

scholarly journals FACTORS ASSOCIATED WITH MORTALITY AMONG LONG-TERM CARE RESIDENTS TRANSITIONING TO AND FROM EMERGENCY DEPARTMENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S821-S821
Author(s):  
Kaitlyn C Tate ◽  
Colin Reid ◽  
Patrick McLane ◽  
Garnet E Cummings ◽  
Brian H Rowe ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Departments ◽  
Structural Equation ◽  
Organizational Context ◽  
Long Term Care ◽  
Care Transitions ◽  
Equation Modeling ◽  
Term Care ◽  
Risk Of Death

Abstract Studies examining risk of death during acute care transitions have highlighted potential predictors of death during transition. However, they have not closely examined the relationships and directional effects of organizational context, care processes, resident demographics and health conditions on death during transition. By employing structural equation modeling, we aimed to 1) identify predictive factors for residents who died during transitions from long term care (LTC) to emergency departments (EDs) and back; 2) examine relationships between identified organizational, process and resident factors with resident death during these transitions; and 3) identify areas for further investigation and improvement in practice. We tracked every resident transfer from 38 participating LTC facilities to two included EDs in two Western Canadian provinces from July 2011 to July 2012. Overall, 524 residents were involved in 637 transfers of whom 63 residents (12%) died during the transition. Sustained dyspnea (in both LTC and the ED), sustained change in level of consciousness (LOC) and severity measured by triage score were direct and significant predictors of resident death during transition. The model fit the data, (x2 = 83.77, df = 64, p = 0.049) and explained 15% variance in resident death. Dyspnea and change in LOC in both LTC and ED needs to be recognized regardless of primary reason for transfer. More research is needed to determine the specific influences of LTC ownership models, family involvement in decision-making, LTC staff decision-making on resident death during transition, and interventions to prevent pre-death transfers.

Impairment and Abuse of Elderly by Staff in Long-Term Care in Michigan: Evidence From Structural Equation Modeling

2010 ◽  
Vol 26 (1) ◽  
pp. 21-33 ◽  
Author(s):  
Tom Conner ◽  
Artem Prokhorov ◽  
Connie Page ◽  
Yu Fang ◽  
Yimin Xiao ◽  
...  
Keyword(s):  
Structural Equation Modeling ◽  
Structural Equation ◽  
Long Term Care ◽  
Equation Modeling ◽  
Term Care

scholarly journals Long-Term Care Nurses’ Intent to Stay, Job Characteristics, and Organizational Justice : A Structural Equation Model

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 85-85
Author(s):  
Lin Wang ◽  
Miao Miao ◽  
Xiaoping Yu
Keyword(s):  
Organizational Justice ◽  
Structural Equation ◽  
Long Term Care ◽  
Intent To Stay ◽  
Job Characteristics ◽  
Equation Modeling ◽  
Intention To Stay ◽  
Term Care ◽  
Convenience Sample

Abstract Background：Gratifying the elderly health-care demands and promoting high-quality of nursing services are based on the effort of long-term care(LTC) nurses. However, the high turnover rate of LTC nurses has become very serious in China. What remains unclear is whether the organizational justice and job characteristics affect the LTC nurses’ intention to stay. Objective: The aim was to investigate intention to stay among LTC nurses in relation to organizational justice and job characteristics. Method: A cross-sectional study was conducted with a convenience sample of 545 LTC nurses. Data collection was performed between July and November 2019. Data were analyzed using structural equation modeling. Results: Most of LTC nurses reported to stay in nursing or current work place, however they still had strong desire to leave if there were other job opportunities. Organizational justice and job characteristics were significant predictors of LTC nurses intent to stay. LTC nurses job characteristics partially mediates the relationship between organizational justice and intent to stay. Conclusion: This would suggest the importance of administrators/ managers understanding how to promote organizational justice, foster a justice climate and increase LTC nurses’ perceived job characteristics. The organizational justice culture programs should be develop as LTC nurses retention strategy.

scholarly journals Who Doesn’t Come Home? Factors Influencing Mortality Among Long-Term Care Residents Transitioning to and From Emergency Departments in Two Canadian Cities

