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PubMed1979

Nutritional care considerations of older Americans.

The US Census Bureau's 1977 projection of the nation's population aged 65 and older by the year 2000 was 31.8 million. This paper addresses the projection that in the future a higher proportion of the population in the United States will be older persons. It is obvious that older Americans are living longer with an increased incidence of diseases such as diabetes, hypertension, cardiac problems, and obesity, requiring medical and nutritional care. This paper discusses commitment to provide quality services in terms of prescribing appropriate and functional therapeutic diets to meet the needs of older Americans. Two mechanisms are discussed that are effective tools for calculating diabetic diet prescriptions and weight reduction diets based on energy level and energy needs. Also discussed are the provision of assistance to meet the social support needs of old people such as food stamps, Meals-on-Wheels, and homemaker's service.

Aged↗
PubMedDate not supplied

Community nursing: nurses' effectiveness in supporting carers.

This article outlines the results of a research project to evaluate the effectiveness of service support to informal carers. There are many ways in which community nurses can support carers, and carers frequently report the benefits of the service. The potential significance of the community nursing service in this role, however, is yet to be realised as nursing is still highly task-orientated, with priority given to specific medical interventions. As a result, some carers face difficulties in obtaining nursing support.

Community Health Nursing↗
PubMed1977

Compassion vs control. Conceptual and practical pitfalls in the broadened definition of child abuse.

A broadened understanding of child abuse has enabled practitioners to think of the parents of abused children not as evil murderers but as human beings caught in a complex web of social isolation and deprivation. Concomitantly, child abuse laws have changed dramatically in the last decade to include virtually all childhood physical symptoms of family crisis; physical, sexual, and emotional abuse and child neglect are now reportable by nearly all professionals who have contact with children. There has been a dramatic increase in case reports, but the services for which families become eligible do not approach the humane rhetoric and intent of child abuse legislation. Society and the helping professions are caught in a dilemma that we characterize and address clinically as compassion vs control.

Attitude↗
PubMedDate not supplied

Improving the quality of Medicaid personal assistance through consumer direction.

As states seek to improve home and community-based services for people with disabilities, many are incorporating consumer-directed supportive services into their Medicaid programs. The national Cash and Counseling Demonstration uses a randomized design to compare an innovative model of consumer direction with the traditional agency-directed approach. This paper presents findings from the first demonstration program to be implemented, in Arkansas. Our survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participants' health and safety.

Adult↗
PubMed2001

Talbot Hospice Foundation. A successful community endeavor.

Since it opened its doors 20 years ago, the Talbot Hospice Foundation, located in Talbot County, Maryland, has grown to be one of the most highly respected service organizations in the county. A professional, non-medical staff of about five full-time employees manages some 800 volunteers who offer free hospice services to anyone in the community. It is dedicated to the concept that dying is not just a medical event, and that trained community lay people can play a significant role in providing practical and emotional support to their neighbors. The Foundation is supported completely by donations and receives no reimbursement from Medicare or other insurers.

Bereavement↗
PubMed1990

The profession of maternity home care assistant and its significance for the Dutch midwifery profession.

Maternity home care assistants in the Netherlands assist the midwife (or GP) during the delivery, help and advise the new mother with the baby during the postnatal period at home. They are trained separately from nurses. Currently, more than three-quarters of mothers use this service. Birth statistics of deliveries attended by maternity home care assistants compare favourably with national statistics. The existence of this profession allows midwives to concentrate on midwifery tasks. It also enables pregnant women to consider giving birth at home or during a short-stay hospital delivery. These options are limited to certain groups in other industrialized countries.

Continuity of Patient Care↗
PubMed2001

State Medicaid programs offering personal care services.

Two Medicaid programs offer personal care services: (1) the Title XIX Personal Care Services (PCS) optional State plan benefit; and (2) the 1915(c) home and community-based services (HCBS) waivers. By 1998-1999, 26 States offered the PCS optional State plan benefit; 45 offered personal care services via a waiver(s). Nationwide, the former program was larger. The latter was the more popular administrative mechanism, possibly because it more reliably controls growth. States vary dramatically in terms of Medicaid personal care. Medicaid personal care participants per 1,000 State population ranged from 7.33 to 0.04. Per capita expenditures ranged from $91.21 to $0.02.

