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At least 19 recordsLinked to original sources
PubMed1985

Factors associated with the elderly falling in intermediate care facilities.

In intermediate care facilities, the records of 41 patients who had fallen and 36 controls were reviewed retrospectively, and the two groups compared for demographics, diagnoses, blood pressures over the prior two months, and prescribed medication. Seven of the sample had a recent weight loss recorded; all seven were in the group that fell. The mean number of medications prescribed for the group of fallers was significantly greater than the mean prescribed for the control group. The mean number of medication changes during the two weeks prior to the fall was significantly greater than the mean number of medication changes during the two weeks prior to data collection for the control group. Our data suggest that caution should be exercised in multiple drug prescribing for patients in intermediate care facilities and that recent weight loss and medication changes may be risk factors for falling.

Accident Prevention↗
PubMed1997

[Record linkage of the elderly in the national surveys on the geriatric intermediate care facility].

Geriatric intermediate care facility, GICF, have been established since 1986 in Japan. The term of 'intermediate' denotes a facility midpoint between a hospital and home, with a powerful rehabilitation function. The annual governmental survey on GICF has been applied to all GICFs in Japan since 1989. This survey is a cross-sectional-type survey. For evaluating the role of GICF, we considered a type of cohort study using these surveys for four years by means of a record linkage method. This method is possible, because subjects of a survey for any year become subjects in the survey of the following year, if they have been in a GICF for more than one year. In this paper, for the purpose of preparing for a study of the role of GICF, we report some results about a record linkage for these surveys, and two continuing rates were calculated for these cohorts. Sources were personal records in 1989 to 1992 gathered by The National Survey on GICF in Japan. The record linkage method is as follows. We divided the annual personal records into several files by both the periods of the last admission and the survey year. Three cohorts, i.e. a cohort-89, a cohort-90 and a cohort-91 for persons for whom the first survey was 1989, 1990 and 1991, respectively are thus obtained. Next, we identified individuals from the annual files in each cohort. As personal names were not available, we identified individuals by sex, birth date, date of admission and facility number by the use of a personal computer and a FORTRAN program. Results were as follows. 1. Multiple matched persons were few (0.5% or less), and identification rates were 90% or more, despite the fact that basic linking variables were used. 2. Continuing rates were about 40% and decreased with new cohorts, while those of a fixed cohort were increased as length of stay increased. These reveal that recent admissions who stay continuously at a GICF were decreasing, but the longer the period for which the elderly stays at a GICF, the less possibility that he will be discharged. 3. Between record agreement rates for individuals over two years for unchangeable characteristics such as a place before admission which are expected to be 100% were about 80%. 4. A record linkage method appears to be useful for calculating continuing rates classified by any attribute.

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PubMed1992

[Factors facilitating the return of the elderly to their homes after discharge from a geriatric intermediate care facility].

Geriatric intermediate care facilities (GICFs) were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Contrary to the initial expectation, only half of users (the elderly) have returned home. In order to examine the factors influencing destination after discharge from GICFs, characteristics of the users of a GICF and their primary caregivers were analyzed in a rural community in Nagano. The users were grouped according to their discharge destinations (i.e. 1: home, 2: hospital, 3: nursing home and other GICFs) and compared with respect to the users' and caregivers' socio-demographic characteristics, the length of stay, the users' activities of daily living (ADL) and mental status, the type of place before admission and after discharge, and the caring capacity of the family (i.e. manpower, housing conditions, household economic level and social support). A multiple logistic regression analysis revealed that the following factors were correlated to their return home: good ADL, a short admission period, good level of health of caregivers, adequate space in the residence, negative perception of the caregivers regarding the costs of GICF, and economic level of the household. Evaluation of these factors at an early stage of admission to GICFs may enable prediction of whether or not a user can be successfully discharged to return home.

Aged↗
PubMed1988

Medicare/Medicaid programs; fire safety standards for hospitals, skilled nursing facilities, hospices, intermediate care facilities and ambulatory surgical centers--HCFA. Final rule.

This final rule amends the fire safety standards for hospitals, skilled nursing facilities, hospices, intermediate care facilities and ambulatory surgical centers. It incorporates by reference the 1985 edition, rather than the 1981 edition now required, of the Life Safety Code of the National Fire Protection Association. This change primarily affects new applicants to the program. The incorporation of the 1985 edition of the LSC is intended to ensure that patients, personnel, providers and the public have the benefit of the most current fire protection standards.

