Housing quality among the elderly: a decade of changes

Little research has been conducted on housing quality among the elderly. The fault lies partly with the lack of reliable data. Studies on elderly housing quality are spotty, anecdotal, and unsystematic. Many rely on decennial census data which provide a limited and unsatisfactory portrait of special housing needs of elders in general. This article seeks to fill this void by reporting a comprehensive study of elderly housing quality. For all units, logistic regression revealed that region and race are the most important predictors of housing inadequacy; tenure and the gender of the person living alone are moderately powerful influences upon inadequacy. Housing inadequacy is greater among blacks, in the South, for males living alone, and for renters.

An information infrastructure for long-term care

Emerging trends promise to alter the way long-term care is practiced. These include: changing regulation of the nursing home industry with emphasis on outcome and assessment, a trend in medical informatics away from expert systems and toward on-line decision support and reminder systems, and the application of industrial statistical quality management techniques to the realm of human services. Emerging standards such as the Arden Syntax and Unified Medical Language Systems and technologies such as Rapid Application Development Tools will facilitate the use of modern computing to mold and implement these converging trends.

[Nursing care in the area of inpatient geriatric services]

At the end of 1994, an Infratest carried out a representative survey in Germany of the life situation of people with disabilities who live in a institution. According to the results, about 660,000 people presently live in homes for the elderly and about 140,000 in homes for the handicapped. Impaired mobility is a characteristic feature for the inhabitants of homes for the elderly. However, only two of three inhabitants (63%) have "need of care". That means that at least every third inhabitant will not receive benefits from the new long term care insurance. 47% of the inhabitants rsp. 60% of those with need of care show mental disorders, which points to dementia. The living and life situation itself show that in Western Germany only 39% and in Eastern Germany only 29% of the inhabitants of the geriatric units of homes for the elderly are able to live in a single-bed room. The typical daily life normally shows routines, e.g., meal times are preset firmly. Restrictions such as no own room or front-door keys or no possibilities to keep pets are common. Therefore, quality control must be directed towards the extension of the living and lifestyle options of the inhabitants in addition to the problems of care giving. The individuality and the needs of the inhabitants must be the guiding rules for the options and procedures in institutions.

Carers of the elderly--knowledge, use of and satisfaction with day care services

This is a descriptive study of carers of dependent elderly in inner city Dublin, outlining their awareness, use of and satisfaction with day services. A striking finding from this work, consistent with other studies, is the heavy burden of care which is shouldered by informal carers which should be acknowledged by society. The study highlights a) that levels of use of domiciliary care by carers appear to be very low, b) that there is some evidence of targeting of domiciliary services to the more dependent elderly, c) that day centres and clubs are popular and acceptable to a minority of carers, d) that many carers have no informal help, e) where informal help is available, relatives of carers play a very important role in facilitating carers to accept formal domiciliary care. Recommendations include, a) improving the level and range of provision of domiciliary care, b) alerting professionals such as general practitioners and public health nurses to their role as informant and facilitator of formal care to carers, c) formulating a plan to encourage uptake of domiciliary services by carers, d) review of care provided in day centres.

Policy issues in the private health sector: examples from long-term care in the U.K

The international trend towards private markets in health care can be illustrated very clearly by developments over the last decade in the U.K., where the balance of health care provision has shifted from a predominantly free, public and comprehensive system to more of a mixed economy model. The shift can be attributed to a variety of factors, and not government policy alone. The relationship between the private and NHS sectors of health care is not a simple one and there are both positive and negative implications of the public-private mix. The growth of private hospitals and acute beds has dominated debates about private health care, but further policy issues have emerged in relation to the significant growth in private residential and nursing home care. This paper briefly reviews developments in private health care and then explores the key policy issues associated with this development. Secondly, an analysis of developments in the private residential care sector is undertaken highlighting the relationship between the public and private sectors of care provision. Policy issues pertaining to the long-term care sector of private health care are raised, including the regulation of residential care, regulatory models, enforcement and quality, and standards of care. Lessons for the regulation of private health care generally are considered and the implications for the private sector of a growing trend towards market deregulation are explored. Future models of long-term care are discussed and the likely balance between the public and private sectors explored.

Pain in the nursing home

The treatment of pain in the nursing home setting is a unique and challenging problem. Studies of the prevalence of pain in this setting have been limited, and many of the assessment tools used routinely with younger adults have not been validated in this population. The application of pharmacologic interventions is more difficult because of the higher incidence of side effects in the elderly, as well as the limited resources and logistical issues often encountered in the nursing home. This article explores these issues and offers suggestions for the appropriate management of pain in the long-term care resident.

