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PubMed1989

The use, cost, and economic burden of nursing-home care in 1985.

Nursing-home expenses constitute one of the greatest financial risks for elderly Americans. This study, based largely on the 1985 National Nursing-Home Survey, examines the economic burden posed by nursing-home care during 1985. The results indicate that nursing-home expenses constitute by far the largest out-of-pocket burden of all health care services. It was found that nursing-home care expenses constituted 82.5% of the out-of-pocket expenditures among the elderly who incurred $3,000 or more in such expenditures during 1985. Surprisingly, though, it was found that the frequency in which those in nursing homes "spend-down" their assets and income, thus becoming eligible for Medicaid, is much lower than others have calculated. This may be due in part to the fact that a large proportion of the elderly are already eligible for Medicaid when they begin their nursing-home stays.

Aged↗
PubMed1994

An international perspective on child day-care health.

If we are committed to the health and development of children, we need to recognize that the vast majority of the world's women are working women. In Africa, 80% of the women are actively engaged in economic activities outside the home. The "economic miracle" in Southeast Asia was made possible by the nimble fingers of thousands of women working in textile and electronics factories. There is need for pre-day-care advocacy for infants, through promotion of breast feeding and maternity leave. When the mother returns to work, the standard of the International Labor Organization should be applied, namely" ...the care of children while the parents are working cannot be ignored because it forms a focal point on which three main concerns of development policy--work, health, and education--converge." Several principles emerged from the presentations in the international panel: 1. Child-care programs must be community based, using the resources of the families and the community organizations themselves. 2. Programs require the active involvement of the communities, women's groups, and other partners. 3. Programs are modified by innovations created by community organizations, universities, and other groups. 4. Programs require the mobilization of trained young men and women into the field of early childhood education and development. This international panel provided an overall uniting theme, that throughout the world the hope for the survival and better life for children unites parents of every country and every creed. This is one of the most powerful and strongest motivational resources in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed2005

Tensions and constraints for nurses in hospital-in-the-home programmes.

Economic necessity constrains health-care expenditure and waiting lists for hospital treatments remain high. As a result, more care is delivered via alternative means, such as same-day surgery initiatives and home-care programmes. Acute care delivered in the home to patients who would otherwise require hospitalization is becoming an increasingly acceptable means of treatment. These Hospital-in-the-Home programmes offer increased comfort while delivering comparable outcomes to many patient groups. The purpose of this paper is to generate discussion concerning the tensions that exist for nurses who practice in the home under the auspices of acute-care institutions. Data drawn from field work that formed part of a critical ethnography is used to generate the discussion. The larger research project explored the constructions of the role of the nurse in four Hospital-in-the-Home programmes in Victoria, Australia. It will be argued that there is significant pressure exerted upon nurses to support the imperative to reduce bed days in acute hospitals by transferring people to their home. At times, this agenda clashes with the nurses' professional commitment to provide holistic patient care, yet the dilemmas are largely unacknowledged and/or unrecognized by the nurses despite the tension they generate.

Home Care Services, Hospital-Based↗
PubMed1996

Economic cost of home-based care for ventilator-assisted individuals: a preliminary report.

STUDY OBJECTIVE: To measure the direct and indirect costs of maintaining a ventilator-assisted individual (VAI) at home. DESIGN: A cross-sectional survey was conducted of primary family caregivers of VAIs residing in 37 states. SETTING: Surveys were delivered to the homes of VAIs. PARTICIPANTS: Two hundred seventy-seven (19.7%) of 1,404 primary family caregivers of patients who were ventilator-dependent and who were living at home. Interventions. None. MEASURES: Participants received the modified Katz Index and an investigator-developed Home Ventilator Care Cost and Utilization Survey (HVCCUS). RESULTS: Total cost of care was determined by summing total direct medical and nonmedical costs of home care and lost wages. Using LPN rates for private duty care, the average total cost of care was estimated to be $7,642 per month (median=$5,406). Using RN rates for private duty care, the average total cost of home care was estimated to be $8,596 per month (median=$5,911). Variation with VAI characteristics is discussed. CONCLUSIONS: Home care of VAIs is a labor-intensive and an economically costly undertaking. The development of policies and programs to support home placement requires additional investigation regarding factors affecting the cost-effectiveness of various placement settings, as well as the ability and/or willingness of family members to accept the cost and responsibility of home care.

