Advance Directives State Requirements, Center Practices, and Participant Prevalence in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers

OBJECTIVES

Adult day services centers (ADSCs) may serve as an entrée to advance care planning. This study examined state requirements for ADSCs to provide advance directives (ADs) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs.

METHODS

Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted.

RESULTS

Nine states had a requirement to provide AD information. About 80.8% of ADSCs provided AD information and 41.3% of participants had documented ADs. There were significant associations between state requirements, awareness, and providing information with AD prevalence. State requirement was mediated by awareness.

DISCUSSION

This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health

INTRODUCTION

Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health.

OBJECTIVE

To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III).

METHOD

Review of mental health legislation from 1990 to 2014.

RESULTS

A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services.

CONCLUSION

The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Department of Veterans Affairs. Grants for States for construction or acquisition of State homes. Final rule

This rule adopts as final, without change, an interim final rule amending the Department of Veterans Affairs (VA) regulations governing prioritization of State applications for VA grants for the construction or acquisition of State home facilities that furnish domiciliary, nursing home, or adult day health care to veterans. As amended, the regulation gives preference to State applications that would use grant funds solely or primarily (under certain circumstances) to remedy cited life or safety deficiencies. This rulemaking also makes certain necessary technical amendments to regulations governing State home grants.

[When you see the light of day at the hospital]

Day Hospital delivers complex treatments to patients with psychiatric illness such as psychosis and severe neurosis. Interdisciplinary work is necessarily required by this device. Our Day Hospital is organized in three sections: community area, clinical area and education and research. Our practice isn't exempt of hindrances, which relate not only to the clinical specifics we deal with, but also with the social, cultural and legal contexts it develops in. Since the approval of the Mental Health National Law (no. 26657) we believe the Day Hospital, our old resource, is given the opportunity to keep fulfilling a space as a proposal both fresh and institutional. The mentioned law states that Day Hospitals are to be promoted as a means for social, labor and community inclusion of patients. We have no doubt on the legal advance this represents but, on daily practice, issues will persist until a strong change decision is shown, implemented as public health policies aligned with the law.

Department of Veterans Affairs. Technical revisions to conform to the Caregivers and Veterans Omnibus Health Services Act of 2010. Final rule

This final rule amends Department of Veterans Affairs (VA) medical regulations to incorporate statutory amendments. Certain statutes authorizing VA health care benefits were amended by the Caregivers and Veterans Omnibus Health Services Act of 2010. The statutory amendments affect enrollment in certain health care priority categories and exempt catastrophically disabled veterans from copayment requirements.

Self-esteem among elderly people receiving care insurance at home and at day centers for the elderly

BACKGROUND

Implementation of the Long-term Care Insurance Law of 1988 in Israel has made it possible to provide services to frail elderly people in the community. This study compares two specific services that are offered to elderly people as part of the law: (1) help offered to elderly people by homecare workers, and (2) help offered in day-care centers.

METHODS

The study sought to analyze the impact of the two social service approaches on the self-esteem of the care seekers, and included 300 elderly women (150 of whom received services at home and 150 at day-care centers).

RESULTS

The findings showed that the self-esteem of elderly women receiving services in a day-care center was higher than that of elderly women receiving the same services at home.

CONCLUSIONS

The study shows that the provision of services in a social context is important in giving elderly people proper attention which increases their self-esteem, self-evaluation and sense of mastery.

[Heterogeneity of the Departments of Mental Health in the Veneto Region ten years after the National Plan 1994-96 for Mental Health. Which implication for clinical practice? Findings from the PICOS Project]

AIMS

This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health ("Progetto Obiettivo 1994-1996") ten years after its launch.

METHODS

The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents.

RESULTS

CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites.

CONCLUSIONS

A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

A comparison of offenders with intellectual disability across three levels of security

BACKGROUND

A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security.

METHOD

A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69).

RESULTS

Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification).

