The Jane Dent Home: the rise and fall of homes for the aged in low-income communities

The Jane Dent Home was established in 1898 (as the Home for Aged and Infirm Colored People) to serve African American elderly barred from admission to most homes for the aged. Sustained by community leadership through difficult times, the Home finally closed in 1975 after growing and persistent racial and economic segregation of Chicago's low-income neighborhoods combined with pressure from state government to ensure fire safety. This history illustrates the decline of not-for-profit homes for the aged while for-profit nursing homes were capturing market share. In Chicago this trend is strongest in low-income communities of color, which may lead to lower quality of care for such communities. Support for indigenous not-for-profit long-term care may promote the goals of health care equity articulated by Healthy People 2010.

Detection and control of influenza outbreaks in well-vaccinated nursing home populations

BACKGROUND

Influenza outbreaks continue to occur in nursing homes despite high vaccination coverage among residents. Recommendations for outbreak control in institutions such as nursing homes advises use of antiviral drugs to reduce influenza transmission.

METHODS

Influenza surveillance was performed among elderly residents of nursing homes in Michigan during 2 influenza seasons. The antiviral drug oseltamivir was used for outbreak control at the discretion of nursing home staff once influenza transmission was confirmed by virus isolation or rapid antigen detection.

RESULTS

During 2000-2001, influenza was not confirmed in any of the 28 participating homes, despite transmission of types A (H1N1) and B in the community. During 2001-2002, influenza type A (H3N2) transmission was confirmed in 8 (26%) of 31 participating homes; influenza vaccine coverage among residents was 57%- 98% in outbreak-associated homes. Oseltamivir was used in all homes with influenza transmission; outbreak control varied according to the rapidity of outbreak recognition and the extent of antiviral use. Reported adverse events were primarily gastrointestinal reactions and rashes. Analysis of the usefulness of rapid antigen detection tests for outbreak recognition indicated a sensitivity of only 77% (specificity, 92%).

CONCLUSIONS

Oseltamivir was reasonably well tolerated, and its use, along with continued promotion of vaccination coverage among nursing home residents and staff, should be a valuable addition to institutional outbreak-control strategies.

Nursing home and nursing home physician: the Dutch experience

Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.

[Deinstitutionalization of long-stay psychiatric patients in upper austria - living situation, social and clinical characteristics more than one year after discharge]

OBJECTIVE

In Upper Austria, a total of 409 long-stay patients were discharged to various residential facilities between 1995 and 2000. This paper describes psychopathology and sociodemographic characteristics.

METHODS

A random sample of 116 former long-stay patients were followed for an average 42.9 months after discharge.

RESULTS

Patients had spent an average 19.3 years in psychiatric wards. 47 patients (40.5 %) were placed in nursing homes, 16 patients (13.8 %) in old-age homes, 32 patients (27.6 %) in other institutions and only 15 patients (12.9 %) in group homes, and 6 patients (5.2 %) with families. ICD-10 diagnosis was schizophrenia in 56 patients (48.3 %) and mental retardation in 33 patients (28.4 %). Level of social and functional disabilities was high.

CONCLUSIONS

Most long-stay patients were able to live outside psychiatric hospitals, but institutional care still plays an essential role.

What types of home are closing? The characteristics of homes which closed between 1996 and 2001

Closures of care homes have received considerable public attention. Fee levels and the cost of upgrading homes to meet the national minimum standards have been identified as the main factors influencing closures. The present paper compares private residential homes, dual-registered homes and nursing homes for older people which have closed between 1996 and 2001 with homes which have remained open. Homes which closed tended to be: smaller; to have had lower occupancy levels in 1996; to be the only home run by the organisation; to occupy converted buildings; to occupy multi-storey buildings, and if so, to have no lift; to have more shared bedrooms; and to have en suite facilities in none or only some of the bedrooms. These factors were interrelated and the effect of these variables in combination was examined using multivariate (logistic regression) analysis. Among the homes which remained open, only 34% provided at least 80% of places in single rooms, which was to have become the national minimum standard for existing homes until the standards were amended in March 2003. A separate analysis of data on social climate found that the homes with a more positive social environment were those most likely to have closed. The findings support the view that there is likely to be an increase in the importance of homes run by corporate providers relative to homes run as single, owner-managed homes, with a consequent reduction in choice for potential residents. At the same time, projections of future demand in a range of countries indicate that a considerable increase in provision will be required to meet the expected growth in the population of dependent older people, while developments in alternative forms of accommodation are unlikely to meet the growth in demand in the foreseeable future.

[Palliative culture in the stationary care for the elderly]

Nursing homes are challenged by a significant change in the patient-structure. To care for dying elderly people means to enable them to live in dignity till the end. Helpful therefore is to implement Palliative Care into existing structures. This requires personal and organizational learning and development. The first step is to make central differences and contradictions visible und communicable. We describe three organizational types which leads into different core-processes. Organizational measures supporting the development of a palliative culture and indicators of successful implementation are presented.

[Successes and problems gerontological system services of social protection of the population]

In analytical review is presented activity gerontological service of social protection of the population (social-gerontological service), on condition on 01.01.2003, and track record of her development for 1991-2002. It Is given detailed feature to activity each of structures, forming this service (stationary institutions of the social service, social care centres, branches home service, day-time branches for the aged, branches acute care and others), as on country as a whole, so and in cut separate regions and federal areas. The reflected main successes and trends of the development social-gerontological service, as well as problems, which permit depends on relations state to senior generation.

