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Biomedical subjects

J M Wiener

Publications and source records attributed to J M Wiener.

At least 19 recordsLinked to original sources
PubMed1991

Will paid home care erode informal support?

One of the main barriers to the expansion of paid home care for the chronically disabled is the fear that policymakers have that it will cause friends and relatives to curtail their informal caregiving efforts. Using the first wave of the National Long-Term Care Survey, we examine whether the amount of paid home care used by disabled elderly persons had a significant influence on the amount of informal support they were receiving. Results from a two-stage least squares regression analysis suggest that the amount of informal home care received was not significantly affected by the level of formal care. This conclusion held for subgroups of formal care users most likely to exhibit substitution: those without cognitive problems, the disabled elderly with above average income, and persons who lived alone. Even the more severely disabled elderly, who are the target of most proposals to expand paid home care, did not substitute paid care for unpaid. Thus, our study suggests that an increase in paid home care will not erode informal support.

Aged↗
PubMed1990

Measuring the activities of daily living: comparisons across national surveys.

The "activities of daily living," or ADLs, are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. Reported estimates of the size of the elderly population with ADL disabilities differ substantially across national surveys. Differences in which ADL items are being measured and in what constitutes a disability account for much of the variation. Other likely explanations are differences in sample design, sample size, survey methodology, and age structure of the population to which the sample refers. When essentially equivalent ADL measures are compared, estimates for the community-based population vary by up to 3.1 percentage points; and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. For example, the National Medical Expenditure Survey estimates that there are 60 percent more elderly people with ADL problems than does the Supplement on Aging.

Activities of Daily Living↗
PubMed1990

Nursing home length of stay patterns: results from the 1985 National Nursing Home Survey.

Length of stay (LOS) for elderly nursing home patients is estimated by converting discharges from the 1985 National Nursing Home Survey into an admission cohort and by adding reported immediate previous nursing home LOS to the surveyed LOS. The ultimate length of aggregated stays is longer than unaggregated estimates for elderly discharged residents. Although the mean length of aggregated stays is 19 months, the mean unaggregated stay is only 13 months.

Aged↗
PubMed1990

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.

Aged↗
PubMed1990

Estimating the extent of Medicaid spend-down in nursing homes.

Although it is commonly thought that a very high proportion of private-pay nursing home patients become eligible for Medicaid during their stay, few national studies have been conducted to determine the extent of Medicaid "spend-down." The discharged resident survey of the 1985 National Nursing Home Survey was analyzed to determine the extent of spend-down among elderly nursing home patients during a single nursing home episode, the proportion of patients who remained Medicaid or private payers throughout their stay, and how the measures varied by patient characteristics. Overall, during a single nursing home episode only 10 percent of nursing home patients who entered as private payers received Medicaid at discharge. Roughly one-third of nursing home patients remained on Medicaid throughout their stay, and another third remained private payers throughout their stay.

Aged↗
PubMed1989

Private long-term care insurance. Simulations of a potential market.

Long-term care is now the most common cause of catastrophic illness costs for the elderly. Although acute care health insurance represents a mature market, private long-term care insurance is in its infancy and poised for development. This study presents a comparative analysis of simulation data, generated from the Brookings-ICF Long-Term Care Financing Model, for five alternative private long-term care insurance models. The simulation results indicate 1) the potential market for private long-term care insurance is substantial, 2) moderately comprehensive long-term care policies are affordable by a significant minority of the elderly, 3) policies are considerably more affordable to those under age 65, and 4) long-term care insurance has somewhat less potential to pay for nursing home costs for high risk groups than for other elderly.

Adult↗
PubMed1989

The potential impact of private long-term care financing options on Medicaid: the next thirty years.

This study analyzes the potential effect on the Medicaid program of private sector financing mechanisms for long-term care. The data are from the Brookings-ICF Long-Term Care Financing Model and include projections over the next thirty years. While private financing alternatives have some modest impacts on Medicaid expenditures and the number of Medicaid long-term care recipients, the data suggest relatively little change in the need for Medicaid. There will be substantial increases in Medicaid long-term care expenditures over time, and private sector options cannot change this much.

Aged↗
PubMed1984

Psychopharmacology in childhood disorders.

Although not explicitly stated elsewhere, it should be clear that medication alone is rarely a sufficient treatment for childhood disorders and should usually be prescribed in conjunction with psychosocial interventions within a biopsychosocial framework. Even when cause is assumed to be largely or wholly biologic, as in infantile autism, there are secondary psychosocial consequences in the child and family that medication does not address. Finally, in the context of careful diagnosis and formulation, the appropriate use of medication is an essential component of effective management.

Anorexia Nervosa↗