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

[Effects of nursing insurance on caregiving daughters--the role of professional nursing care]

In view of the demographic development the topic of "Nursing of elderly relatives" is gaining more and more importance within nursing research. The object of the investigation described in this paper was to assess the measures of the Pflegeversicherung [Long Term Care Insurance] with regard to its effects on care-giving daughters. This publication assesses one of the questions of the study--what part professional services play in the support of care-giving daughters. The data was collected by individual biographic-narrative interviews in the private household of care-giving daughters. The data was then evaluated according to the method of biographical case reconstruction developed by Gabriele Rosenthal. This way we were able to gain a deeper insight into the situation of care-giving daughters and analyse the consequences of the Pflegeversicherungsgesetz [Long Term Care Insurance Law] from an "inner perspective". The results of the study point to both the positive effects of the Pflegeversicherungsgesetz and its limits. We were able to show that the expansion of out patient services leads to an enhanced nursing infrastructure. In view of the part that professional nursing services play, however, the biographical access also made it clear that the Pflegeversicherung will not lead to far-reaching changes in nursing arrangements. In spite of Pflegeversicherung caregiving relatives still suffer from personal and emotional strain. Also the legal requirements are too narrow and allow hardly enough space for the consideration of the family environment and the history of life of relationship between daughter and mother.

[The reform of psychiatric care in Poland--2001]

Both positive and negative effects of the reform of the health care financing system are noted. Low prices offered by Sickness Funds for particular services (a bed-day, a visit) should be regarded as a negative effect of the reform. Particularly insufficient were the prices of services in some specialised psychiatric wards and in outpatient clinics. Prices in many community-based psychiatric facilities were also considerably underestimated. Undoubtedly, the reform has led to positive changes in the organization of inpatient care. These changes include: further reduction of beds in large hospitals organisational structure as well as a marked increase in the number of psychiatric wards at general hospitals, which should be the key units of psychiatric inpatient care. Increase in the number of day hospitals is another positive effect of the reform. The programme of psychiatric care transformation is presented mostly in the Mental Health Programme. The main goal of this programme is to ensure appropriate care for the mentally disordered people, namely comprehensive and accessible health care as well as other forms of help and and support necessary for living in family and in society. This goal will be accomplished by health care and other forms of help mentioned in the Mental Health Act and in the Social Help Act. Community-based model of psychiatric care is the key element of this system. Also, the Programme states desired accessibility rates for staff, number of beds and number of particular forms of psychiatric and alcohol treatment care. Separate rates for adult and children/youth population have been elaborated.

State legislation to support family caregivers. Opportunities for partnerships abound

This article focuses on three examples of state legislation that can improve the quality of life of family caregivers while enhancing the role of home care agencies.

[Legislative, medicolegal and economic aspects of day hospitals]

After a short historical review and having dwelled on the nomenclature and legislative framework, the authors describe the medicolegal implications of the day hospital. They describe international experience within the various disciplines, with reference to economic aspects in terms of costs and the increased efficacy of these structures, the quality of service and government policies, in particular in industrialised countries. The authors conclude that day hospitals present considerable advantages both in economic terms and for patients. However, the organisation of the system needs to be improved and, where possible, procedures standardised. Bearing in mind the importance of costs to modern medicine, it is impossible not to take economic aspects into account, while also improving the quality of relations between doctors, patients and the health system.

[Partial inpatient treatment as a responsibility in psychosomatic rehabilitation]

Day clinic rehabilitation is part of the development of the medical rehabilitation system. Psychosomatic rehabilitation faces the task of developing a concept of day treatment and of collecting experiences with such models in clinical practice. The basis of this task consists in regulations laid down by the social security insurance authorities which serve as a frame for the development. The main points of these regulations are presented and their relevance for psychosomatic rehabilitation is outlined. The institutional and conceptual establishment of day treatment presents psychosomatic rehabilitation with a number of problems that are particular in this area and which are discussed in detail. Besides that, consequent elaboration of day treatment could stimulate further development of psychosomatic rehabilitation in general and help to overcome prevailing shortcomings of this part of the rehabilitation system.