Directions in Environmental Gerontology: A Multidisciplinary Field

This article considers developments and directions for environmental gerontology drawing on the three papers in this Forum. The multidisciplinary field came of age during the 1960s with Powell Lawton's powerful environmental press paradigm and its applications to empirical research and building design. Recent theoretical developments in Europe and America have advanced and integrated concepts in psychology, geography, and related disciplines. Time dimensions and active use of space are essential for understanding aging individuals and microenvironments as well as changing populations and macroenvironments. Research on residential environments by health professions is informing community care that is enhancing the independence and well-being of older people. With its proven responsiveness to social and policy priorities, environmental gerontology is now providing strong conceptual and empirical bases for advancing healthy aging and age-friendly societies.

Social capital and successful aging: the role of senior housing

Social capital is defined as the resources available to individuals and groups through social connections and social relations with others. Access to social capital enables older citizens to maintain productive, independent, and fulfilling lives. As the U.S. population ages, accompanied by a rise in the prevalence of seniors living alone, the availability of social capital within communities will become an important ingredient of successful aging. Recent evidence suggests that many traditional forms of social capital in communities-as represented by civic engagement in local associations and by the extent of voluntarism and social trust-are on the decline. If this observation in correct, there is no simple solution to rebuilding this lost social capital. Novel forms of senior housing, such as planned care developments and assisted-living facilities, may offer promising modes of delivery of social capital to the aging population. However, assisted living remains financially inaccessible for a large segment of the U.S. population, so investment in communities "aging in place" may be the key to delivering the health dividends of social capital.

Emergency department usage by community step-down facilities--patterns and recommendations

OBJECTIVE

This study examines the interface between institutional community step-down facilities (CSDFs) and acute hospital's Emergency Department (ED). It also provides a comprehensive description of the usage of an ED's services by CSDFs in its vicinity.

MATERIALS AND METHODS

This is a prospective 12-week observational study conducted in the Accident and Emergency Department of Changi General Hospital in Singapore. All patients from CSDFs transferred to the department were eligible for the study. Hospital records were used to extract relevant clinical data after admission for the length of stay and final discharge diagnosis.

RESULTS

There was a total of 201 referrals to the ED over the 3-month period. The age of the patients ranged from 32 to 107 years, with a median of 83 years. Ninety-two patients (45.8%) were male residents. There were more referrals from CSDF on weekdays than on weekends. In particular, the number of referrals from CSDFs on Mondays were significantly higher (P < 0.05, Poisson regression) than other days of the week. Fifty-one per cent of the ED visits occurred during regular working hours. Eighty-two per cent of the transfers were admitted. The main complaint was shortness of breath with cough, followed by fever and falls. The most common investigation ordered was chest radiograph, followed by electrocardiogram and other radiographs. The most common treatment procedure in the ED was placement of an intravenous line. For those admitted residents, average length of hospital stay was 8.27 +/- 8.19 days (median, 5 days). Seventeen patients (10.3%) died within 3 days of admission, while 31 patients (18.8%) stayed less than 3 days. The admitted residents had an average turnaround time (from time of registration to time of leaving the ED and proceeding to ward) of 97.94 minutes. For patients discharged from the ED, the average turnaround time (time from registration to time of leaving the ED) was 177 minutes.

CONCLUSION

Residents from CSDFs are transferred to the ED for a variety of medical reasons. The most appropriate role of the ED in evaluation of residents of CSDFs is not yet clearly defined. There is increasing need to streamline processes in acute hospitals to cope with an increasing ageing population and to ensure that quality care is delivered to the institutionalised sick.

[Changes and necessity of local geronto-psychiatrical networks]

This article discusses the problems and possible solutions of health care for older mentally ill people and people with dementia by the means of an analysis of literature and hermeneutical reflection. On the basis of statistics and scientific knowledge, the need of local gerontopsychiatric institutions is shown from a professional, ethical and economical point of view. The City of Bremen is taken as an example to describe the need as well as the possibilities in gerontopsychiatric health care structures.

Forecasting the nursing home population

OBJECTIVE

To forecast growth in the US nursing home population, as a function of trends in disability and marriage.

METHODS

Nursing home residence is modeled as a function of disability status, marital status, and other demographic covariates. Our predictions for nursing home residence are built upon joint forecasts of marriage and disability. We use data from the 1992 to 1996 Medicare Current Beneficiary Surveys, which are individual-level data sets designed to be representative of the US population older than the age of 65.

RESULTS

Today's young cohorts will have higher rates and levels of institutionalization than their older counterparts. This will reverse several decades of decline in rates of disability and institutionalization. The nursing home population is likely to be 10-25% higher than would be suggested by a simple extrapolation of past declines in disability.

CONCLUSIONS

In recent years, the rate of institutionalization among the elderly has been falling. It is predicted that this trend will reverse itself within the next decade, and that we will see substantial increases in the incidence of institutionalization among the elderly. This result is generated by our prediction of rising disability among the younger cohorts that are beginning to approach old age.