[Development of disability in the elderly]

In two representative infratest-surveys, needs for care were systematically assessed regarding 24 basic activities of daily living (hygiene, mobility, communication, etc.). About 1.2 million persons in private homes and .5 million in homes for the elderly or handicaped were found to need care at least once a day. Impaired mobility was a persisting characteristic, partly due to physical disability, partly due to cognitive deficits. Being unable to phone or to orientate oneself outside the home, for instance, points to dementia. For the future, an increase in the number of persons who are dependent on care to 1.32 million in private homes and 900,000 who probably will live in homes for elderly, can be calculated for the year 2040 as a consequence of the demographic impact. Nevertheless, also in the future nearly one out of two elderly will be able to live independently without any need of care or help. Self-maintenance can be identified as the essential problem, because people with need of care will increasingly live alone without any relatives.

Informal care vs. formal services: changes in patterns of care over time

Longitudinal data from a representative sample of community-residing older persons were used to document changes in patterns and costs of care, both informal and formal. It was found that use of formal services was usually in conjunction with, and secondary to, informal care. Limited availability of informal care as well as increased disability raised the odds of using services. Substitution of formal services for informal care was limited and usually temporary. Total costs of community care, including living expenses, were generally less than the cost of nursing home care.

Effect on physical functioning of care in adult foster homes and nursing homes

This study tested the effects on physical functioning of substituting adult foster care (AFC) for nursing home care. Secondary data from Oregon's Medicaid agency were used to compare change in ADL functioning of 1,032 nursing home and 279 AFC residents. Maximum likelihood estimation was used to analyze selection of long-term care setting and change in functioning. One-third of surviving AFC residents would have been better off in a nursing home, whereas almost all nursing home residents were placed appropriately. Further research on outcomes that clients value most along with efforts to support functioning are needed.

Should a geriatric nurse practitioner become part of a multispecialty group?

The addition of a geriatric nurse practitioner to the staff of a medical group that visits nursing home residents appears to offer benefits to the professional staff, the nursing home staff, and the nursing home residents, according to interviews with nursing home personnel and the physicians and administrators of the multispecialty group providing medical services to the nursing homes.

European models of long-term care in the home and community

In the 1980s, faced with a rapidly increasing elderly population and soaring costs of health and long-term care services, many European governments began to reexamine fiscal policies that often encouraged institutionalization of frail and dependent elders. A number of these countries have now turned to new models of home and community-based care. This report describes home care policies that serve the needs of frail elders in Sweden, Denmark, the Netherlands, and Great Britain, with special attention to experimental projects that have tested varying approaches for providing high quality, low-cost care in the home and in the community. The central governments in these countries have developed long-term care systems that improve quality of care, ensure more efficient delivery of services, and control or lower costs. They have (1) discouraged the building of additional nursing homes and instead supported the development and expansion of a range of housing alternatives; (2) shifted greater responsibility to local governments for delivering long-term care services, bringing those services closer to those who need them; (3) developed care management techniques that enable care providers to better target appropriate services to each elderly client; and (4) provided incentives for different types of care providers to coordinate their work, resulting in improved service delivery and greater client satisfaction.

The changing face of community and institutional care for the elderly

BACKGROUND

The NHS and Community Care Act 1990, implemented from 1 April 1993, was expected to alter profoundly the provision of domiciliary services to old people. This change needs to be compared with what would have happened if no action had taken place. We sought to identify trends in community and residential care before and after 1993 to facilitate this comparison.

METHODS

Statistics were collated from diverse government publications and other authoritative sources.

RESULTS

Between 1985 and 1993 there was a progressive contraction of public community and residential services, as well as hospital beds available to the elderly. The concomitant huge increase in places publicly funded in private old people's and nursing homes appears to have been little affected by the implementation of the NHS and Community Care Act.

CONCLUSIONS

The NHS and Community Care Act has had little effect in curbing the institutionalization of old people, which has reached now the highest percentage this century at 7 per cent. A considerable expansion of community services would be required to return to the per capita provision of the early 1980s.

Sharing a home: the experiences of American women and their parents over the twentieth century

Trends and determinants of daughter-parent coresidence over the twentieth century are examined by using the 1987-1988 National Survey of Families and Households. Young women from more recent birth cohorts leave their parents' homes for the first time at earlier ages, but are more likely to make return trips home than those born earlier. Thus cohorts show remarkable consistency in the proportion of life lived in the parental home. For the 1900-1929 birth cohorts, daughters' lifetime probability that a parent will move in with them is approximately 15%; younger cohorts show similar age-specific probabilities to date. Explanations for these trends are considered.

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.