2020 ◽  
pp. 073346482096263
Author(s):  
Kaitlyn Tate ◽  
R. Colin Reid ◽  
Patrick McLane ◽  
Garnet E. Cummings ◽  
Brian H. Rowe ◽  
...  
Keyword(s):  
Structural Equation ◽  
Long Term Care ◽  
Equation Modeling ◽  
Future Research ◽  
Term Care ◽  
Palliative Care Consultation ◽  
Level Of Consciousness ◽  
Standardized Reporting ◽  
Using Data

Residents of long-term care (LTC) whose deaths are imminent are likely to trigger a transfer to the emergency department (ED), which may not be appropriate. Using data from an observational study, we employed structural equation modeling to examine relationships among organizational and resident variables and death during transitions between LTC and ED. We identified 524 residents involved in 637 transfers from 38 LTC facilities and 2 EDs. Our model fit the data, (χ2 = 72.91, df = 56, p = .064), explaining 15% variance in resident death. Sustained shortness of breath (SOB), persistent decreased level of consciousness (LOC) and high triage acuity at ED presentation were direct and significant predictors of death. The estimated model can be used as a framework for future research. Standardized reporting of SOB and changes in LOC, scoring of resident acuity in LTC and timely palliative care consultation for families in the ED, when they are present, warrant further investigation.

scholarly journals THE STRUCTURE OF CARE MANAGERS’ PRACTICE RESPECTING THE AUTONOMY OF THE FRAIL ELDERLY IN JAPAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S504-S504
Author(s):  
Chiemi Hata ◽  
Sachiko Kasahara
Keyword(s):  
Frail Elderly ◽  
Structural Equation ◽  
Goodness Of Fit ◽  
Long Term Care ◽  
Self Esteem ◽  
Equation Modeling ◽  
Term Care ◽  
Self Reflection ◽  
Care Managers

Abstract The objectives of current study are to clarify the structure of practice respecting the autonomy of the frail elderly under the Long-Term Care Insurance system in Japan and to discuss the related factors to the practice. The mailed self-administered questionnaire survey was conducted on 1398 care managers who working in In-Home Long-Term Care Support Providers in A City in Osaka with the condition that “office with multiple care managers engaged and one care manager with more than 5 years’ experience”. The response rate was 51.0% (713persons) and no missing data 615 (44.0%) was analyzed. Analysis was carried out using Mplus.ver8. The structure of practice respecting the autonomy of the frail elderly and the rerated factors were examined as a causal model using structural equation modeling. As the result, it was confirmed the goodness of fit to the data (RMSEA=0.049, CFI=0.927). By the confirmatory factor analysis, the care manager’s practice respecting the autonomy of the elderly was confirmed associating with three-factors structure; (1)data collection and assessment, (2) strength perspective and (3) professional relationship. Furthermore the practice was significantly affected by self-esteem of care-managers performance (β=0.494) and self-reflection to own work (β=0.269). In conclusion, the current study supported the hypothetical consideration in which self-esteem and self-reflection in care manager’s practice significantly affected the practice respecting the autonomy of the frail elderly.

Financing and Policy for Long-Term Care

2018 ◽  
Author(s):  
Alexandrina Stoyanova ◽  
David Cantarero-Prieto
Keyword(s):  
Informal Care ◽  
Social Protection ◽  
Long Term Care ◽  
Quality Care ◽  
Functional Limitations ◽  
Well Being ◽  
Term Care ◽  
Traditional Pattern ◽  
The Right

