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At least 19 recordsLinked to original sources
PubMed1990

Canada's disabled population in institutions.

One percent of Canada's population are long-term residents of health care institutions. Of this group an estimated 97% have a disabling condition. This article profiles disabled people living in institutions using data from the Health and Activity Limitation Survey (HALS) undertaken by Statistics Canada. HALS collected data on: the nature, number and severity of disabilities; the underlying causes of the disabilities; and the degree of assistance required for daily activities. For the institutional component of HALS, a sample of 19,000 disabled individuals from 1,100 institutions was used. The institutional survey indicated that almost 80% of the disabled population in institutions were aged 65 or older, while about 90% had mobility and/or agility-related disabilities. The most frequently cited underlying cause of disability for respondents living in both institutions and households was disease or illness. Among young adults in institutions, mental retardation was the main disabling condition. Among the elderly, diseases of the musculoskeletal system and connective tissue (including arthritis) were most common. Most respondents in institutions required daily help with personal care, shopping and personal finances.

Activities of Daily Living↗
PubMed1986

Correlates of early disability in Huntington's disease.

Functional disability in Huntington's disease usually results from a combination of the movement disorder, intellectual decline, and psychopathological changes, but the unique contribution of each element has never been investigated. The Shoulson-Fahn functional capacity rating scale measures independence in such daily activities as eating, dressing, and managing personal finances, and is used to stage the illness and follow its progression. To determine which problems contribute most to reduced functional capacity as the disease evolves, we reviewed the records of 48 consecutive patients who were evaluated for intellectual and emotional status and motor disability. Each patient was staged and rated for functional capacity at the time of the examinations. Thirty-three of these patients were followed over several years with repeat evaluations at 6-month intervals. Intellectual impairment and depression correlated significantly with reduced functional capacity. However, when the somatic symptoms of depression were eliminated from the analysis, its relationship to functional capacity was no longer significant. Duration of illness, motor disability, and age at onset also had little impact. Neuropsychological test performance and functional capacity deteriorated over time. Our data suggest that intellectual impairment is a major factor in reducing functional capacity in the early stages of Huntington's disease.

Activities of Daily Living↗
PubMed1991

How stressful is retirement? Findings from the Normative Aging Study.

The stressfulness of retirement both as a transitional event experienced during the past year and as a life stage was investigated. Transitional stress was assessed using a life events approach, and stage stress using a "hassles" approach. Respondents were 1,516 male participants in the Normative Aging Study, 45% of whom were retired. Among those retiring in the past year, respondents' own and spouse's retirement were rated the least stressful from a list of 31 possible events. Only 30% found retirement stressful. Retirement hassles were also less frequently reported and were rated less stressful than the work hassles of men still in the labor force. The only consistent predictors of both transitional and stage retirement stress were poor health and family finances; personality did not predict retirement stress.

Adult↗
PubMed1990

Credentialing for international fellowships.

The common market may provide a unique opportunity to develop certification models between countries as some of the economic, social, and language barriers begin to soften. International fellowships must be encouraged, especially those from the third world, but with the understanding that the purpose of such international education is for the fellow to return to the country of origin and improve the health care delivery there, not to improve the personal finances of the fellow in an adopted country. The autocratic dogmatic certification by the decreed blessing of the department chair must give way to objective examination by impartial boards. There are too many differences now to establish an international certifying process, but everyone must encourage and work toward common professional, educational, political, national, and economic goals so that eventually such certifying might be possible. Dialogue between boards in the United States and analogous bodies in other countries (such as colleges of surgeons) to nurture the definition of necessary core knowledge, standardize examination design and technique, and eventually develop reciprocity for requirements to take examinations should also be encouraged.

Certification↗
PubMed1990

Financing health care for persons with HIV infection: guidelines for state action.

Financing health care for persons with HIV infection is an increasing burden on states and their taxpayers. The major problems of state policy in the 1990s are how to organize and finance both early detection of infection and preventive drug treatment for persons without symptoms and how to provide a full range of health and social services for infected persons whose life expectancy is unknown. This article first describes the shift in the perceptions of HIV infection from a plague to a chronic disease and the implications of this shift for state government. Then it places the history of financing for health care in the context of general health care financing policy during the past decade. Next it describes the history of state action to finance care for HIV infection, especially the use of of Medicaid Waivers, problems of state financing for expensive prescription drugs, and state initiatives, especially in California, Michigan, New Jersey and New York. Finally, the article presents seven policy questions that states should consider in deciding what, if any, legislation or regulations to enact in order to organize treatment and pay some or all of the costs of care for persons with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Making fair decisions about financing care for persons with AIDS.

An estimated 40 percent of the nation's 55,000 persons with acquired immunodeficiency syndrome (AIDS) have received care under the Medicaid Program, which is administered by the Health Care Financing Administration (HCFA) and funded jointly by the Federal Government and the States. In fiscal year 1988, Medicaid will spend between $700 and $750 million for AIDS care and treatment. Medicaid spending on AIDS is likely to reach $2.4 billion by fiscal year 1992, an estimate that does not include costs of treatment with zidovudine (AZT). Four policy principles are proposed for meeting this new cost burden in a way that is fair, responsive, efficient, and in harmony with our current joint public-private system of health care financing. The four guidelines are to (a) treat AIDS as any other serious disease, without the creation of a disease-specific entitlement program; (b) bring AIDS treatment financing into the mainstream of the health care financing system, making it a shared responsibility and promoting initiatives such as high-risk insurance pools: (c) give States the flexibility to meet local needs, including Medicaid home care and community-based care services waivers; (d) encourage health care professionals to meet their obligation to care for AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1976

The measurement of expenditures for outpatient physician and dental services: methodological findings from the health insurance study.

Survey data measuring outpatient health expenditure are evaluated for item nonresponse, measurement error, and bias. Item nonresponse is high for persons whose health care is financed through the public sector, but is otherwise manageable. Estimates of mean total and out-of-pocket physician and dental expenditure from two surveys using indirect methods (including the Health Insurance Study) are compared with nonsurvey estimates. Out-of-pocket physician expenditure is overestimated, but the other measures appear unbiased. Estimates using direct, self-administrated methods appear biased upward. We demonstrate that commonly used record check methods for evaluating survey data will make random error appear as bias, and a methodology we develop shows substantial random error in the measurement of dental expenditure: 44 per cent of the total variance in survey data and 39 per cent of the variance in records.

Ambulatory Care↗
PubMedDate not supplied

Financial and time costs to parents of severely disabled children.

This paper considers the financial burden of parents caring for severely disabled children. A model to predict parents' out-of-pocket expenses and caregiving time demands is described. Discriminant analysis correctly classified high and low group membership for out-of-pocket expenses and caregiving time at 72 percent and 77 percent, respectively. Expected rates were 50 percent. Time spent caregiving was the best predictor for out-of-pocket expenses, and out-of-pocket expenses was the best predictor of caregiving time. A need-based approach for the distribution of resources that recognizes and adjusts for caregiving time and out-of-pocket costs is recommended.

Adolescent↗
PubMed1990

Costs of community care for disabled elderly persons: the policy implications.

This paper presents results from our analysis of the National Long-Term Care Channeling Demonstration Project data. We used this data to estimate the costs of community-based long-term care services for disabled elderly persons. Our results indicate that both costs per community day and the likelihood that any costs would be incurred, would increase noticeably if a program similar to the Channeling project were implemented nationally. To illustrate the effects of disability-based eligibility criteria on total program costs, we present unit costs in conjunction with numbers of persons having different levels of ADL dependency.

Activities of Daily Living↗