Child and Adult Care Food Program: improved targeting of day care home reimbursements--Food and Consumer Service, USDA. Final rule

This final rule amends the Child and Adult Care Food Program regulations governing reimbursement for meals served in family day care homes by incorporating changes resulting from the Department's review of comments received on a January 7, 1997, interim rule. These changes and clarifications involve: The appropriate use of school and census data for making tier I day care home determinations; documentation requirements for tier I classifications; tier II day care home options for reimbursement, including use of child care vouchers; calculating claiming percentages/blended rates using attendance and enrollment lists; and procedures for verifying household applications of children enrolled in day care homes. This final rule also amends the National School Lunch Program regulations to facilitate tier I day care home determinations by requiring school food authorities to provide elementary school attendance area information to sponsoring organizations. These revisions implement in final form the provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to target higher CACFP reimbursements to low-income children and providers.

Medicare program; partial hospitalization services in community mental health centers--HCFA. Interim final rule with comment period

This rule sets forth the coverage criteria and payment methodology for partial hospitalization services in community mental health centers. The purpose of this rule is to establish regulations governing this coverage under the provisions of section 4162 of the Omnibus Budget Reconciliation Act of 1990.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); partial hospitalization--DoD. Final rule; delay of grace period

This document is to advise interested parties that the Director, OCHAMPUS is extending the grace period for partial hospitalization programs (PHPs) already accredited under the Joint Commission on Accreditation of Health Care Organizations (JCAHO) general hospital standards to obtain JCAHO accreditation under the Mental Health Manual. Due to the number of PHPs requesting JCAHO accreditation, an extension of the grace period is needed to allow sufficient time for PHPs to receive the mandatory JCAHO accreditation.

A medicare adult day care model: proposed criteria and available supply

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting them were: services to be provided directly, 14.6%; multi-disciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings, implications for Medicare funding policy are discussed.

Compulsory psychiatric treatment in the community. II. A controlled study of patients whom psychiatrists would recommend for compulsory treatment in the community

Several English consultant psychiatrists were asked to identify which patients currently under their care they would recommend for treatment with a community treatment order, if such a provision existed. The psychiatrists were asked to match each such 'nominated' patient for age, sex and diagnosis with one or two control patients, not considered to require compulsory treatment in the community. From specific data collected, it was found that: the two groups did not differ in their 'lifetime' histories of psychiatric admissions, substance misuse, criminal charges or dangerousness; 65-72% of the total sample had a history of serious dangerousness; but in the 12 months before nomination, the 'nominated' patients were significantly less likely than the controls to have complied with psychiatric treatment, and more likely to have defaulted from follow-up. The results indicate that a psychiatrist's decision to recommend a patient for treatment with a community treatment order will depend predominantly on specific criteria related to the patient's recent past.

State statute reference concerning partial hospitalization, 1988

A survey process was begun in 1983 collecting and examining state statutes governing Partial Hospitalization programs. Data were collected from 37 states and the Country of Canada, which were then analyzed into the categories of definition, goals, target population, length of stay, frequency of patient participation, duration of a program day, program services, staffing, and documentation and quality assurance. The results revealed a great diversity of the operationalization of the treatment modality of partial hospitalization through state statutes. There is a clear need for increased levels of clarity and uniformity of this treatment mode.

Partial-hospital treatment of potentially violent patients, or who's afraid of Tatiana Tarasoff?

Partial hospitalization has taken on an increasingly important role in the treatment of violence-prone patients. In response to the 1976 Tarasoff decision in California and its progeny widening the scope in many jurisdictions of a therapist's duty to protect endangered third parties from the violent acts of such individuals, strategies relevant to the day hospital need to be formulated. Treaters can provide beneficial containment through the use of informed consent, the therapeutic contract, and reality-based work which involves the patient and significant others. Nevertheless, the partial-hospital team must not lose sight of the limits of such interventions and should consider inpatient care as a serious option.

Commitment to outpatient treatment: a national survey

State mental health directors and state attorneys general were surveyed on the use of outpatient commitment in their states. The survey found considerable disagreement between the two groups on responses to several of the items, including whether outpatient commitment was even permitted in their states. The responses also indicated that two-thirds of the jurisdictions that permit outpatient commitment use it as an alternative to inpatient commitment in fewer than 5 percent of commitments. The author concludes that unless states obtain more input from both inpatient and outpatient clinicians in devising procedures for outpatient commitment, it will continue to be underutilized and ineffective.