[The study of house monitoring system in Welfare Techno-House Mizusawa]

In 1999, 8 elderly people aged over 70 stayed for 5 days in Mizusawa Welfare Techno-house and their health conditions and activities of daily life were monitored using 16 sensors attached around the house. To determine a few feasible, practical sensors and optimal sensor positions, accumulated data was analyzed. Because of bud get conditions only two sensors (infrared sensor and life line monitor sensor) were placed in one voluntary house and the data were transferred from the voluntary house to the techno-house through the ISDN and CATV lines. The data were analyzed every days. Only 2 sensors to detect were placed and attached this year, however one more sensor to detect physical conditions such as ECG records during sleeping time, will be used next year. On the other hand, an integrate system that can analyze many data transferred from various sensors simultaneously was developed. To introduce this system into privatehouse, many problems such as privacy protection, security, etc must be solved.

The delegate's dilemma: ACAT re-assessment in hostels

The provision for 'ageing in place' in the Aged Care Act of 1997 has provided an opportunity for hostel facilities to broaden their scope of care for older people. Aged Care Assessment Teams (ACATs) are required to provide assessments to give approval for high or low level entry to these facilities, and to provide approval for reclassification from low to high care. However, guidelines for ACAT assessments are contradictory with respect to the Resident Classification Scale (RCS) which provides the facility funding formula, thus creating gatekeeping compared with advocacy difficulties for the ACAT. If the facility can support a claim of high care need for a resident via the RCS but the ACAT (using different and less in-depth criteria) does not agree with that claim, then the care of that resident might be compromised due to inadequate funding. Recommendations made to solve this dilemma include conferring the right of the hostel staff to reclassify residents when necessary, with the responsibility for confirmation of that classification to remain with the trained validation officers from the Commonwealth Department of Health and Family Services, not the ACAT.

Volunteer and paid long term care ombudsmen: differences in complaint resolution

Data are reported from a pilot study of the ombudsman reporting system in one southeastern state. The focus of this article is the relationship between types of complaints investigated and resolved by both paid and volunteer long-term care ombudsmen operating under various auspices. Statistically significant differences exist between the resolution of complaints by volunteer and paid ombudsmen. Data are discussed in terms of the implications of these differences for the implementation of a federal mandate to increase citizen participation in long-term care facilities.

A measure of satisfaction for the assisted-living industry

A self-administered satisfaction survey instrument for the assisted-living industry was developed and validated. The survey contains 45 Likert-type items that measure residents' and family members' satisfaction with the most central aspects of housing and care. The scale covers six key service dimensions: activities, personnel, dining, apartment, facility, and management. Internal consistency tests indicate high reliability. Multiple tests of validity confirm the scale's effectiveness in measuring residents' and family members' satisfaction with the six dimensions. Overall, residents are less satisfied with assisted-living programs than their family members are, but they may feel inhibited about expressing criticism in the presence of family. A priority index highlights service areas in which performance improvement efforts should be made to obtain the greatest increases in satisfaction while making the most efficient use of limited resources. Managerial implications of the tool are discussed.

Policy implications on assistance for the "caged elderly" in Hong Kong

Social policy for the "caged elderly" in Hong Kong should be formulated in the context of how they lived in the society where they were located. The paper examines (1) whether some of these elderly experienced financially constrained conditions with a weakened social support system; and (2) what policy choices, such as compassionate housing or closer monitoring of such residences, can be undertaken by a formal organization.

[Elderly people in dirty dwellings: an underestimated and complex problem]

Two women aged 60 and 81 years were reported by their GPs to the department of Outpatient Geriatric Psychiatry because they seriously neglected themselves and their dwellings and their cognitive functioning was markedly reduced. A management involving regular contacts, home care, assistance in money matters, structuration, diagnostics and checking for risks was instituted, coordinated by a social-psychiatric nurse, to enable timely intervention when necessary. The first patient deteriorated greatly and was committed to a psychiatric hospital, the second is living at home with home care. The difficulties and characteristics in providing adequate help to this group involve psychiatric, somatic and social factors. The number of patients concerned is probably underreported because they do not ask for help by themselves. Close co-operation between social and medical help services and early signalling of the problems are necessary to prevent eviction from their homes and subsequent homelessness and further deterioration.

