[Regional disparities in accessibility of inpatient treatment for elderly patients]

This article analyzes the supply of residential care facilities for old people in Germany with the aim to discover regional disparities. The analysis is based on the directory of residential institutions for old people (Altenheimadressbuch). On a national level the supply of residential care facilities in this data base is comparable with the results of the national statistic (Heimplatzstatistik). The results show considerable disparities that only to a minor extent coincide with the regional distribution of older people. Although there is no definite coherence between the supply of residential care facilities and the family care potential, there is a significant negative correlation between both.

The changing availability of residential aged care in Australia

Australian aged care services have undergone a series of substantial reforms in recent years under the rubric of the Aged Care Reform Strategy. Overall, there has been a progressive refinement of the targeting of available services on those most in need, defined in terms of both disability levels and financial resources. A key component of this process has been a deliberate reduction in the relative emphasis accorded to nursing home care within the aged care system. This has been accompanied by increases in the resources directed toward less intensive forms of residential care (hostels) and community based services. This paper explores the actual consequences of these intentional policy changes in terms of the availability of nursing home and hostel care, and the changing characteristics of nursing home residents. The results suggest that a more substantial reduction has occurred in the availability of nursing home care than has hitherto been suggested, with consequent decreases in the proportion of aged persons in nursing homes. The effect has been particularly marked amongst women and the very old. These findings raise policy questions about the appropriateness of current and planned future levels of provision.

The social context of Hong Kong's booming elderly home industry

Hong Kong experienced a rapid increase in private homes for elderly people in recent years. This paper examines the social background of that development. Private elderly homes thrived in a context of rising demand due to changing demographics, particularly massive emigration secondary to political instability, which created a large potential market of elderly people in need of residential care. However, entrepreneurs would not be attracted unless it is a profitable business, and much of that profit is likely derived from social security payments to elderly people. Because the amount of social security benefits is way below the level required for purchasing good quality service in the private sector, many elderly people are bound to ive in very poor residential settings.

Waiting times for nursing-home placement: the impact of patients' choices

OBJECTIVE

To identify patient characteristics and characteristics of long-term care facilities that significantly affect the waiting time for transfer from hospital to nursing home.

DESIGN

Cohort study.

PARTICIPANTS

All patients designated to be transferred from four Winnipeg hospitals between June 1, 1988, and May 31, 1989. The patients were followed up until placement, death or May 31, 1990.

MAIN OUTCOME MEASURE

Length of time waiting for nursing-home placement and relative rates of placement.

RESULTS

The variable found to shorten the waiting time the most was the patient's choice of a for-profit or nonprofit secular facility; other significant variables were male sex, age of 75 to 84 years and occupancy of an acute care bed during the wait.

CONCLUSION

The province has three policy options: it can increase the proportion of secular nursing-home beds when new facilities are built; it can require that hospital patients accept an interim nursing-home placement pending transfer to the nursing home of their choice; or it can tie the sponsorship of new facilities to a formula based on the ethnoreligious distribution of the population currently aged 55 to 64 years.

[Policy on the aged of the Federal government in the 12th legislative period]

Social policy for the elderly requires an analysis of the older generation's living conditions in the Federal Republic of Germany. Personal competence has to be maintained in order to prevent the need for nursing care. The urgent problems resulting from demographic changes in the population structure are met by societal and political institutions.

Boom in rest homes in Auckland: implications for the future

Available beds for frail elderly people in the rest home sector in Auckland increased from 44 to 67 per 1000 population over 65 years between 1981 and 1988. This expansion is partly explained by the financial incentives provided by various government subsidies including an open-ended number of rest home subsidies available subject only to an assessment by a geriatric team and a means and assets test. Four estimates of the number of beds required in the Auckland region for the year 2001 indicate that as few as 3414 beds or as many as 7450 beds will be required depending on the assumptions used. The best estimate suggests that approximately 5200 beds are required for the population 65 years and over in the year 2001, 800 fewer than the 6000 currently available. This estimate does not include an allowance for the provision of care for people less than 65 years of age, nor for a proportion of beds to remain vacant and nor for seasonal fluctuations in the demand for rest home beds. These projections have important policy implications for the future funding and provision of rest home care.

The decision process for retirement center development: is market research being used effectively?

This paper examines the role of market research in the decision process used to invest in continuing care retirement centers (CCRCs). Given changing demographics and the availability of financing, there has been a rapid increase in the number of CCRCs that are being developed. However, a large number of these centers have either failed or are experiencing financial difficulty. Some industry participants have blamed poor or inadequate market research as a factor contributing to the failure of many centers to meet expectations. This paper discusses how the process used to invest in centers and how the motivations of the different actors in the investment decision can influence the role and use of market research. Recommendations are suggested for how industry investors can better understand and use market research in the decision to invest in a retirement center.

Analysis of nursing home use and bed supply: Wisconsin, 1983

This article presents evidence that in 1983 excess demand was a prevailing characteristic of nursing home care markets in Wisconsin, a state with one of the highest bed to elderly population ratios. It further shows that excess demand is the source of at least three types of error in use-based estimates of the determinants of the need for nursing home care. First, if excess demand is present, estimates of the determinants of Medicaid use may simply represent a crowding out of Medicaid patients, driven by the determinants of private use. As a result, factors associated with greater overall need in an area will be correlated with fewer Medicaid patients in nursing homes, ceteris paribus. Second, estimates of the substitutability of home health care for nursing home care may be misleadingly insignificant if they are based on the bed supply-constrained behavior of Medicaid-eligible subjects. Third, because the determinants of bed supply become the determinants of overall use under excess-demand conditions, the determinants of use will reflect, to some extent, the nursing home's desire for profits. Because profitability considerations are reflected in use based estimates of need, these estimates are likely to be misleading.

[Local backgrounds of demand and supply of nursing homes]

This report deals with the question, why municipalities differ so much in the number of elderly who are staying in a home for the aged. Official statistics, the national survey in 1982 and a local survey among the elderly in a municipality with a low capacity have been analysed. Some interesting results of the report are: if there isn't a home for the elderly in the domicile -- and the elderly have to move to another village for the care they need -- many prefer to stay on their own. In the past alternatives (such as special dwellings, more home help, etc.) have been created. In municipalities with many small villages also a relatively low capacity of homes for the elderly has been realised in the past. An other determinant of the capacity is the political and religious structure of a municipality.