Understanding Long-Term Outcomes of Public Health Strategy in Palliative Care at Micro Level: Impact of Home-Based Palliative Care Services under Local Self-Government Institutions in Kerala, India

Objectives: Palliative care units under Local Self-Government Institutions (LSGIs) are increasing in number in the state of Kerala, India, since the announcement of the Pain and Palliative Care Policy, 2008. Whether these units are functioning with a view to materialise the long-term objectives, following the guidelines stipulated by the Government of Kerala and serve the neediest patients with quality care are a matter of debate. Hence, a microlevel study of the palliative care unit is attempted. The aims of the study were to understand the extent to which the structure and nature of functioning of the Pain and Palliative Care Unit under LSGI comply with guidelines set by the Pain and Palliative Care Policy of the Government of Kerala and to check whether the palliative care services are reaching the needy and, if so, are they provided to patients in good quality. Materials and Methods: The award winning Pain and Palliative Care Unit attached to LSGI is selected for analysis and a hybrid research design is followed. Data are collected from 25 patients and their caregivers selected randomly. Mean score of satisfaction level on the basis of Quality care questionnaire -Palliative care is used. Results: Sample unit complies with the revised guidelines of 2015, Pain and Palliative Care Policy. It serves the neediest patients and the quality of care is satisfactory. Conclusion: The study reaffirms the strength of the public health model in palliative care which can provide quality care to the neediest patients.

Bridging the Gulf on Health Care Policy Beyond the Affordable Care Act

This article presents a brief overview of the Affordable Care Act (ACA) and changes ushered into the health care system by the Act. The overview is followed by arguments for and against the ACA, integrating and situating the divergent arguments within the context of both democratic and conservative standpoints on health care policy. Furthermore, the article explores the possibility of identifying factors responsible for the seeming difficulty in transiting policy from agenda status to adoption in a democratic system of governance. The article concludes with suggestions on ways and strategies that can help in bridging the ostensible gap between divergent positions, with the hope of charting the course to the desired destination of an equitable and sustainable health care policy for the United States.

Care Policy in Slovenia: Divergent Trends and Convergent Attitudes

Slovenia makes a compelling case for care policy analysis since it is marked by extreme dichotomy in care. Therefore, placing Slovenia on a continuum of care regimes ranging from defamilialised to familialised with respect to care is difficult, with care for children being highly defamilialised, and care for older people highly familialised. The country’s childcare policies build on a historically well-developed system of public childcare provision and generous leave policies, together with a well-developed social protection system targeting families. These have been retained and, in some cases, were expanded, still following the 2009 economic crisis, certain austerity measures were introduced. On the other hand, care policies for older people started to develop later and after the initial growth they relatively stagnated (especially the social homecare system). A comprehensive long-term care system has yet to be developed and become a subject of ongoing political debates. Further, unlike in childcare, the increasing role of private actors can be observed in this sector. In the article, we discuss these care policy developments in Slovenia in terms of the role of relevant actors (state, family, private actors) with an emphasis on the views of people regarding care, based on data gathered within an innovative method of democratic forums. The article reveals that the dichotomy of care policies, as well as the differing recent trends in family policies for children and care for older people, is not present in people’s attitudes and their preferences for the arrangement of such policies. Key words: care, social policy, Slovenia, older people, childcare, democratic forum, attitudes.

Care Centers and Professional Caregivers: from the Project to a Sustainable Social Child Care Policy

In Lithuania the deinstitutionalisation of children left without parental care is being implemented since 2014. The term of transformation is more recognizable in the political context of the country. Various alternative services to institutional care are being developed during the transformation process, but some have become massive and overly institutional in nature (e.g., community children living homes), while the institute of professional caregivers has not gained popular attention when comparing child care rates across different alternatives. This article presents and discusses the activities of care centers that train permanent guardians (caregivers) and professional guardians. The article presents a research during which the staff of the care center evaluated the effectiveness of the activities of the care center and the guardians on duty. The results of the study revealed that care centers face the risk of projectivity at both micro and macro levels. Cooperation and support between the Ministry of Social security and labout and municipalities and other institutions is also very important for the effectiveness of care centers.

Simulation approach to interprofessional education

A team practice simulation approach to interprofessional education is presented. Participants (79 trainees over 4 years) were assigned to one of six teams representing clinical services for a client with complex clinical needs (medical care, outpatient therapy, dental, nutrition, speech and hearing, leadership). Each student within the team was assigned a specific role (e.g., primary care, policy maker, family member). A critical component of this activity is that each participant adopted the role and perspective of an individual in a different clinical area than their own. In preparation for a live discussion by all participants, each team met to study their assigned clinical roles and to prepare a one-page slide addressing specific questions given only to their team. At the live session, the overall goal was to develop a coherent clinical plan for the client. This is an effective approach for IPE in care of clients across the lifespan.

Promising Long-Term Residential Care Policy Guidance for Staff to Support Resident Quality of Life

This paper reviews 63 policy documents in four Canadian jurisdictions that guide long term residential care staff on how to enhance 11 resident quality of life in Canada. We found guidance in each jurisdiction that provide clear language to support staff discretion and flexibility to navigate regulatory tensions and enhance resident quality of life. Newer policies tend to reflect more interpretive approaches to staff flexibility and broader quality of life concepts. We argue that if interpreted through a resident quality of life lens and with the right structural supports, these promising texts offer important counters to the rigidity of long term residential care policy landscape and can be leveraged to effectively broaden and enhance quality of life for residents in long term residential care.

Does Long-Term Care Policy Enable or Limit Volunteers’ Roles in Enhancing Resident Quality of Life?

This paper examines how volunteer roles are represented in Canadian long term care (LTC) policy in four Canadian jurisdictions, attending to how these regulated roles might impact resident quality of life. Overall, we found that policies define volunteer roles narrowly, which may limit residents’ quality of life. This happens through (1) omitting volunteers from most regulatory policy, (2) likening volunteers to supplementary staff rather than caregivers with unique roles, and (3) over-emphasizing residents’ safety, security and order. We offer insights into promising provincial policy directions for LTC volunteers, yet we caution against further regulating volunteers. Instead, we argue, addressing the cultural, social and structural changes required for volunteers to enhance LTC residents’ quality of life effectively.