Letter: Quality of life.
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Home-chore service delivery can provide nonprofit organizations with opportunities for service, employment, training, and economic development. This article describes the ways that such organizations can fund and develop home-chore programs. It examines the five major funding sources and the opportunities for combining program funds to promote comprehensive care. It then discusses issues to consider in competing for contract bids with proprietary providers. Marketing strategies are outlined for each funding source, including which services to offer and how to project a favorable agency image. This section places special emphasis on ways to tap the often overlooked but largest potential client population, the private pay sector. Finally, there are guidelines and projections for preparing budgets.
The organizational structure and of the role of home help service is described. Doctors working in both geriatric medicine and the community are aware of the home help service through shared contact mainly with frail elderly patients. They are usually well informed about the practical value of the home help service to the patients but seem to lack knowledge about the internal structure of the home help service and its value as an important source of information about the mental and physical ability of the elderly in the community. In our experience direct contact with the home help service is more effective than indirect contact--through the hospital Social Worker. Home care organizers should be part of the multi-disciplinary team when discussing the possible discharge of a frail elderly patient. All medical staff caring for the elderly, whether community or hospital based, should be aware of the administration structure of the home help service to facilitate the interchange of information.
This study reports on job satisfaction from a survey of 132 home health aides using Locke's Action Tendency Interview Schedule. The major findings were that respondents who had been employed in home health care for five years or less were more satisfied than those who had been working in the area for a longer period and that there were no differences in job satisfaction by age.
This study documents high levels of role complexity and functional overlap in the field of home health care. Personnel perform a wide range of "professional/organizational" and "community/familial" service functions though the emphasis is on the delivery of a battery of pseudo family-like tasks. The importance of a familial orientation does not significantly decline when controlling for length of employment or organizational rationality. Role orientation is, however, significantly associated with a worker's chronological age. Results lead to program planning recommendations meant to influence staff training paradigms in home health care.
Social workers in home care agencies obtained through a national random sample responded to a mail questionnaire that examined the relationship between the frequency of discharge with unmet patient need and patient/family characteristics, agency auspice, and practice activities when social workers' assessment of patient needs and managed care payment limits conflict. Regression analysis found that the importance of social work financial planning with clients and intra-agency advocacy were significant negative contributors, and patient cognitive impairment, inadequate family care, and agency auspice were significant positive contributors to a regression model explaining 31 percent of the variance in the frequency of discharge with unmet need. Implications for practice, education, and research are discussed.
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This article describes some of the findings of a longitudinal survey of three samples of older people living at home in East London and Mid Essex. It describes the service use and need for community services of the three samples at their baseline interviews, and then looks at how their patterns of use and need changed by the time of their follow-up interviews. It shows that older people are generally using services appropriately, but that there are still unmet needs. Service use was found to increase with age as health and functional ability declined. Further findings will be published shortly.
The New York City Home Care Work Group, initiated a research and planning project designed to draw a profile of the home care system of New York City and formulate specific proposals to address system-wide home care service delivery issues. The resultant report focuses on ways to improve the quality of home care services and means of involving government toward that end.
In 1984, Overlook Hospital added a for-profit home health agency to its already established hospital-based home health agency. While the rationale for the development of two distinct organizations was sound, there were special legal, financial, and quality assurance issues and problems to consider.
In response to a strong demand for "house-related services" among the elderly, the Robert Wood Johnson Foundation established a Supportive Services Program for Older Persons. Not only does the program help the elderly maintain their homes, it provides an important link between its clients and home health agencies.
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A new tool has been developed to assist community health nurses in the supervision of care provided by home care aides, the providers of personal care and the extension of skilled services.
Supervision and evaluation of the direct care provider can be a costly and time-consuming activity. A comprehensive process to coordinate the various aspects of the home care aide evaluation is a creative solution for the efficient use of supervisory and staff time, paperwork reduction, and cost containment.