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Diversified funding and programming for homemaker and home health aide services.

Homemaker-home health aide services can be the backbone of a home health agency. Due to the increased community needs of the frail elderly, the potential of abuse and neglect of both adults and children, and the challenge to delay or prevent institutionalization, homemakers and health aides are a vital component to programming for in-home services. Agencies are challenged to seek funding opportunities and move toward diversification to meet community needs.

Aged

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

Earlier discharge with community-based intervention for low birth weight infants: a randomized trial.

BACKGROUND: Prolonged hospitalization of low birth weight infants increases the risk of medical and psychosocial complications. The feasibility of earlier discharge with community-based follow-up of infants of < or = 2000 g birth weight, without the use of home apnea monitors, was investigated. METHODS: One hundred infants of < or = 2000 g birth weight were randomized to either an intervention or control group. Intervention infants were discharged when readiness criteria were met. Based on assessed need, intervention group families received public health nursing and homemaker services for up to 8 weeks. Control infants were discharged to their homes at the discretion of the attending physician. All infants were assessed blindly at age 1 year with the Bayley and Home Observation for Measurement of the Environment (HOME) scales. RESULTS: There were no group differences in baseline infants' characteristics or in neonatal complications. Infants in the intervention group were discharged from the hospital at an earlier postconceptional age (mean +/- SD 36.6 +/- 1.5 weeks vs 37.3 +/- 1.6 weeks; P < .04). Median length of hospital stay (23 days vs 31.5 days) and mean weight at the time of discharge (2200 +/- 288 g vs 2275 +/- 301 g) were lower, but not significantly, for infants in the intervention group. A secondary analysis by birth weight strata (< or = 1500 g and 1501 through 2000 g) revealed that the most significant reductions in hospital stay and weight at discharge were realized in infants of 1501 through 2000 g birth weight. The persistence of apneic episodes and need for electronic monitoring prevented earlier discharge of infants of < or = 1500 g birth weight. Postdischarge services to the intervention group included 185 public health nurse home visits (3.8 +/- 0.91), 410 phone contacts (8.4 +/- 5), and 2298 homemaker hours (46 +/- 78) of service. At 1 year, there were no deaths and no group differences in rehospitalization rates, use of ambulatory services, or Bayley scores. Intervention families had significantly higher 1-year HOME scores. Minimum cost of hospital care was $873 per day, while the total cost of community-based services averaged $626 per infant. CONCLUSIONS: A significant reduction in average length of hospital stay was achieved for infants of 1501 through 2000 g birth weight. Earlier discharge of infants weighing < or = 1500 g at birth was hampered by persistent apneic episodes and feeding difficulties. A community-based program designed to provide individualized support and education for families of low birth weight infants was cost-effective and had a positive influence on the home environment.

Aftercare

Role analysis of the position of the homemaker-home health aide.

This research attempted to clarify the definition of the role of the homemaker-home health aide, the individual who provides directly the personal and homemaking services to enable persons who cannot perform these basic tasks for themselves to remain in their homes. The research focused on the definition of this role by analyzing it from the perspective of role theory and by describing the role activity among agencies that meet the National HomeCaring Council criteria for formal accreditation and/or approval. The findings revealed very little conflict in role definition between the providers and the consumers of homemaker-home health aide services.

Conflict, Psychological

Toward a continuum of care for the elderly: a note of caution.

The search for better ways to care for the chronically ill elderly has led to "alternatives to institutional care." A study fo geriatric day care and homemaker services finds that they were used as an add-on to existing care, few patients benefited, and costs were 60-71% higher than costs of a control group. Four more studies have confirmed the lack of substitution effects. Services could be targeted on those who need them even though it is very difficult to do so, and efficacy should be demonstrated before benefits are expended to new services.

Aged

Effects and costs of day-care services for the chronically ill: a randomized experiment.

Two long-term care settings not now covered by Medicare--adult day care and homemaker services--were studied in a randomized experiment to test the effects on patient outcomes and costs of using these new services. This article reports findings for day care. Patients' physical, psychosocial and health functions were assessed quarterly, and their Medicare bill files were obtained. Medicaid data were obtained on most patients, but few used many Medicaid-covered long-term care services. Multistage analysis was performed to mitigate effects of departures from the randomized design. Day-care patients showed no benefits in physical functioning ability at the end of the study, compared with the control group. Institutionalization in skilled nursing facilities was lower for the experimental group than the control group, but the factors other than the treatment variable appeared to explain most of the variance. There was a possibility that life was extended for some day-care patients. the new services averaged $52 per day or $3,235 per year. When costs for existing Medicare services used were added, the yearly cost of the experimental group was $6,501, compared with $3,809 for the control group--an increase of $2,692 or 71 per cent.

California

Social and economic incentives for family caregivers.

The recent emphasis on developing programs and policies to support families who care for aged relatives makes it important to understand the families' receptivity to the specific social and economic incentives under consideration. The research reported in this paper draws on the experiences of 203 individuals identified as the primary caregiver to an aged frail relative currently receiving home care or day care services in New York City. As part of a larger study of caregiving behavior, respondents were asked to rank their preferences for various service and economic support programs. Findings indicate that family caregivers perceive service and social supports, specifically medical care and homemaker service, as more crucial than both direct and indirect financial incentives. Furthermore, the issue of economic incentives elicited an extremely negative reaction from a significant minority who refused to consider such support in their personal family situations. The analysis indicated that the caregiver's background characteristics were not critical in differentiating caregivers who select either a service or an economic incentive. Among the set of variables defining the current caregiving situation, only sex of the aged relative and utilization of home care services were significantly related to choice of program. Respondents caring for females and high service utilizers were more likely to prefer service supports. Relevance of findings to current policy initiatives regarding financial incentives to families are presented.

Aged

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