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Use and sources of payment for health and community services for children with impaired mobility.

A survey was made of the parents of 380 children whose mobility impairments require the use of a wheelchair, walker, or braces. They were asked about equipment, health services, related services, and family support services used during the previous year. There was extensive use of equipment and traditional medical and health services, such as visits to primary care and specialist physicians; there was moderate use of related health services, such as physical or occupational therapy and child counseling; and there was very little use of community-based family support services, such as respite care, after-school care, homemaker services, and summer camp. The cost of health care, particularly medical specialty care, was defrayed in large part by private insurance and public programs, such as Medicaid and Title V Programs for children with special health care needs, while financial support for related services, such as physical therapy and speech therapy, came largely through the schools. Compared to funding for health and related services, financial aid for community-based family support services is largely lacking.

Adolescent

The evaluation of the National Long Term Care Demonstration. 5. Formal community services under channeling.

Channeling was intended to improve access to formal community services, both through the facilitating activities of case managers and through direct purchase of services. It was expected that formal community service use would increase both because more individuals would stay in the community and because use would increase for those in the community. Only the latter effect was observed. Even though a majority of individuals in the control group also received formal services, for those in the community, channeling achieved increases in in-home care. The largest effects were for personal care and homemaker services. These effects were substantially stronger under the financial control model of channeling, which included expanded funding for such services. There were also increases in home-delivered meals, transportation, and day-care services under the financial model but not under the basic model. Both models increased the use of special equipment.

Aged

Getting by at home. Community-based long-term care of Latino elders.

Although evidence suggests that the morbidity and mortality of Latino elders (of any Hispanic ancestry) are similar to those of non-Latino whites, Latinos have higher rates of disability. Little is known about influences on the use of in-home health services designed to assist disabled Latino elders. We examine the effects of various cultural and structural factors on the use of visiting nurse, home health aide, and homemaker services. Data are from the Commonwealth Fund Commission's 1988 national survey of 2,299 Latinos aged 65 and older. Mexican-American elders are less likely than the average Latino to use in-home health services despite similar levels of need. Structural factors including insurance status are important reasons, but acculturation is not pertinent. Physicians should not assume that Latino families are taking care of their disabled elders simply because of a cultural preference. They should provide information and advice on the use of in-home health services when an older Latino patient is physically disabled.

Activities of Daily Living

Shortened hospital stay for low-birth-weight infants: nuts and bolts of a nursing intervention project.

Prolonged hospitalization of low-birth-weight (LBW) newborns places them at increased risk for a number of medical and psychosocial complications. A randomized trial of earlier hospital discharge with community-based nursing follow-up and intervention was performed. Community-based, in-home, public-health nursing and homemaker services were provided on an individualized basis according to assessed need. A significantly higher number of nurse home visits and telephone contacts were made to the intervention families. One of the most identified needs of families of LBW infants was assistance with breastfeeding. More than half of the early discharge families needed and received homemaker assistance during the first 8 weeks after the newborn's discharge from hospital. Results showed that a community-based program that provided individualized support and education for families of LBW infants was safe, cost-effective, and had a positive influence on the home environment.

Community Health Nursing

The effects of Quebec home aid services on the utilization profile of sociosanitory resources: a substitution study.

The development of home aid services in Quebec is based on the hypothesis that this new program will help to maintain at home people who would otherwise be institutionalized and also contribute to reducing costs in the health care sector. Accordingly, home aid services can be viewed as a substitute for conventional health care services. This study evaluates utilization modifications of health care services subsequent to the introduction of a home-aid program in October 1977. A modified, non-equivalent, control group design was used on a target population including all residents aged 65 or more in one region of Quebec. Multiple regression was used to explain variations in resources utilization in relation to population characteristics and different health care settings. Results for the utilization of hospitals are discussed. We discovered that the anticipated substitutive effects of a home-aid program on the use of health care services cannot be ascertained.

Activities of Daily Living

A nontraditional supportive services program: VNA independence plus.

The Visiting Nurse Association (VNA) of Texas received a grant from the Robert Wood Johnson Foundation to develop a financially self-sustaining program of nontraditional, homebased supportive services for the elderly in March 1987. The new, fee-for-service program, VNA Independence Plus, used market research to develop a service package that would meet the needs of area elderly. Services offered include housekeeping, transportation, yard care, and handyman services.

Aged

A scheme of augmented home care for acutely and sub-acutely ill elderly patients: report on pilot study.

A pilot study for a scheme of augmented home care for elderly patients with acute or sub-acute illnesses is described. General practitioner care was supplemented by the services of a geriatrician. Home Help and District Nursing Services were involved where appropriate. Functional recovery was assessed using a new index based on the individual patient's pre-morbid function. Of 37 patients treated at home, six required admission to hospital and three died. The remainder made satisfactory functional recovery. Preliminary evidence suggests that in patients with comparable illness, recovery of function in terms of the Activities of Daily Living is more rapid at home than in hospital. This augmented home-care scheme proved practicable and acceptable to patients and participants and suggests that further controlled studies should be carried out.

Activities of Daily Living

Home care and the older adult: illness care versus wellness care.

If older citizens are to maximize their potential for optimal functioning and independence, there will surely be a greater need for holistic nursing care. How can nurses fulfill this need in view of existing barriers? What can they do to ensure that home- and community-based holistic nursing care will be available to elderly citizens for whom the quality of life is at risk? Although there are no easy answers, there are several strategies that nurses might find useful in this current predicament. These strategies fall into four categories: Documentation. When restrictions are imposed, nurses must be prepared to challenge fiscal intermediaries. To do this, they must have strong documentation of the rationale for service. Every effort must be made to document those services that are reasonable and necessary for the treatment of a client's illness or injury. Client advocacy. Because of the restrictions on service that are imposed by the principal sources of public funding, nurses must seek wide support from other community sources. Gaining such support requires a knowledge of community structure, the display of activism and leadership, and a willingness to engage in the political process. Lobbying. As an extension of client advocacy, nurses must create an effective lobbying force to educate public policy makers and legislators. Nurses must persuade elected representatives that there is a need to develop a broader interpretation of what constitutes a "skilled nursing service." Research. Nursing research, sweeping but creative, must become part of every professional nurse's responsibility. Ways to measure the outcomes of holistic nursing must be found.(ABSTRACT TRUNCATED AT 250 WORDS)

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