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Cross-Sectional Study on Risk of Flooding and Landslides and Their Associated Perceptions Among Home Health-Care Patients Living in Fukui Prefecture, Japan. Disaster Med Public Health Prep 2022; 17:e264. [PMID: 36226466 DOI: 10.1017/dmp.2022.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to evaluate a risk of flooding and landslides among home-care patients, to reveal an extent to which patients require support for evacuation, and to determine whether risk was accurately perceived among the patients. METHODS This is a cross-sectional study targeting the patients who were actively treated at the home-care clinic in Fukui Prefecture, Japan. We collected data on the patients' sociodemographic and clinical characteristics. Additionally, we collected data on their risk of flooding and landslides through hazard maps and distributed a questionnaire to these patients regarding their risk awareness of flooding and landslides. RESULTS Of the 199 eligible home-care patients, 84.9% (169 of 199) were at risk of flooding and/or landslides, and 58.6% (99 of 169) of them needs support during evacuation. Furthermore, of those who were at risk of flooding and/or landslides, 46.0% (45 of 99) had accurate risk assessments. Factors that resulted in inadequate risk awareness of flooding and landslides included: not placing importance on evacuation, not using medical equipment, and living on the first floor. CONCLUSIONS There was limited risk awareness of flooding and/or landslides among the home-care patients. The information of the risk factors regarding inadequate risk awareness of flooding and landslides should be used to sophisticate flooding and landslides evacuation strategy.
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Quinlan C, McKibbin C, Cuffney C, Brownson R, Brownson C, Clark J, Osvold L. Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration. Clin Gerontol 2022; 45:1167-1179. [PMID: 32981469 DOI: 10.1080/07317115.2020.1820651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. METHODS A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). RESULTS Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. CONCLUSIONS Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. CLINICAL IMPLICATIONS Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.
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Affiliation(s)
- Claire Quinlan
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | | | - Cari Cuffney
- Wyoming Department of Family Services, Cheyenne, Wyoming, USA
| | - Ross Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeff Clark
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | - Lisa Osvold
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
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Influence of socio-economic profile of neighbourhoods on the selection of home care strategies for older dependants. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Care strategies for older dependants are determined by not only individuals or network characteristics, but also contextual factors. The objective of this study is to determine whether urban contexts (neighbourhoods) are linked to the use of family care (informal), public services or private care at home (formal). We applied logistic regression analysis to data from the Survey of People in a Situation of Dependence 2018. The sample was composed of 530 older people (55 years old and over) living in two types of socio-economic groups of neighbourhoods in Barcelona, Spain. The type of neighbourhood is relevant in explaining the home care that older dependants receive. In neighbourhoods with a high socio-economic level, dependants are more likely to use private services and less likely to use informal care services and public services, even after controlling for household income, degree of dependency, sex, age and the number of people in the household. Understanding the factors that determine the use of public care services, private care services or family care-giving is important due to the increment in the number of older people in the population. Our results suggest that differences in urban socio-economic contexts determine some inequalities in the use of services even after controlling for socio-economic individual differences. The characteristics of neighbourhoods should be considered to adjust care policies for older dependants.
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Iyer M, Bhavsar GP, Bennett KJ, Probst JC. Disparities in home health service providers among Medicare beneficiaries with stroke. Home Health Care Serv Q 2016; 35:25-38. [PMID: 27064307 DOI: 10.1080/01621424.2016.1175991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.
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Affiliation(s)
- Medha Iyer
- a Department of Psychiatry , University of Tennessee Health Sciences Center , Memphis , Tennessee , USA
| | - Grishma P Bhavsar
- b Department of Health Sciences , California State University, Northridge , Northridge , California , USA
| | - Kevin J Bennett
- c South Carolina Rural Health Research Center, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,d Department of Family and Preventive Medicine, School of Medicine , University of South Carolina , Columbia , South Carolina , USA
| | - Janice C Probst
- d Department of Family and Preventive Medicine, School of Medicine , University of South Carolina , Columbia , South Carolina , USA
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Shen HW, Feld S, Dunkle RE, Schroepfer T, Lehning A. The prevalence of older couples with ADL limitations and factors associated with ADL help receipt. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 58:171-89. [PMID: 25036802 PMCID: PMC4297741 DOI: 10.1080/01634372.2014.944248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Using the Andersen-Newman model, we investigated the prevalence of activities of daily living (ADLs) limitations in married couples, and couple characteristics associated with ADL help-receipt. In this sample of 3,235 couples age 65+ in the 2004 Health and Retirement Study, 74.3%, 22.1%, and 3.6% were couples in which neither partner, one partner, or both partners had limitations, respectively. Logistic regression results indicate that help-receipt was associated with certain health needs in the couple, but not with their predisposing characteristics or enabling resources. Social workers could target couples most in need of assistance by assessing both partners' health problems.
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Affiliation(s)
- Huei-Wern Shen
- a School of Social Work , University of Missouri-St. Louis , St. Louis , Missouri , USA
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Li H, Kyrouac GA, McManus DQ, Cranston RE, Hughes S. Unmet home care service needs of rural older adults with Alzheimer's disease: a perspective of informal caregivers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2012; 55:409-425. [PMID: 22783958 DOI: 10.1080/01634372.2011.650318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.
