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Biomedical subjects

Pamela Nadash

Publications and source records attributed to Pamela Nadash.

13 recordsLinked to original sources
PubMed2005

Managed care and long-term care: a potential solution?

This brief summarizes research by Sparer (2003) and Hughes (2002) on managed care issues for people with long-term care needs. Managed care has been proposed as a solution to the difficult problem of managing the health of this complex population. Sparer's research examines the reasons behind the failure of states' attempts to encourage commercial managed care plans to take on this task. He argues that understanding these reasons can yield important lessons for the mostly provider-sponsored plans that currently serve the long-term care population, as well as for states, that aim to save money and better serve this population. Hughes' evaluation of a small, provider-sponsored organization found that when the organization became a managed care provider, it faced significant organizational challenges that forced it to become more efficient. Importantly, it showed that the use of capitation reimbursed the plan more effectively than fee for service, increased the range of services provided to clients, and maintained client satisfaction; however, capitation did not affect the rate of nursing home admission.

Capitation Fee↗
PubMed2005

Strategies to support HCBS.

States are spending more money on home- and community- based services (HCBS) and are spending a greater proportion of their long-term care (LTC) dollars on these services rather than on institutional care. Some states have been more successful than others in supporting HCBS. This brief reviews strategies states have used to promote HCBS and summarizes existing research on the effectiveness of these strategies in increasing access, expanding revenues, and moderating institutional bed supply. Research shows that increased use of Medicaid waivers and Medicare home health services are important predictors of increased access to HCBS. Using regulation to constrain the number of institutional beds (and redirect resources to HCBS) shows mixed results. Research on the effectiveness of capitating LTC to increase access to HCBS has not been conclusive, though initial findings are promising and appear to be worth pursuing

Aged↗
PubMed2005

Long-term care: an overview.

This brief provides an overview of long-term care (LTC), a term that refers to a broad range of health and supportive services delivered in a variety of service settings, including people's own homes and nursing homes. People of all ages and with many different health conditions may need LTC. Although the demand for these services is increasing, funding sources for LTC remain unstable. Moreover, lack of societal agreement about the goals of LTC makes it difficult to establish an effective LTC policy for the future. This brief discusses these issues and reviews the key challenges that must be confronted in order to build a strong infrastructure for LTC.

Aged↗
PubMed2004

Two models of managed long-term care: comparing PACE with a Medicaid-only plan.

PURPOSE: In this study an attempt is made to understand how a Medicaid-only managed long-term-care (MMLTC) plan for elders differs from the Program of All-Inclusive Care for the Elderly (PACE), a fully integrated model, in terms of structure, operations, patient population, and service utilization. DESIGN AND METHODS: With the use of information from the Outcome and Assessment Information Set and administrative data from a MMLTC plan in New York City, enrollees were compared at the start of care and their first-year service utilization with PACE, using the PACE national data set. RESULTS: The plans differ in the range of services covered and in the larger number of members served by the MMLTC plan. The served populations differ in their sociodemographic profiles and have levels of functional need that are high, but they also differ in their relative severity of dependency in activities of daily living and instrumental activities of daily living. During the first year of enrollment, the utilization of traditional home- and community-based services was higher in PACE than in the MMLTC plan, although MMLTC plan members received much more care in the home. Total hospital utilization was lower in PACE, but nursing home utilization was higher. IMPLICATIONS: MMLTC is a feasible option for serving a population whose level of impairment is similar to that of PACE. Whereas PACE's reliance on adult day centers is seemingly associated with a stronger medical focus and lower hospital use, the MMLTC plan's emphasis on home-based personal care seems to be linked with lower nursing home use.

Aged↗
PubMed2004

The effectiveness of a nurse-led transitional care model for patients with congestive heart failure.

This research brief reports on a study that evaluated the effectiveness of a transitional care model for patients with congestive heart failure (CHF). The model focused on improving the transition from hospital to home care by upgrading traditional discharge practices and implementing an evidence-based educational program. It used usual care nurses, rather than specialist nurses, to carry out the intervention. The study found that health-related quality of life improved and the number of emergency room visits was reduced.

Journal Article↗
PubMed2004

Bringing managed care home to the long-term care population.

Managed care has been proposed as a solution to the problems facing long-term care: its high costs, bias towards nursing homes, lack of coordination with acute and primary care, and inflexible service delivery. Kodner and Kyriacou (2003) argue that home care agencies may have considerable advantages in creating managed care systems for this population over traditional managed care organizations because of the experience home care organizations have in caring for older adults as well as people with disabilities. Although home care agencies are likely to better understand the needs of the long-term care population, they may lack the expertise and organizational resources to develop successful managed care organizations. Addressing these deficiencies will be key in order for home care organizations to successfully operate as managed care providers.

Adult↗
PubMed2003

Individualized education can improve foot care for patients with diabetes.

Providing individualized education to home care patients with diabetes can significantly improve their foot care practices. A nurse researcher from the Intercollegiate College of Nursing at Washington State University conducted a study of 40 home healthcare patients with Type 2 diabetes and found that an individualized educational intervention led to improved foot care knowledge, self-care practices, and confidence performing foot related self-care.

Community Health Nursing↗
PubMed2003

Effective health care: integrating research into practice.

Although researchers are building a substantial evidence base on best practices in home care, less is known about how best to promote these practices. Well-thought-out strategies are needed to encourage the adoption of evidence-based practice, which integrates clinical expertise and patient preferences with the judicious use of the best available evidence. The authors outline some of these strategies, and explore why some are effective and some are not.

Community Health Nursing↗
PubMed2003

Adult day centers: everything you wanted to know but were afraid to ask!

Adult day services are a growing component of the wide spectrum of home and community-based care. However, up until now there has been only sketchy information about how many centers there are, what they do, whom they serve, and how they operate. This research brief presents findings from a new study by Partners in Caregiving: The Adult Day Services Program at the Wake Forest University School of Medicine, which provides the most comprehensive information to date about this important service. Understanding what centers do and whom they serve can be the start of a beautiful relationship.

Accreditation↗