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Biomedical subjects

F G Caro

Publications and source records attributed to F G Caro.

At least 19 recordsLinked to original sources
PubMed2001

Extending the effectiveness of home care for elders through low-cost assistive equipment.

A recent demonstration project in Massachusetts suggests that low-technology, low-cost assistive equipment has the potential to make traditional publicly-funded home care programs for elders more effective. The demonstration also identified implementation problems that must be addressed if public home care programs are to be a vehicle for making assistive equipment available to functionally disabled elders living in the community. The demonstration was carried out by the Gerontology Institute at the University of Massachusetts Boston in cooperation with the Massachusetts Executive Office of Elder Affairs, and was funded by the Robert Wood Johnson Foundation through its Home Care Research Initiative.

Activities of Daily Living↗
PubMed2000

Performance-based home care for the elderly: the quality of circumstance protocol.

The paper introduces a performance-based protocol for use by case managers in home care programs for the elderly. Drawing upon the goal attainment approach to service planning and evaluation, the protocol specifies a set of five observable conditions ranging from the highly desirable to the highly undesirable that correspond to each ADL and IADL dimension plus five other dimensions of importance to community residing frail elders. The conditions documented through the protocol provide a basis for setting explicit expectations of what can be achieved through home care interventions. The paper describes a pilot effort to test the protocol in the Massachusetts state funded home care program. Both the protocol's client assessment form and data collection guide are included as appendices.

Activities of Daily Living↗
PubMed1998

Facility-level outcome performance measures for nursing homes.

Risk-adjusted nursing home performance scores were developed for four health outcomes and five quality indicators from resident-level longitudinal case-mix reimbursement data for Medicaid residents of more than 500 nursing homes in Massachusetts. Facility performance was measured by comparing actual resident outcomes with expected outcomes derived from quarterly predictions of resident-level econometric models over a 3-year period (1991-1994). Performance measures were tightly distributed among facilities in the state. The intercorrelations among the nine outcome performance measures were relatively low and not uniformly positive. Performance measures were not highly associated with various structural facility attributes. For most outcomes, longitudinal analyses revealed only modest correlations between a facility's performance score from one time period to the next. Relatively few facilities exhibited consistent superior or inferior performance over time. The findings have implications toward the practical use of facility outcome performance measures for quality assurance and reimbursement purposes in the near future.

Activities of Daily Living↗
PubMed1998

A longitudinal analysis of nursing home outcomes.

OBJECTIVE: To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. DATA SOURCES: Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. STUDY DESIGN: Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. PRINCIPAL FINDINGS: The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. CONCLUSIONS: The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures.

Activities of Daily Living↗
PubMed1997

The impact of the closing of three Massachusetts public chronic disease hospitals: a multidimensional perspective.

The closing of three public chronic disease hospitals in Massachusetts in 1991 as a cost-cutting measure sparked renewed attention to the consequences of relocation. Massachusetts officials faithfully carried out a series of measures to assure that patients would be transferred to facilities providing high quality care and that the relocation process would be highly sensitive to patient needs. A survey of family representatives revealed that both the relocation process and the outcome tended to be perceived positively. Quasi-experimental studies of health and survival outcomes, however, provided less favorable results. On two of three measures of health change, relocation was found to have no effect. However, relocation was found to increase the likelihood of incontinence. For patients at the hospital with the greatest concentration of older patients, relocation lead to heightened mortality rates. Also disappointing for State officials was the fact that the anticipated cost savings were less than anticipated. The findings point to the need for renewed efforts to understand the circumstances when relocation places institutionalized older people at serious risk, more careful cost estimates of the savings to be achieved through proposed cost-saving policy changes, and more carefully formulated policy guidelines for relocation of the institutionalized elderly that balance the risks associated with relocation against other public policy objectives.

Adult↗
PubMed1997

Self-direction in home care for older people: a consumer's perspective.

