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Biomedical subjects

N Morrow-Howell

Publications and source records attributed to N Morrow-Howell.

At least 19 recordsLinked to original sources
PubMed2001

How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care.

PURPOSE OF THE STUDY: This study sought to increase knowledge about the impact of rater role on the assessment of in-home supportive care. The authors compared the perspectives of care recipients and professionals on one aspect of the broad concept of quality of care in home care-the sufficiency of the amount of care provided by informal and formal caregivers. DESIGN AND METHOD: Sufficiency of home care was assessed through concurrent elderly persons' self-report through telephone interview and nurse clinical report based on in-home interviews with the elder. Care was assessed in terms of the sufficiency of the amount of informal and formal assistance received to meet functional dependency needs. Statistical analyses compared the ratings of elder and professional. RESULTS: Professional ratings of the sufficiency of care were significantly lower than those of the elderly care recipients. From the perspective of both care recipients and professionals, sufficiency of care was significantly related to coresidence of elder and caregiver, and to caregiver health. IMPLICATIONS: Consistent with previous literature, rater role was found to influence the assessment of the sufficiency of in-home care. Researchers and providers should recognize that care recipient and professional ratings are not interchangeable.

Activities of Daily Living↗
PubMed2000

Adequacy of home care and hospital readmission for elderly congestive heart failure patients.

Readmission to acute care facilities is a frequent and costly problem among older adults with congestive heart failure (CHF). The study reported in this article tested the hypothesis that adequate home care, operationalized as patient-perceived adequacy of formal and informal assistance, is associated with lower readmission to acute care facilities. The study followed 253 elderly (age 65 and older) Medicare patients discharged to their homes after hospitalization for CHF, through structured telephone interviews at two, six, 10, and 14 weeks postdischarge. Study findings point to the importance of home care in reducing the high risk of readmission among elderly patients. The findings raise implications for practice, policy, and research.

Aged↗
PubMed1999

Home-based multidisciplinary diagnosis and treatment of inner-city elders with dementia.

The Memory and Aging Project Satellite (MAPS) of the Washington University Alzheimer's Disease Research Center was developed to meet the medical, social, and housing needs of minority and medically underserved elders with cognitive impairments. MAPS is located in the offices of the St. Louis Area Agency on Aging (AAA). This program provides multidisciplinary outreach, as well as home-based diagnosis, treatment, and case management. It differs from most other satellite programs in that it seeks to provide service to individuals who do not voluntarily seek help for dementia. Cognitively impaired clients had numerous, unmanaged medical conditions and social problems. Few clients were adequately served by health and social service systems. Despite recent contact, only 10% of clients received a formal diagnosis of dementia from a physician. Treatment was hampered by the absence or limitations of caregivers. Despite the complexities of these cases, the MAPS staff have been generally successful in addressing client problems.

Aged↗
PubMed1999

Service use by elderly patients after psychiatric hospitalization.

The extent and source of services used by older adults discharged to a community setting after a psychiatric hospitalization were examined in a prospective follow-up study. Patients were asked about service use in structured telephone interviews one month after hospital discharge. Subjects had comorbid medical conditions and high levels of functional impairment. Service use was low, highly skewed, and spread across three sectors of care-mental health specialty care (38 percent of the services), general medical care (35 percent), and social services and formal aging services (27 percent). Most service episodes were related to mental disorder.

Aftercare↗
PubMed1997

Physical and cognitive functioning among chronically ill African-American and white elderly in home care following hospital discharge.

OBJECTIVES: Although race is recognized as an important variable in health status and medical care, the conditions of African-American and white elders have not been studied sufficiently as they enter home care after hospital discharge. This study tests hypotheses that African-American elders enter home care sicker, more dependent, and cognitively impaired. METHODS: Hypotheses were tested in two independent studies, both conducted in a Midwestern city. Study 1 compares the physical and cognitive conditions of 208 African-Americans and white elders discharged home after hospitalization for congestive heart failure. Data were obtained from medical records and from patient interviews. Study 2 compares the physical and cognitive conditions of 212 African-Americans and white elders discharged home after hospitalization for hip fracture, cerebral vascular accident, and congestive heart failure. Data were obtained from medical records and interviews with patients' discharge planners. RESULTS: African-Americans were found to go home more sick, more dependent, and more cognitively impaired, although no race difference was found in instability at discharge. CONCLUSIONS: These findings raise concerns about African-American elders' access to care in community settings, given their greater needs at discharge.