Adult↗
PubMed1999

Efficiency of home care: notes for an economic approach to resource allocation.

Home-delivered health-related services are not valued for themselves but are, rather, highly customized inputs that can be used in the production of several alternative "commodities" ultimately demanded by consumers. These valued commodities are the restoration, improvement, or maintenance of health and functional status that can be produced by home-delivered care (and by alternative services) and the everyday support of daily functioning at home. If we can describe how inputs into the production of these two commodities are allocated, it may be possible to make judgments about whether home-delivered care and other services would produce more value if they were allocated differently.

Cost-Benefit Analysis↗
PubMed2002

The effect of older people's economic resources on care home entry under the United Kingdom's long-term care financing system.

OBJECTIVE: To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom. METHODS: In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization. RESULTS: Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income. DISCUSSION: UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.

Activities of Daily Living↗
PubMed2000

Ambulatory care or home-based treatment? An economic evaluation of two physiotherapy delivery options for people with rheumatoid arthritis.

OBJECTIVE: To assess the difference in costs of home-based versus clinic-based physiotherapy (PT) for patients with rheumatoid arthritis (RA) from a societal perspective. METHODS: A cost analysis was performed using statistical and financial information provided by The Arthritis Society, Ontario Division, from April 1, 1997 to March 30, 1998. Cost estimates included treatment costs and costs borne by patients. A sensitivity analysis was conducted to examine the effect of altering the valuation of treatment time and patient employment status. RESULTS: Total costs per case were $210.87 for the home setting, and $183.87 for the clinic setting when patients were employed. Sensitivity analysis did not change the trend of the results. The estimated start-up costs for an arthritis clinic were between $302.90 and $652.40. From the perspective of the health care system, these costs would be recovered after serving 4 to 8 RA patients at a clinic. CONCLUSION: The findings suggest that ambulatory PT care is less costly than home-based services for people with RA based on The Arthritis Society model. Further studies should be conducted to examine the effectiveness and the possible adverse consequences of alternative settings for service delivery.

Aged↗
PubMed1997

[Hospital at home and conventional hospitalization. An economic evaluation].

BACKGROUND: To carry out an economic evaluation of hospital at home (HH) vs. conventional hospitalization (CH) from the hospital cost perspective. METHODS: A minimization cost analysis were performed in 2 groups of patients (HH: 148 patients, 1,776 days of care; CH: 148 patients, 1,113 days) with similar characteristics. We used cost per hospital episode (only for the comparable period in HH and HC) and cost per day as outcome measures. The costs of health care professionals, pharmacy, sanitary material, diagnostic and therapeutic tests and transport were directly estimated for each patient. Other costs were indirectly assigned from the hospital accountability information system. RESULTS: The average episode cost at home was 172,043 ptas. (about $1,300) less compared to the conventional hospitalization. Cost per diem for HH was 25,565 ptas. less than CH. Marginal costs were 14,987 and 2,913 ptas. minor in HH than CH, per episode and day respectively. When we consider HH staff as a differential cost (i.e. to establish a new hospital at home unit with new staff) marginal cost per episode was 2,276 pesetas higher than CH. CONCLUSIONS: HH is a cost-effective option when decisions take into account the average cost (establishment of a new unit vs. a new ward) or when the HH unit is created as a substitute service through the conversion of pre-existent resources. However, HH is a disadvantaged cost option when it is created as an additional resource.

Adolescent↗