Interest among elder home care consumers in playing a stronger role in planning and supervising their own care was examined. Elder home care consumers were surveyed to determine their willingness to assume more responsibility for their home care such as in the hiring, paying, scheduling, supervising and/or firing of their home care worker. Telephone interviews were conducted of 883 home care clients in the Massachusetts Home Care Program which is administered through 27 local, private, non-profit Home Care Corporations (HCC) and which currently serves 33,000 clients. Respondents reported high levels of satisfaction with their home care services and home care worker. However, a substantial minority of respondents reported a willingness to assume more responsibility for their own home care services. A quarter to a third of the respondents indicated that they could take greater responsibility for supervising a home care worker and needed less assistance from a case manager. Multiple regression analyses revealed that prior experience in directing an in-home worker, greater length of receipt of home care services, greater current involvement in directing a home care worker, and lower levels of satisfaction with home care services were associated with a willingness to assume responsibility for directing a home care worker. Pilot projects are needed that develop and test options for older people with disabilities to exercise greater control over their own personal assistance.

Aged↗
PubMed1995

Balancing formal and informal care: meeting needs in a resource-constrained program.

Implications of the presence of informal help for the adequacy of formal home care services are examined in a public program that restricts service authorizations to needs that are not addressed by informal caregivers. Four areas of need were examined: local transportation, shopping, housecleaning, and dressing/bathing. The mixture of formal and informal help varied greatly from one area of need to another. Contrary to expectations, the frequency of informal help tended to be positively associated with the reporting of unmet need. The data suggest that in some areas of need, the reporting of unmet need reflects the view that the demands on informal caregivers are excessive and that additional formal services would provide them with welcome relief.

Activities of Daily Living↗
PubMed1994

Physicians' knowledge of drug costs for the elderly.

OBJECTIVE: To measure physicians' knowledge of the costs of commonly used medications in geriatric practice and how such awareness influences their prescribing decisions. DESIGN: A survey of pharmacies to determine the prices of 14 commonly used brand name and generic drugs and an in-person survey of physicians asking them to price these drugs. SETTING: Eastern Massachusetts. PARTICIPANTS: One hundred thirty-two primary care practitioners were surveyed during hospital rounds and medical society meetings. MEASUREMENT: The study examined physician awareness of patients' ability to afford drugs, the use of generic drugs, clinical decision-making practices, and the physicians' level of knowledge of drug costs. Actual drug prices were measured by surveying 22 pharmacies. RESULTS: Of the 132 respondents, 85% reported that inability to afford medications was a problem for some of their patients. One in five indicated that they did not believe generic drugs to be as safe or effective as brand name drugs, and 30% reported that they rarely or never had access to information about drug costs. Of the 99 physicians who estimated drug prices, there was a marked trend toward underestimation of the prices of more expensive drugs as well as overestimation of the prices of less costly drugs. Physician estimates of prices were highly variable; their estimates were much more variable than pharmacy prices. Younger physicians were more likely than older physicians to make correct estimates, and specialists in internal medicine were less likely to make correct estimates than physicians in other specialties. CONCLUSIONS: These data indicate that substantial knowledge deficits exist in physicians' understanding of the economic implications of the prescriptions they write. Considerable educational activity will be necessary in this area if clinicians are to function as cost-effective prescribers under health care reform.

Aged↗
PubMed1994

Productive aging: an overview of the literature.

"Productive aging" describes an array of activities through which older people contribute to society. Both the extent of current productive activities among older people and the barriers to more extensive productive activity are reviewed. If certain adjustments can be made for their special needs, older people have the potential to make substantial contributions. However, a variety of prejudicial attitudes and discriminatory practices continue to limit the opportunities of older people to make productive contributions, particularly in workplace settings. Interventions are needed to strengthen opportunities for retraining, employment, and volunteering for older people. At the same time, programs and policies to facilitate the productive participation of older people cannot easily correct for the adverse effects of a lifetime of racial or gender discrimination.

Aged↗
PubMed1988

The role of home care service in family care of developmentally disabled children: an exploratory study.

Recent concern about the needs of developmentally disabled children living at home has led to increased attention to family support programs. Home care service is one family support option which should be viewed as a basic fundamental support strategy. An exploratory study of a small number of families caring for developmentally disabled children in New York City indicates that publicly-funded home care produces a great number of benefits for this special population.

Adolescent↗