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PubMed2003

Long-term care planning for baby boomers: addressing an uncertain future.

The number and proportion of older Americans are rising rapidly and are expected to increase into the middle of the 21st century as Baby Boomers reach age 65. Medicare has been the traditional health care insurance for the elderly. Medicare was enacted in a health care climate of acute care and hospitalization. Chronic disease is the major health care cost of the 21st century with the need for long-term care growing rapidly. Medicare was never designed to pay for long-term care and custodial services. The limited scope of Medicare coverage is a problem now and will be a greater problem in the future. Long-term care is a personal responsibility and requires planning ahead. Nurses offer strategic solutions to meeting present and future needs by serving as educators, advocates, coordinators of resources, and activists working on many levels to influence care for the elderly now and in the future. This article focuses on the origins of traditional health care insurance, current and projected costs of long-term care, the current role of the government and private sector in financing long-term care, and nursing initiatives for the individual and community.

Aged↗
PubMed1999

Bed-blocking in the National Health Service in Scotland: a study of bed-blocking in Scottish National Health Service trusts; its nature and extent.

OBJECTIVE: To determine the perceptions of managers in Scottish NHS trusts concerning bed-blocking. To help determine the causes of bed-blocking and suggest possible solutions to the problem. DESIGN: The first part of the study consisted of qualitative research interviews with key figures in NHS trusts and an examination of the existing literature on bed-blocking. This informed the second stage which was based on a questionnaire survey of senior managers in 35 trusts. SETTING: Interviews were carried out in three trusts in Forth Valley Health Board and Grampian Health Board areas. Questionnaires were sent out to 44 trusts throughout Scotland. The three trusts that were excluded from this study did not contain bed-blocking patients. SUBJECTS: Questionnaires were sent to chief executives of 44 NHS trusts in Scotland. Respondents were nominated by chief executives on the basis of their experience and understanding of bed-blocking problems within their own trust. RESULTS: Of the 44 questionnaires sent to trusts in Scotland, there were 35 responses (80%) which identified a total of 1845 beds as being blocked. The NHS secondary care-based respondents indicated that social services were responsible for 1406 bed-blocking patients in 35 trusts, an average of 40 patients per trust between August and September 1997. Some 600 of these "social services responsible" bed-blocking patients, an average of 21 patients per trust, were reported as awaiting comprehensive assessment by a social worker. In addition, 710 of these "social services responsible" bed-blocking patients, an average of 24 patients per trust, were awaiting funding authorization for a nursing home or residential home placement. NHS trusts were responsible for 237 bed-blocking patients, an average of seven patients per trust. In a further 202 cases bed-blocking was deemed to be neither the responsibility of the trust nor of social services as patients were awaiting vacancies in the patient's or carer's specific choice of residential or nursing home. CONCLUSION: Results from this study show that there would appear to be a significant number of blocked beds in NHS trust hospitals throughout Scotland. Trust staff, whilst acknowledging the complex nature of bed-blocking, perceive social services, who are responsible for the assessment, placement and financing of patients being transferred from hospitals to residential care in the community, as being responsible for the majority of these beds being blocked. It is, however, acknowledged that social services are under-funded and under-resourced. If the situation is to be improved, consideration should be given to changing service delivery processes in the context of the implementation of Designed to Care.

Bed Occupancy↗
PubMed2004

Out-of-Pocket expenditure for depression among patients attending private community psychiatric clinics in Pakistan.

BACKGROUND: Depression is a serious public health problem in Pakistan because of the disabilities it causes and the cost burden for the family. About 6% of the Pakistani population suffers from this illness and approximately 50% ofthose affected seek treatment. The health budget of the country is very low, average per capita income is 430 US dollars and 35% of the population falls below the poverty line. It follows that depression puts a heavy economic burden on its sufferers. AIM: The aim of this study was to estimate the economic burden on patients suffering from depression who were attending community psychiatry clinics. METHODS: This is a prevalence-based analysis of mental health care expenditure in a sample of 200 patients with an ICD-X diagnosis of depression. The patients attended four private community clinics, run on a once-a-week basis, with all care paid for by the patients out of pocket. A questionnaire was designed with a view to gathering information on out-of-pocket treatment and travel expenditures. The data was subjected to SPSS analysis. RESULTS: Among the subjects enrolled in the study (n=200), 85% were spending over Rs. 3,133 (51.40 US dollars) per month as general expenses on health. Sixty-five percent of the subjects were earning below Rs. 5,000 ( 86.00 US dollars). The majority used the public bus for transportation, costing the family Rs. 83 (1.40 US dollars) per trip. Laboratory investigation costs were negligible as there is a lesser emphasis on lab tests in psychiatry. DISCUSSION: The high cost of depression keeps a vast majority of the population away from ongoing treatment, which contributes to the misery of the illness and the associated loss of productivity. The national budget is very low, the average income for the majority is far from satisfactory, and though partial support from charitable organizations, public sector hospitals, insurance cover and medical facilities is available, the majority of needs are unmet. It is essential to increase the health budget and enhance efforts toward preventive strategies. Further research on health economics is needed along with an appropriate government database.

Adult↗
PubMedDate not supplied

After the funding is gone: evaluating the sustainability of a community-based project.

The Rural Elderly Enhancement Project was a nurse-initiated grant funded by the W.K. Kellogg Foundation and administered by an urban school of nursing. The major purpose of the nine-year grant was the development of a model of community participation and empowerment. An informal evaluation was conducted to assess the communities' perception of the project and to determine the sustainability of the project's initiatives. A random sample of individuals from community agencies, schools, and churches were interviewed by six senior baccalaureate nursing students enrolled in a community nursing course. Results demonstrated that the communities had a very positive view of the project and that many project initiatives were sustained and have expanded.

Aged↗
PubMed1990

The conundrum of charitability: reassessing tax exemption for hospitals.

Tax exemption is an ancient, honorable and expensive tradition. Tax exemption for hospitals is all of these three, but it also places in sharp focus a fundamental problem with tax exemption in general. Organizations can retain their tax exemption while changing circumstances or expectations undermine the rationale that led to the exemption in the first place. Hospitals are perhaps the best example of this problem. The dramatic changes in the health care environment have eliminated most of the characteristics of a hospital that originally persuaded the citizenry to grant it an exemption. Hospitals have entered into competition with tax-paying businesses, and have increasingly behaved like competitive actors. Such conduct may well be beneficial, but it does not follow that tax exemption is appropriate. Rather than an undifferentiated subsidy, a shift to focused goals will provide charitable hospitals with the opportunity and incentive to "do the right thing."

Community Participation↗