Long-term care (LTC) systems entitle frail and disabled people, who experience declines in physical and mental capacities, to quality care and support from an appropriately trained workforce and aim to preserve individual health and promote personal well-being for people of all ages. Myriad social factors pose significant challenges to LTC services and systems worldwide. Leading among these factors is the aging population—that is, the growing proportion of older people, the main recipients of LTC, in the population—and the implications not only for the health and social protection sectors, but almost all other segments of society. The number of elderly citizens has increased significantly in recent years in most countries and regions, and the pace of that growth is expected to accelerate in the forthcoming decades. The rapid demographic evolution has been accompanied by substantial social changes that have modified the traditional pattern of delivery LTC. Although families (and friends) still provide most of the help and care to relatives with functional limitations, changes in the population structure, such as weakened family ties, increased participation of women in the labor market, and withdrawal of early retirement policies, have resulted in a decrease in the provision of informal care. Thus, the growing demands for care, together with a lower potential supply of informal care, is likely to put pressure on the provision of formal care services in terms of both quantity and quality. Other related concerns include the sustainable financing of LTC services, which has declined significantly in recent years, and the pursuit of equity. The current institutional background regarding LTC differs substantially across countries, but they all face similar challenges. Addressing these challenges requires a comprehensive approach that allows for the adoption of the “right” mix of policies between those aiming at informal care and those focusing on the provision and financing of formal LTC services.

Les soins de longue durée aux personnes âgées: Choix d'un système clinico-administratif dans le contexte d'un réseau de soins intégrés

2004 ◽  
Vol 23 (1) ◽  
pp. 35-45
Author(s):  
Nicole Dubuc ◽  
Réjean Hébert ◽  
Johanne Desrosiers ◽  
Martin Buteau
Keyword(s):  
Long Term Care ◽  
Elderly Person ◽  
Individual Characteristics ◽  
Care Organization ◽  
Term Care ◽  
Care Systems ◽  
Casemix System ◽  
Similar Resource ◽  
Dependent Elderly

ABSTRACTFor the past 10 years, in long-term care systems, we have witnessed the accelerated deployment of casemix management systems. A casemix is formed by clusters, defined by individual characteristics that explain similar resource use. However, certain questions regarding the development of these systems must be raised. Moreover, none of these systems was developed in the context of an integrated care organization that can track the progress of a dependent elderly person through every kind of care arrangement available—from own home, through intermediate facility, to long-term care institution. This article emphasizes the necessity of being well informed about the features of existing systems, in order to choose or develop the system that best answers the goals of a particular health care system. Finally, it underlines important elements that should be considered in each step of the development of a casemix system in this context.

scholarly journals Claims data-based analysis of the influence of individual and regional characteristics on the utilisation of long-term care by people with dementia in Baden-Wurttemberg, Germany

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Johanna Forstner ◽  
Michel Wensing ◽  
Jan Koetsenruijter ◽  
Pamela Wronski
Keyword(s):  
Informal Care ◽  
Long Term Care ◽  
Respite Care ◽  
Individual Characteristics ◽  
Nursing Home Care ◽  
Level Of Care ◽  
Term Care ◽  
People With Dementia ◽  
Care Utilisation

Abstract Background Challenges of future dementia care include increasing shortage of qualified healthcare providers and decreasing potential of informal care by relatives. In order to meet those challenges, changes in dementia care are needed. These changes should be based on data of both care utilisation and care supply. The aim of this study was to provide insight into individual and regional characteristics that influence the utilisation of long-term care by people with dementia. Methods The study was a retrospective cross-sectional analysis of claims-based data and other available data referring to one index year. All data were aggregated for small geographic districts. The study population comprised people with a dementia diagnosis, 65 years and older in Baden-Wuerttemberg and insured by the largest health insurer. Utilisation of nursing home care, informal care, and respite care was analysed using binary coded logistic multilevel analyses. Results Seventy nine thousand three hundred forty-nine people with dementia were included in the analyses. Nursing home care was used by 20.4%, informal care by 30.6%, and respite care by 3.5% of people with dementia. Individual characteristics that influence care utilisation included age, sex and the level of care dependency. The utilisation of informal care (OR = 1.713) and respite care (OR = 2.036) was higher in rural districts than in city districts. Respite care supply had an effect on the utilisation of respite care (OR = 1.173). Conclusions The study found differences between districts in the utilisation of long-term care for dementia. These differences were largely explained by the composition of the population within the districts. An exception was the utilisation of respite care, which was higher in districts which have higher supply. Individual characteristics that influenced care utilisation are age, sex, level of care dependency and, with regard to informal care, comorbidity. Further research should be conducted on a small-area level, include further individual characteristics as well as other care and living forms.

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