Use of multidimensional assessment to provide testimony on behalf of residents in a life-care home

City administrators challenged a life-care home's tax-exempt status. A successful, empirically-based case was made based on data collected by gerontological nurses using the Iowa Self-Assessment Inventory (ISAI) and related instruments (Mini-Mental State Examination [MMSE], Instrumental Activities of Daily Living Scale [IADLS], and Physical Self-Maintenance Scale [PSMS]) to describe the life-care population. Testimony by gerontological nurses included comparisons between these life-care residents and statewide data on elderly individuals currently residing in nursing homes and in the community. The data they presented showed not only that this life-care home provided a high quality of life, but also saved society substantial amounts of money in government-funded services that would otherwise be provided to residents of this home. The judge ruled in favor of continuing tax-exempt status for this life-care home because credible evidence clearly demonstrated that taxpayer savings from the services provided to life-care home residents and the life-care commitment dramatically outweighed the taxpayer costs associated with lost tax revenues.

Perceptions of care and satisfaction in assisted living facilities

This study had two objectives: (1) to determine current consumers' perceptions and satisfaction with assisted-living facilities and (2) to determine current consumers' evaluation and preferences for nursing assistants. Responses from residents and family members indicated positive, but not strong, satisfaction with care. Areas identified as often unsatisfactory were; the mealtime experience, the nursing assistants, and recreational activities. Preferred qualities of nursing assistants identified by both residents and family members were genuine concern, kindness, respect, and consistent attentiveness. Residents only identified a pleasant disposition as an essential quality of nursing assistants and only family members identified knowledge regarding aging, gentle assertiveness, and commitment to staying on the job as essential qualities of nursing assistants.

The prevalence of diabetes mellitus and quality of diabetic care in residential and nursing homes. A postal survey

OBJECTIVE

to investigate the prevalence of known diabetes mellitus in care homes and the patterns of diabetes care in these institutions.

DESIGN

a postal questionnaire sent to all 98 care homes in Sheffield.

RESULTS

70 care homes (71%) returned the questionnaire, indicating that 233 (8.8%) of 2648 residents were known to have diabetes. Of these, 76 (33%) were treated with diet alone, 105 (45%) with diet plus oral medication and 52 (22%) with insulin. Only seven registered nurses (2%) in the homes had certified diabetes training. Forty-two homes (60%) did not carry out a structured, diabetes-related assessment of residents on entry and only 29 (42%) had regular review of diabetic residents by a general practitioner or practice nurse. Most homes (89%) were visited by an optician, 56 (80%) also had a regular chiropody service, although 32 (46%) of these charged their residents for this service.

CONCLUSIONS

the known prevalence of diabetes is similar to that reported previously. This study highlights the need for structured care with defined standards for care-home residents with diabetes.

The effect of long-term care environments on health outcomes

This study contrasts rates of mortality and of relocation to higher levels of care as well as trajectories of cognitive status, functional ability, depression, and subjective health of residents of an assisted living facility with those of a nursing home. Data were collected from medical records and face-to-face interviews with 158 residents at baseline and 4, 8, and 12 months later. All participants lived on a single long-term care campus. Logistic regression revealed that facility was not a significant predictor of mortality or relocations due to declining health. A repeated measures analysis of variance found that outcomes for people living in the two facilities did not change at different rates. These consistent findings suggest that although the assisted living and nursing home environments claim to have different philosophies of care, health outcome patterns for people living in the two environments were similar.

Institutions for the elderly operating without a license: quality of care and the surveillance process

In 1992, Israel's Services for the Aged identified private institutions for the elderly operating illegally, which are notorious for poor quality. This article presents the findings of screening visits in 97 "pirate" institutions, as part of a plan to improve surveillance, and evaluates the outcomes as a measure of the effectiveness of intervention. Although a high proportion of deficiencies was found, some institutions showed a significant ability to correct them.