Activities of Daily Living↗
PubMed1990

Use of community support services by elderly patients discharged from general medical and geriatric medical wards.

This descriptive study examines the use of community support services by elderly persons discharged from general and geriatric medical wards of a large acute care British teaching hospital. A convenience sample of 40 patients were interviewed at 6-week intervals over a 3-month period about their need for and use of community support services. The type of ward from which patients were discharged did not influence the use of nursing, homemaker, physician, or warden/community visitor services, hospital day care, or meals-on-wheels. Patients who used the largest number of community services, and were the most frequent users of all available services, were those who, because of their fragility, died or were readmitted to hospital within 6 weeks of discharge. All families interviewed identified a need for more information about their elderly members' illnesses and prescribed medical regimes.

Aftercare↗
PubMed2004

Personal & supportive care services: an international perspective on workforce issues.

Familiehulp, the largest home care organization in Flanders, Belgium, has 40,000 clients and 7,400 employees. Believing its staff is its most valuable capital, Familiehulp has instituted the concept of self-steering teams. The United Kingdom's home care was unregulated until April 2003. A major objective of that country is to get the disabled back to work. In the United States, the average tenure of home care aides for this presenter's agency is eight years. He shares his secrets for recruiting and retaining the best.

Aged↗
PubMed2004

The current state of personal assistance services: implications for policy and future research.

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research.

Health Policy↗
PubMed2000

Performance-based home care for the elderly: the quality of circumstance protocol.

The paper introduces a performance-based protocol for use by case managers in home care programs for the elderly. Drawing upon the goal attainment approach to service planning and evaluation, the protocol specifies a set of five observable conditions ranging from the highly desirable to the highly undesirable that correspond to each ADL and IADL dimension plus five other dimensions of importance to community residing frail elders. The conditions documented through the protocol provide a basis for setting explicit expectations of what can be achieved through home care interventions. The paper describes a pilot effort to test the protocol in the Massachusetts state funded home care program. Both the protocol's client assessment form and data collection guide are included as appendices.

Activities of Daily Living↗
PubMed1997

Working conditions in home care: negotiating race and class boundaries in gendered work.

Home care work in metropolitan areas is a source of employment for immigrant women of color. Service work of this type intertwines domestic and caring labor in ways that reinforce the historically gendered and racialized nature of the work. Such macro level economic and political issues are played out at the micro level of daily service provided within elderly clients' homes. A study of these processes in home care work was carried out in urban southern Ontario in two nonprofit home care agencies. In-depth interviews and focus groups held with visible minority home care workers suggested that workers deal daily with racist attitudes and behaviors from clients and their families; agencies recognize these oppressive processes but usually handle them on a case-by-case basis through supervisors; and home care workers handle racism on the job as they do in their off-work hours-by avoidance, situating incidents within an analysis of the circumstances of elderly clients, setting boundaries on discussions, and occasionally, confrontation.

Adult↗
PubMedDate not supplied

A social services-public health partnership in child protection: a rural model.

It is widely recognized that the amelioration of individual and family problems which contribute to child abuse and neglect requires a multidisciplinary effort. Unfortunately, however, these efforts are often sporadic or disjointed. This article is a description of a county social service-public health partnership in rural Minnesota which can serve as a model for other agencies interested in developing more interactive relationships with one another to the benefit of dysfunctional families and vulnerable children. A respect for one another's professional knowledge base and skills, a shared philosophy of intervention, and supportive agency administrators are the key components that make this model successful. Social workers and public health nurses working together--and in cooperation with still other professionals in the community--can identify and help to resolve those unmet social, psychological, and health needs which often are found in dysfunctional families. Public health nurses have many talents and a very diverse knowledge base that can be tapped by legally designated social workers who are charged by State statutes with intervening in cases involving physical or sexual abuse or neglect of children. The Brown County, MN, model is an example of a collaborative strategy that can be replicated nationwide.

