The battle against reproductive rights: the impact of the Catholic church on abortion law in both international and domestic arenas.
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Abortion, Induced↗
Biomedical subjects
R Fleishman
Publications and source records attributed to R Fleishman.
Functional improvement of elderly residents of institutions.
Studies have shown that some elderly persons who suffer decline in activities of daily living (ADL) functioning experience an improvement. This phenomenon has been examined mainly among elderly persons in the community using summary ADL indices. This article examines functional improvement among 2,527 residents of institutions for semi-independent and frail elders in Israel in four specific ADLs--bathing, eating, bladder continence, and mobility--at two points in time, 2 to 4 years apart. Demographic, functional, and institutional variables were used to predict functional improvement through logistic regression. The variables were found to differentially affect each ADL, highlighting two opposite aspects of institutionalization--deterioration, on the one hand, and rehabilitation through intervention by highly trained staff, on the other.
Activities of Daily Living↗
Institutions for the elderly operating without a license: quality of care and the surveillance process.
In 1992, Israel's Services for the Aged identified private institutions for the elderly operating illegally, which are notorious for poor quality. This article presents the findings of screening visits in 97 "pirate" institutions, as part of a plan to improve surveillance, and evaluates the outcomes as a measure of the effectiveness of intervention. Although a high proportion of deficiencies was found, some institutions showed a significant ability to correct them.
Aged↗
Improving the quality of institutional care of urinary incontinence among the elderly: a challenge for governmental regulation.
This article describes actual UI prevalence and quality of care at Israeli LTC institutions for the elderly. The analysis is based on current regulatory data on 14,406 residents at 196 residential homes, and 8,278 patients at 159 hospitals for the chronically ill. It includes a calculation of summary indices of quality, the percentage of institutions with deficient items and of those showing change, and a description of functional status profiles. Multiple regression explains the deficiency rate variance through independent institutional variables. There is a higher prevalence of severe functional impairment and full incontinence at hospitals for the chronically ill than at residential homes. There were higher rates of deficiencies and lower rates of corrections for structural items than for process items at both. A major improvement occurred for process items (50-100 per cent). Regarding outcomes, 34 percent of the residents with UI during the first assessment were continent two years later.
Activities of Daily Living↗
An innovative method of government surveillance of services for the aged in Israel.
Explains the conceptual framework behind and the foundation and implementation of the regulation, assessment, follow-up (RAF) method, and continuous improvement of quality of care in the Israeli Government surveillance of long-term care institutions. The RAF method has made crucial changes in the goals, tasks and tools of surveillance and in therapeutic approaches to the elderly. The "maintenance approach" has been replaced by a "rehabilitative approach" bringing about a real improvement in the quality of care in institutions. Presents selected findings from an evaluation of the RAF method's use in the surveillance system operated by the Israeli Service for The Aged of the Ministry of Labor and Social Affairs.
Accreditation↗
Non-medical predictors of quality of care of hypertension in elderly patients.
Describes a study designed to develop instruments for examining the quality of routine care of hypertension among the elderly and, using non-medical predictors of quality--such as elderly patient and doctor variables and doctor-patient interaction variables--to explain the variance in the quality of care. The study population comprised 352 elderly people (92 per cent) in one Jerusalem neighborhood who were members of Israel's largest sick fund. Interviews, screening, observation and examination of records were the sources of information. Multivariate analysis was performed. The findings indicated a plethora of deficiencies in the quality of routine care, mostly in the quality of surveillance and the control of hypertension. It was found that the outcome of care is primarily a result of the physician-patient interaction, rather than of a lack of patient compliance. Proposes a national programme using the instruments developed.
Aged↗
The long-term care system in Israel.
The long-term system in Israel is not a centralized entity but rather a fragmented conglomerate of services for the elderly. Many of its problems are common to the long-term care system in the United States. Three major trends have emerged in recent years: (1) privatization, (2) shift to community-based services, and (3) gradual development of mechanisms for quality assurance.
Aged↗
A regulatory approach to improving long-term and residential care.
After a 10-year collaborative effort by researchers, policy makers, and fieldworkers in Israel, the national regulatory systems for long-term and residential care institutions have been transformed. Use of the RAF Method for Regulation, Assessment, Follow-up and Continuous Improvement of Quality of Care has led to a dramatic improvement in the quality of care in these institutions.
Activities of Daily Living↗
Evaluating intervention programmes for quality assurance in hospitals.
Describes a methodological framework for evaluating intervention programmes to establish and develop quality assurance systems in general hospitals, based on the authors' experience in participating in a specific intervention programme in quality assurance. Both the approach and the design of the evaluation programme were shaped by the unique characteristics of this intervention programme. The evaluation programme was based on a model of organizational behaviour and change developed especially for the introduction of quality assurance systems into hospitals. With modification. the programme can also be used to evaluate other intervention programmes.
Education, Continuing↗
Licensing, quality of care and the surveillance process.
As part of the evaluation of an experimental programme of surveillance of institutions for the semi-independent and frail elderly using the regulation, assessment, follow-up (RAF) method, an examination was made of the licensing status, quality of care, and completeness of the surveillance process. Included in the examination were 126 institutions which underwent the surveillance process between 1990 and 1993. Aims to investigate whether the RAF method of surveillance was being implemented in a professional and uniform manner. Concludes that surveyor's recommendations to grant or not grant a licence were usually based on findings about the quality of care. Nevertheless, in order to reinforce the relationship between licensing and quality of care, it was suggested that surveyors be given clear criteria of quality on which to base their recommendations regarding conditional licensing. It was found that the surveillance process is indeed implemented uniformly in long-term care institutions of varying quality.