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Affiliation(s)
- Hong Li
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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McAuley WJ, Spector W, Van Nostrand J. Formal home care utilization patterns by rural-urban community residence. J Gerontol B Psychol Sci Soc Sci 2009; 64:258-68. [PMID: 19196690 PMCID: PMC2655168 DOI: 10.1093/geronb/gbn003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 09/17/2008] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined formal home care utilization among civilian adults across metro and nonmetro residential categories before and after adjustment for predisposing, enabling, and need variables. METHODS Two years of the Medical Expenditure Panel Survey (MEPS) were combined to produce a nationally representative sample of adults who resided in the community for a calendar year. We established 6 rural-urban categories based upon Urban Influence Codes and examined 2 dependent variables: (a) likelihood of using any formal home care and (b) number of provider days received by users. The Area Resource File provided county-level information. Logistic and negative binomial regression analyses were employed, with adjustments for the MEPS complex sampling design and the combined years. RESULTS Under controls for predisposing, enabling, and need variables, differences in likelihood of any formal home care use disappear, but differences in number of provider days received by users emerged, with fewer provider days in remote areas than in metro and several other nonmetro types. CONCLUSIONS It is important to fully account for predisposing, enabling, and need factors when assessing rural and urban home care utilization patterns. The limited provider days in remote counties under controls suggest a possible access problem for adults in these areas.
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Affiliation(s)
- William J McAuley
- Department of Communication, George Mason University, 4400 University Drive, Research 1 Building, Room 253, MSN 6A9, Fairfax, VA 22030, USA.
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Madigan EA, Wiencek CA, Vander Schrier AL. Patterns of community-based end-of-life care in rural areas of the United States. Policy Polit Nurs Pract 2009; 10:71-81. [PMID: 19383620 DOI: 10.1177/1527154409333861] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There is relatively little empirical data on the supply of community-based end-of-life (EOL) providers especially in rural areas despite projections for growth. This study examined the availability of community-based EOL providers in eight states using mapping techniques and statistical approaches. Analysis of variance and geographic information system approaches were used to compare the availability of community-based EOL providers at the county level by degree of rurality. Examining numbers of rural counties by provider, it was found that hospices were the least available community-based EOL providers in rural counties with 62% to 92% of rural counties not having hospice providers (exception: Vermont). When examining the number of providers by population older than 65 years, few differences were found. It is concluded that there are substantially fewer hospice providers in the most rural areas, raising issues of access to care. Examination of both unadjusted and adjusted numbers of providers is important to understand community-based EOL provider supply.
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Affiliation(s)
- Elizabeth A Madigan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA.
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Mitchell J, Bradley D, Wilson J, Goins RT. The Aging Farm Population and Rural Aging Research. J Agromedicine 2008; 13:95-109. [DOI: 10.1080/10599240802125383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Grabowski DC. The market for long-term care services. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2008; 45:58-74. [PMID: 18524292 DOI: 10.5034/inquiryjrnl_45.01.58] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although a large literature has established the importance of market and regulatory forces within the long-term care sector, current research in this field is limited by a series of data, measurement, and methodological issues. This paper provides a comprehensive review of these issues with an emphasis on identifying initiatives that will increase the volume and quality of long-term care research. Recommendations include: the construction of standard measures of long-term care market boundaries, the broader dissemination of market and regulatory data, the linkage of survey-based data with market measures, the encouragement of further market-based studies of noninstitutional long-term care settings, and the standardization of Medicaid cost data.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA.
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Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, de Andres AL, Esteban y Peña MM, de Miguel AG. Coverage and predictors of influenza vaccination among adults living in a large metropolitan area in Spain: a comparison between the immigrant and indigenous populations. Vaccine 2008; 26:4218-23. [PMID: 18579263 DOI: 10.1016/j.vaccine.2008.05.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 05/14/2008] [Accepted: 05/20/2008] [Indexed: 10/22/2022]
Abstract
This study sought to evaluate influenza vaccination coverage in Madrid (Spain). Coverages were estimated for vaccine target groups and special attention was placed on the immigrant population. Individual data from 7341 adults included in the Madrid City Health Survey conducted in 2005 was used. Overall influenza vaccination coverage was 24%. Compliance with age-based influenza vaccine guidelines (>or=65 years) was 63.9%, among those<65 years who had an associated chronic condition, it was 37.9% and 24.1% among HCWs. Immigrants accounted for 12.4% of the sample. Overall crude coverage was significantly lower among immigrants than among the indigenous population (11.2% vs. 25.9%), but once the multivariate analysis had been performed, the association became non-significant. In conclusion, it must be said that all the available evidence indicates an inadequate level of influenza vaccination coverage among HCWs and high-risk subjects <65 years. On the other hand, coverages among subjects aged >or=65 years are acceptable and there is no observable difference in vaccine use between immigrants and indigenous subjects. Strategies that have demonstrated their effectiveness in enhancing vaccination coverages should be applied in Madrid.
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Affiliation(s)
- Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda de Atenas s/n, Alcorcón 28402 Madrid, Spain.
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Guerriere DN, Wong AYM, Croxford R, Leong VW, McKeever P, Coyte PC. Costs and determinants of privately financed home-based health care in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:126-136. [PMID: 18290978 DOI: 10.1111/j.1365-2524.2007.00732.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.
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Affiliation(s)
- Denise N Guerriere
- Department of Health Policy, Management and Evaluation, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Hellinger FJ, Encinosa WE. The impact of state laws limiting malpractice damage awards on health care expenditures. Am J Public Health 2006; 96:1375-81. [PMID: 16809580 PMCID: PMC1522105 DOI: 10.2105/ajph.2005.077883] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2005] [Indexed: 11/04/2022]
Abstract
Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.
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Affiliation(s)
- Fred J Hellinger
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA.
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