Activities of Daily Living↗
PubMed1996

Implementation of discharge plans for chronically ill elders discharged home.

Although discharge plans are viewed as the primary means to ensure that patients' needs will be met in the posthospital environment, little is known about the implementation of arranged care. This study addressed the extent to which discharge plans for elderly patients with congestive heart failure were implemented as planned, tested the consequences of implementation problems, and identified factors associated with implementation problems. For 40 percent of patients, one or more components of the discharge plan were not implemented as planned, with discrepancies more likely among low-income patients. Implementation discrepancies had negative consequences in terms of unmet needs, deficient quantity of help, and less than adequate care. Implications for hospital discharge planners and home health care are discussed.

Activities of Daily Living↗
PubMed1996

Racial differences in discharge planning.

Given previously reported findings of racial differences in elderly people's use of posthospital care, this article focuses on discharge planning processes as explanations of differential service utilization. We studied the discharge plans for 369 African American and white elderly patients and examined options pursued for posthospital care by social workers, patients, and families for evidence of racial differences. We also looked for racial differences in ruling out nursing home care for reasons of patient and family preference. Discharge planning with African American patients and family members involved less pursuit of nursing home care and more pursuit of formal services in the home than planning with white patients and families. Implications for practice and future research are discussed.

Black or African American↗
PubMed1995

Post-hospital home care for African-American and white elderly.

This study of 208 chronically ill African-American and white elderly entering home care after hospitalization examined race differences in informal and formal services received and adequacy of care. Controlling for marital status, interference in activities from chronic conditions, socioeconomic status, age, and gender in regression analyses, African-Americans received significantly fewer hours of formal care per week but received significantly more hours of informal care per week from the primary caregiver. However, there was a tendency for African-Americans to rate their care as less adequate. Implications of the findings for practice, policy, and research are discussed.

Black or African American↗
PubMed1995

Pediatric discharge planning: complications, efficiency, and adequacy.

The complications encountered in discharge planning in an acute care pediatric hospital were documented. The cases of 105 children hospitalized on selected units of an acute care, regional, pediatric hospital in the Midwest were studied. The most frequently encountered complications were financial, family unavailability and lack of cooperation, family inability/unwillingness to learn patient care, custody issues, unexpected medical developments, and transportation problems. Team differences in understanding the child's psychosocial situation and custody disputes were associated with delays in discharge. Private insurance, late referral, and lack of family availability were associated with the adequacy of the discharge plan, as rated by the discharge planner at discharge. Results show discharge planning to be a complex process, affected by family, resource, and team work issues.

Adolescent↗
PubMed1994

Discharge destinations of Medicare patients receiving discharge planning: who goes where?

This study aims to increase knowledge about factors affecting discharge destinations of Medicare patients leaving the hospital after receiving discharge planning services. Medical, social, financial, and demographic factors are tested in relation to three dispositions: home, nursing home, and rehabilitation unit. Polytomous logistic regression was used to assess the likelihood of going to one destination versus another. For both nursing home versus home and rehabilitation unit versus home, destination was a function of first medical and then financial factors, with social resources playing a lesser role in the models. The only demographic variable with a significant relationship to destination was race, with black patients less likely to enter nursing home settings.

Black or African American↗
PubMed1994

Hip fracture.

One of the major factors contributing to a deterioration in the quality of life and independence of older adults is osteoporosis and hip fracture. Recent advances in our knowledge of the causes of hip fracture are providing new and effective approaches to the prevention of this disabling condition. Because hip fracture is a leading cause of disability, significant efforts have been directed to the development of strategies for the more effective rehabilitation and treatment of the fracture patient.