Accreditation↗
Two-unit reliability analysis of questionnaires used in a regulatory system.
An interjudge reliability test was conducted to evaluate the questionnaires used in the surveillance of residential care institutions. Because the reliability test was carried out as part of the routine surveillance program and not as part of a controlled experiment, it was subject to deviations from the optimal reliability test model. However, this nonpure design provided an opportunity to not only examine the reliability of the items in the surveillance tool, but also to gain a better understanding of the use of a reliability test in an "imperfect" field setting. Two different surveyor teams administered the 257 questions on the questionnaires to a representative sample of 32 institutions on two separate occasions. In order to explain the variance in the reliability scores, a multivariate analysis was conducted for two units of analysis: the surveillance questions and the institutions. Based on the results of the reliability test, changes were introduced to improve the questionnaires and their administration.
Aged↗
Improving regulation of care.
The JDC-Brookdale Institute of Gerontology, in collaboration with Israel's Ministry of Labor and Social Affairs and Ministry of Health, has developed a program to improve government regulation of long-term care institutions for the elderly, and thus the quality of institutional care. The aim of the program was to introduce greater uniformity and objectivity into the existing surveillance system, increase the participation of institution residents, and ensure public access to instruments and criteria. The tracer methodology was used and tracers representing the medical, nursing, psychosocial and environmental-operational areas were developed in consultation with specialists in each field. The program was welcomed by surveillance personnel, and implemented on a nation-wide basis. Although there have been difficulties with its implementation, these have largely been resolved through discussion, workshops and supplementary training for surveyors. Due to the program's success, new programs are being developed to improve the regulation of other kinds of institution.
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Quality of care in residential homes: a comparison between Israel and Florida.
This paper reports on two studies of the quality of care in long-term care institutions for the elderly, one in Israel and one in Florida, which used the tracer methodology developed by the JDC-Brookdale Institute of Gerontology for examining quality of care in such institutions. A tracer is a well-defined and frequently occurring problem which has a known treatment. Tracers from the medical, nursing and psychosocial areas of care were used in the studies. Data were collected by multidisciplinary teams of medical and paramedical personnel who examined and interviewed elderly residents, interviewed staff members, conducted observations, and reviewed records. Differences inherent in the two study groups--such as in cultural norms and organizational systems--were taken into consideration, and the instruments were adjusted accordingly. The tracer method proved to be a feasible method for assessing quality of care in both locales. Findings regarding 12 tracers show that for units previously assessed as either good or poor/mediocre by surveyors, good units consistently scored higher than poor/mediocre units in quality of care. Florida scored higher for quality of care in the medical area, and Israel in the nursing and psychosocial areas.
Aged↗
Reliability of direct observation of schoolchildren's consumption of bag lunches.
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Child↗
Improving the quality of service in long-term care institutions for the elderly.
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Aged↗
Cognitive impairment and the quality of care in long-term care institutions.
This study sought to determine whether cognitively impaired elderly in long-term care institutions receive a lower quality of care than do the non-impaired. The quality of care for each of 136 elderly in nine units for independent, frail and nursing residents was examined through the tracer method. On the basis of the MSQ test and an assessment by the ward nurse, a composite scale for measuring cognitive impairment was developed. Sixty-one percent of the elderly were found to suffer moderate to severe cognitive impairment. The cognitively impaired patients were found to receive poorer nursing care and staff were unaware of the existence of a greater proportion of their medical problems, compared with the non-impaired. The findings suggest that the lower quality care provided to the cognitively impaired is related to their greater behavioral and social problems such as aggressiveness and apathy. Staff members are apparently less inclined to have contact with patients displaying such problems. Changes of referral policies and training programs for institutional staff on the care of the cognitively impaired elderly are necessary in order to improve care for this group.
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Oral mucosal lesions among elderly in Israel.
The prevalence of ulcerative or proliferative oral mucosal lesions (OML) is an important parameter in evaluating the oral health of an elderly population. This paper relates the prevalence of OML in an elderly population to possible risk factors and defined high-risk groups. The second objective was to examine whether effective prediction of OML was possible from interview data alone. The elderly population of a Jerusalem neighborhood was surveyed in 1981: 456 elderly were interviewed by trained interviewers, and their oral cavities were examined by an oral epidemiologist. Specific diagnoses were confirmed by an independent senior clinician. Almost 40% of the elderly presented ulcerative or proliferative oral mucosal lesions. The prevalence of these OML was strongly related to the condition and age of dentures. The association between these OML and oral hygiene disappeared after controlling for the condition of the denture. Two variables ascertained by interview--age of denture and self-reported suitability of denture--turned out to be strong predictors of denture condition.
Aged↗
Epidemiological study of oral health among the elderly of Baka, a Jerusalem neighborhood.
This epidemiological study of the elderly in a Jerusalem neighborhood assessed oral health using five indicators: prevalence of oral mucosal conditions, denture condition, the age of dentures, oral hygiene status and periodontal condition. The utilization by the elderly of dental services and their awareness of their oral problems were also surveyed. Ninety-six percent of the elderly population were assessed as needing oral care. The capacity of the subsidized dental services in Jerusalem covers only about 15% of the elderly in need of such services.
Aged↗