The ethical problems of prolonged physical restraint

The rising prevalence of physical restraint warrants careful examination of the moral, ethical, and legal dimensions of the practice. For the frail elderly, quality of life, decision making, and informed consent are significant issues. The ethical dilemmas created by the use of physical restraints, and the need to consider restraint as an issue fundamental to the nursing home milieu and beliefs about quality of life, require understanding of and commitment to care that is individualized and person-centered. The elements identified in care settings where restraints are rarely, if ever, used evolve from an awareness of the needs of the individual resident, continuous monitoring of health status, and appropriate adjustments in the care plan.

Trends in the spatial dimensions of the long term care delivery system. The case of New York State

Over the past twenty years, the long term care sector of the health delivery system has sought to shift the delivery of services away from costly (nodalized) facilities to community-based (dispersed) delivery structures. An anti-institutional societal view has influenced the formation of current long term care policy. While home is the preferred site for elderly in need of care, the health services literature suggests that the cost and personal functional benefits expected to result from community-based long term care occur only for a small segment of the dependent elderly. This paper also looks at health planning policy as it has been carried out in New York State during the 1980s to find that, despite mid-1980s thrusts to disperse care in the community, an expansion of residential health care facilities is underway as of the end of the decade. Moreover, congregate care provided in group homes (supportive housing) is being added to the care spectrum.

[Seniors in the new German states]

The contribution comprises data collection by gerontologists and statistical analyses of living conditions of elderly people in the five new German states (formerly the GDR). Particular attention is paid to recent changes in the living conditions of East German senior citizens. This includes observations on the psycho-sociological situation of large cohorts of old people.

[Out-of-hospital geriatric facilities]

In France there are many and varied housing structures for the elderly. They were created after the war in response to the progressive ageing of the population, bringing in its wake an ever increasing dependence. These structures consist of accommodation equipped for almost complete nursing care. There is a large number of such establishments situated between individual homes and long-term hospital care: homes in the form of small family type reception units (such as sheltered housing), living with a family, rest-homes and sun-homes for the least disabled. Service-flats provide a further large group of private establishments at all prices with various levels of medical care. Retirement homes with medical cures, the MAPAD, can look after the dependent chronically ill. The biggest problem concerns provision for intellectually dependent patients who are cared for in psychogeriatric units of the MAPAD or their equivalent and in structures based on very different concepts: "the cantous" or the "Jardins d'Eleusis".

Predicting elderly nursing home admissions. Results from the 1982-1984 National Long-Term Care Survey

Predictors of elderly nursing home admissions were identified using the 1982-1984 National Long-Term Care Survey. The authors found age and health factors were important predictors. Gender was not a significant predictor for disabled elderly admissions when controlling for other variables, even though women constitute the vast majority of nursing home residents. Three of four measures of informal support availability and use were not significantly related to nursing home admission by the disabled. Income and asset wealth were also nonsignificant predictors of institutionalization by the disabled community population.

From almshouse to dedicated unit: care of institutionalized elderly with behavioral problems

This article provides an historical overview of the care of older persons with behavioral problems, from the almshouses of the early 20th century to the dedicated care units of today. The rôle of the psychiatric nurse in relation to the need for more mental health programming and changes in reimbursement mechanisms for the institutionalized elderly is examined.

Designing for psychogeriatric care

After two years of design research, the near-term goal of the Senior Citizens Department, Regional Niagara, was to build innovative homes to address the issues and programs the studies revealed. The long-term objective was to build homes that would start to change the public perception of long-term care facilities. Featuring a "Town Square", the home comprises five houses of 20 beds, each providing a different level of care. Corridors are a unique design, and each house has its own dining room facilities and activity room. A central Day Care lounge features dining room facilities for family and friends. The Department hopes the overall design will help to break down the stereotype image of long-term care design, and provide a suitable environment for the mentally and physically frail, as well as ambulatory residents.

[Management of elderly citizens in a residential setting]

On the basis of demographical and social developments as well as of the "demand" for nursing resources in the GDR, the medical and social care situation for the elderly is discussed with special emphasis on the responsibilities of the family practitioner. Concluding from our own investigations we propose to use the Classification of Disabilities for deducing indications of care activities and standards. Examples are given, in particular, in respect of differing forms of protected lodging of care-needing elderly citizens.

Senior assisted living: a hospital niche?

Nationwide demographic trends indicating a growing elderly population are creating interest in a number of senior related services, especially within the health care industry. A relatively new concept in senior care, assisted living, may well be the greatest area of growth in the senior housing industry today. Understanding assisted living, the factors which make it successful, and the role hospitals can play in development is critical to wise decision-making.