Adolescent↗
PubMed1998

Diagnosis and management of glutaric aciduria type I.

Glutaric aciduria type I (GA1) is a preventable cause of acute brain damage in early childhood, leading to a severe dystonic-dyskinetic disorder that is similar to cerebral palsy and ranges from extreme hypotonia to choreoathetosis to rigidity with spasticity. Degeneration of the putamen and caudate typically occurs between 6 and 18 months of age and is probably linked to changes in metabolic demand caused by normal maturational changes and superimposed catabolic stress. Recognition of this biochemical disorder before the brain has been injured is essential to outcome. Diagnosis depends upon the recognition of relatively non-specific physical findings such as hypotonia, irritability and macrocephaly, and on performance of urine organic acid quantification by gas chromatography--mass spectrometry or selective searches of urine or blood specimens by tandem mass spectrometry for glutarylcarnitine. The diagnosis may also be suggested by characteristic findings on neuroimaging. In selected patients diagnosis can only be reached by enzyme assay. Specific current management by the authors of this paper includes pharmacological doses of L-carnitine, as well as dietary protein restriction. Metabolic decompensation must be treated aggressively to avoid permanent brain damage. Multicentre studies are needed to establish best methods of diagnosis and optimal therapy of this disorder.

Amino Acid Metabolism, Inborn Errors↗
PubMed2001

Elders' needs and experiences of receiving formal and informal care for their activities of daily living.

Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.

Activities of Daily Living↗
PubMed2003

Microbial flora of hands of homemakers.

OBJECTIVES AND METHODS: Because of increasing concern about antimicrobial resistance in the community, aerobic flora of hands of 224 healthy homemakers in northern Manhattan, New York, were examined. RESULTS: Mean log colony-forming unit counts before and after handwashing were 5.72 and 5.69, respectively, P =.60; mean number of species identified/sample was 3.6 before washing and 3.3 after (P =.02). After handwashing gram-negative bacteria were isolated from 75.1% of subjects; yeast from 32.9%; and Staphylococcus aureus from 18.5%, 1 of which (2.4%) was oxacillin-resistant. Generally, these community isolates were more sensitive than isolates from inpatients in the local hospital, although community isolates of Pseudomonas aeruginosa were significantly more resistant than inpatient isolates for 4/10 agents tested. CONCLUSIONS: Hands of healthy persons in the community were usually colonized with gram-negative bacteria, a single handwash had little impact on microbial counts, and hands of healthy adults may increasingly become one reservoir for antimicrobial resistance.

Adult↗
PubMed1995

Self-care and assistance from others in coping with functional status limitations among a national sample of older adults.

Using data from the first wave of a new longitudinal data set collected in the late fall and winter of 1990-1991, the National Survey of Self-Care and Aging (NSSCA), we examined older adults' self-care practices in coping with functional status limitations based on in-person interviews with a national probability sample of 3,485 noninstitutionalized adults aged 65 or older selected from Medicare beneficiary files. A composite score of functional status was calculated to reflect the presence and severity of disability in three dimensions: basic, mobility, and instrumental activities of daily living. Three types of self-care coping strategies were defined: use of equipment or devices, changes in behavior, and modifications in one's environment. National estimates of self-care practices, assistance from others, and functional status measures were presented. Data revealed that the likelihood of engaging in self-care coping strategies increased as the severity of disability increased, except among the most severely disabled. Generally, those receiving assistance from others were more likely to engage in self-care activities, suggesting that receiving assistance supplements, rather than supplants, self-care coping strategies.

Activities of Daily Living↗
PubMed1993

Home care reimbursement and effects on personnel.

Reimbursement policy plays a critical role affecting the ability of providers to recruit and retain paraprofessional home care workers in an industry heavily influenced by public funding. In this article, estimates of paraprofessional home care revenue and size, the composition of the industry, and the workforce incentives inherent in different forms of reimbursement are presented. The findings from this review indicate that the industry's reliance on public funding places special importance on payment policies that recognize the critical role of trained caring staff in meeting long-term care policy goals.

Homemaker Services↗