Impact of growing numbers of the very old on Medicaid expenditures for nursing homes: a multi-state, population-based analysis

We utilized Medicaid data from five states which account for 39 per cent of Medicaid expenditures to study the impact of the near-trebling of persons age 85 and older (the very old) projected to occur by the year 2012 upon Medicaid nursing home expenditures. We found a one-year prevalence of Medicaid-covered nursing home residence of 20 per 100 among the very old. If this rate continues, with no changes in current levels of Medicaid nursing home payments, and if population forecasts are accurate, increasing numbers of the very old will generate an additional +6.3 billion (1982 dollars) annually of Medicaid nursing home payments by 2012: an increase of 280 per cent from 1982 levels. The stress this trend will place upon societal ability to check growth in public expenditures for medical care while maintaining basic services for other low income populations will be an important force shaping public health policy in the next 25 years.

[Responsibility for patients dependent on outside help, especially elderly citizens]

The present paper will pay attention to tendencies and problems in the care of persons requiring help, particularly of older ones. It is attempted to outline the developmental conditions for the present dealing with old people in our society and from this to derive the growing responsibility of public health and social welfare services for the direct care of these people as well as the organisation of their care within the family and the housing community. The inpatient sector of different specialties in the territory as well as the outpatient sector, in particular the family doctor and the community nurse, must participate in this responsibility. Moreover, the care for older persons, the forming of adequate attitudes to them within the population and the creation of more favourable conditions for a care within the family is a task of the whole society.

[Management of elderly citizens dependent on outside help from the clinical viewpoint]

The increase of life expectancy has led to a higher percentage of the oldest and requiring help people. The present paper described the possibilities and situation of care for this part of the population on the basis of an analysis of a district of Berlin. It must be stated that the cooperation between social organizations and ambulatory institutions and hospitals can be improved. The hospitalisation of older people requiring help should be an exception and is ethically legitimated only then, when it is performed with the intention of the patient. The willingness for care on the side of the members of the patients' families is analysed and discussed in the sense of improvement.

Community care for the elderly 1976-84

The aging of the elderly population is of crucial importance as people who are over 80 make far greater use of health and social services than any other age group. Government guidelines on the provision of services, which are generally related to the whole population aged 65 and over, fail to take account of this change in the age structure of the elderly population and are no longer appropriate. Recent trends in the provision of domiciliary services, day care, specialist housing for the elderly, and residential care have been related to changes in the number of potential consumers. Ironically, despite the government's stated commitment to "community care," the chief growth area has been private institutional care. The number of day care places and sheltered housing units has also increased in real terms, but the provision of domiciliary services, such as home help and health visitor visits to the elderly, has either fallen behind or barely matched the increase in the number of very old people. If community care is to be made a reality and if the present inadequate levels of service are to be maintained, let alone improved, then additional resources, greater cooperation among agencies, and a more imaginative approach to the development and delivery of services are urgently needed.

Projecting the demand for institutional care by the aged in Singapore in the year 2000

One of the areas of concern in a rapidly ageing population is the anticipated increase in demand for institutional care by the aged. This paper reports a procedure used for projecting such type of demand by the aged population in Singapore for the year 2000. The procedure involves two fundamental processes: estimating the present demand for such services and projecting the demand at some future time-frame (year 2000) using the baseline information and making assumptions about the influence of demographic, health and socio-economic factors altering demand. Estimation of present demand is made using a model that generally classifies aged persons in the population by functional status and residential status. Projection of future demand for institutional care is done using a 3 X 3 matrix of projection models. Three principal models (representing low, medium and high projections) are used to represent varying degrees of expected change in disease load among the aged population. Three sub-models are, in turn, used to fine-tune each principal model to reflect possible changes in the demand for institutional and hospital care within each functional status group.

[Aging in Chile]

First some detailed demographic data concerning the elderly population in Chile are presented. Then their extremely deficient social and economic life conditions and the negative image of old age are described. The informal and formal systems of social security for the aged and their severe deficiencies are also reported upon. Finally, some institutions for the elderly are presented.

[Aging in Mexico]

Demographic social and economic aspects of the situation of the elderly in Mexico are described with special emphasis upon education programmes and types of care in nursing homes. Considering the future trends of an increase in Mexico's elderly population, the author calls for more efforts in research and training in the field of gerontology. First results in this area are reported.

[Health status and management of elderly citizens of a residential district and a home for the aged in the city of Erfurt]

Preservation, furtherance and recovery of health and great joy the old age - these are requests of social politics in GDR. The ageing may be influenced by a series of sanitary and social factors of risk. We have examined 100 townsmen in a home for aged people and 100 pensioners in housing-settlement of Erfurttown. The result gives a statement about state of health, about social and medical care. Illness's of systems are standing in front of heart-circulation, of respiration, of connective tissue and movement. We can not find a difference between both groups. The combinations of illness were found frequently (42%). The indigence of care in compliance with the criterions of Siggelkow and Körner are 48% from pensioneries, 39% of old aged people who got occasional good help and care. The dynamic and adapted shaping of the relation men - environment results in a positive effect. The demands on the concil in town, on social workers, on medical care and on the behaviour of the old aged people are formulated.

[Aging in Nigeria]

Following the presentation of demographic data concerning the situation of the elderly in Nigeria, the government's policy with regard to the aged is described. One aim is to strengthen the traditional system of the extended family. Reference is made to the difficulties involved in gerontological research.

[2 homes for the aged in Lima/Peru]

Two selected homes for the elderly in Lima, Perú, are described with particular consideration of infrastructure, conceptions, inhabitants, equipment and regulations. Some results of a preliminary study concerning life and behavior of the inhabitants are given.

Evaluation research in care of the elderly. Some Swedish experiences

Research projects in order to evaluate social and health care programmes are unusual in Sweden. Evaluation studies have had little or no discernible effect on the planning of services for the elderly which is largely the product of convention rather than rational thinking. It is difficult to carry out evaluation studies in a field that is rapidly changing. The variations in elderly care between different areas, between institutions and over time makes it difficult to devise general methods of evaluation. Of five recent and current Swedish studies two are treating innovations inside institutions, two deal with innovations outside institutions and one is a relocation study. One thing common to these studies is that they are administered by university departments. However, evaluation is too important to be a matter just for university disciplines. We should also encourage local initiatives to start more evaluation of 'their' interventions. It will then be a task for more centrally placed researchers to educate and guide the administrators and representatives from other areas in what respects the result of a local study can be generalized.

An intervention study among elderly people. Methodological and practical experiences

Based on a three years controlled intervention study among elderly subjects, aged 75 years or more and living in their own homes, the methodological and practical experiences achieved through interdisciplinary cooperation is described. The combination of social, medical and psychological interventions within the framework of a clinical controlled trial has documented remarkably favourable consequences for the intervention group. The planning, intervention, work up and publication periods of the study are described in the wish that future necessary intervention studies may be guided to an easier procedure.

[Forgotten rehabilitation]

Based on the development of gerontology and geriatrics in the Federal Republic of Germany, various geriatric rehabilitation issues are presented. The different types of geriatric facilities are described.