Accidental Falls↗
PubMed1993

Identification and measurement of productive behaviors in senile dementia of the Alzheimer type.

Caregivers of 106 individuals with senile dementia of the Alzheimer type (SDAT) were administered the Functional Behavior Profile (FBP) as part of a caregiver assessment battery. Three factors--task performance, problem solving, and social interaction--accounted for 70.6% of the variance. Analysis yielded a reliable and valid assessment that documents the observable productive behaviors of a person with SDAT. Significant differences across the stages of the disease were observed. The FBP can serve as a guide for individualized caregiving strategies by helping the caregiver focus on the presence of productive behaviors useful in managing the impaired person.

Aged↗
PubMed1993

Classification and correlates of ethical dilemmas in hospital social work.

The authors used categories based on the NASW Code of Ethics to code hospital social workers' descriptions of ethical dilemmas according to the specific principles in conflict. They also developed codes to identify discharge destination and medical care issues involved in the ethical dilemma. Most ethical dilemmas were found to involve conflicts between client self-determination and client best interest. Ethical dilemmas were more likely when patient mental status was impaired and when decision making was problematic. Ethical dilemmas were related to delayed discharge, in-hospital mortality, and less-than-adequate postdischarge care. The study enhances understanding of ethical dilemmas and advances a methodology for studying their occurrence and consequences.

Aged↗
PubMed1992

Patient and family satisfaction with discharge plans.

This study explored factors affecting patient and family satisfaction with discharge plans, an outcome of discharge planning provided by the hospital department of social work. Adequacy of discharge plans was rated by 126 patients and 130 family members within 24 hours before hospital discharge. Patient ratings of discharge plans were related to their degree of involvement in decision making, social support networks (sex and marital status), and physical condition (diagnosis and functional ability). Three types of factors were important to family members: 1) factors related to the discharge planning process, 2) the patient's discharge destination, and 3) length of patient hospital stay. Findings are discussed in terms of their implications on maximizing consumer satisfaction in the cost-conscious environment.

Aged↗
PubMed1992

Service utilization by well-organized frail elderly individuals.

In spite of extensive legislation intended to provide social services for elderly individuals, there is a lingering question about how much elderly persons actually use these services. This article reports findings from a study involving an innovative program called STAES (System to Assure Elderly Services), located in downtown St. Louis, Missouri and in particular finds that frail elderly individuals in the STAES program are using services in greater numbers than the review of the literature seems to suggest. In-home services such as homemaker services and visiting nurses' services are indeed used by elderly individuals who are in greater need than others. Through discussing the objective and operation of this program, the article explains why elderly individuals participating in the STAES program are effective users of publicly provided social services.

Aged↗
PubMed1990

Complications in discharge planning with Medicare patients.

Discharge planning is a complex professional task that affects hospital fiscal health and the quality of posthospital care. A study of discharge planning found that social workers encounter many complications in working with patients, families, other professionals, and service providers in arranging posthospital care. The study found that several complications are associated with delays in discharge and less adequate discharge plans, assessed by social workers at the time the patient is leaving acute care and by the patient 1 month posthospitalization. Results suggest the importance of various skills for social workers in acute medical care.

Aftercare↗
PubMed1990

The impact of race on volunteer helping relationships among the elderly.

As programs solicit their help in providing transportation, shopping assistance, telephone reassurance, counseling, and information and referral to needy elderly people, older adults are going to fill increasingly important roles as volunteers in the social service system for this aging society. Little empirical work has been done on effective volunteer behavior. This article aims to increase understanding of this topic by exploring how race influences relationships between volunteers and the people they serve. This analysis reveals that race by itself does not affect volunteer helping behavior; black and white older adults perform similarly in volunteer roles on measures of time committed to service and satisfaction levels of clients. However, the racial composition of the dyad does have significant effects on the helping relationship; higher levels of contact and client satisfaction are reported when the volunteer and the client are of the same race. Professional training and support are necessary to overcome problems associated with racial differences between volunteers and their clients.

Black or African American↗