Accident Prevention↗
PubMed2001

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Medicaid program; modification of the Medicaid upper payment limit transition period for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Final rule.

This final rule modifies the Medicaid upper payment (UPL) limit provisions by establishing a new transition period for States that submitted plan amendments before March 13, 2001 that do not comply with the new UPLs effective on that date (but do comply with the prior UPLs) and were approved on or after January 22, 2001. This new transition period applies to payments for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services.

Ambulatory Care↗
PubMed1993

[Follow-up study of the elderly users of a geriatric intermediate care facility after discharge].

Geriatric intermediate care facilities (GICF) were started by subsidies from the Ministry of Health and Welfare in 1987 to promote the return of elderly from hospitals to their homes or nursing homes and to give support to the cared elderly and their families. This paper describes about the function of a GICF established in a rural community in Oita, Kyushu. One hundred seventy four elderly users (66 males, 108 females: mean age; 81 years old) who were discharged from the GIFC between July 1990 and June 1991 were studied. The main results were as follows: 1. The reason for admission to the GIFC of 174 elderly users were cerebrovascular disease in 50 cases, bone and/or joint diseases in 63, senile dementia in 25 and other diseases in 36.2. Eighty three persons (48%) needed continuous care. 3. The activities of daily living of approximately 37% of those who needed continuous care improved to some degree. 4. Ninety six users were discharged and went home, 43 were readmitted to a hospital, 32 were admitted to a nursing home, and 3 died at the GIFC. 5. The situation as of September 1991 was 70 persons (40%) at home, 12 persons in hospital, 33 persons in the GICF, 35 persons in nursing homes and 24 deaths. 6. Fifty two persons (37%) used the GICF more than twice. These findings suggested that the GICF enabled care for weak elderly persons at home.

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PubMedDate not supplied

Oral hygiene care levels in Iowa intermediate care facilities.

This study was undertaken to improve understanding of current oral hygiene care practices in intermediate care facilities. Questionnaires were sent to directors of nursing of all licensed intermediate care facilities in Iowa. Results show that an estimated 57% of residents needed direct oral hygiene assistance. In all intermediate care facilities, the majority of direct oral hygiene care was provided by aides. Oral hygiene care was often not provided at an optimal level, and the main reasons reported for this lack of care were uncooperative residents (82%), lack of perceived need by aides (68%), and inadequate time/personnel (49%). Development and promotion of oral hygiene care programs in intermediate care facilities must take into consideration the realities and problems involved. Otherwise, efforts to introduce or implement new or improved care programs will fail.

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PubMed1995

[Factors influencing users' destination upon discharge from a geriatric intermediate care facility in an urban area].

Geriatric Intermediate Care Facilities (GICF) have been established to help the hospitalized elderly return home. Users of the GICF are elderly persons who do not need hospitalization, but are mentally or physically impaired. To determine what factors influence users' destinations upon discharge from GICF, we analyzed various characteristics such as age, sex, place of residence before admission, length of stay, intellectual impairment, ability to perform activities of daily living (ADL) among users (N = 389) in a GICF in Chiba City. Multiple logistic regression analyses revealed that, compared with the users who were hospitalized, users who were male, admitted for home, stayed for long periods, and had a high ability to perform ADL were more likely to return home. The analyses also revealed that, compared with the users who were institutionalized, users who came from home, stayed for short periods, and had a high ability to perform ADL were more likely to return home. Evaluating a user's physical, mental, and socioeconomical conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended period.

Activities of Daily Living↗
PubMedDate not supplied

Factors associated with staff injuries in intermediate care facilities in British Columbia, Canada.

BACKGROUND: Large variations in staff injury rates across intermediate care facilities suggest that injuries may be driven by facility-specific work environment factors. OBJECTIVES: To identify work organization, psychosocial, and biomechanical factors associated with staff injuries in intermediate care facilities, to pinpoint management practices that may contribute to lower staff injuries, and to generate a provisional conceptual framework of work organization characteristics. METHODS: Four representative intermediate care facilities with high staff injury rates and four facilities with comparable low staff injury rates were selected from Workers' Compensation Board (WCB) databases. Methods included on-site injury data collection and review of associated WCB data, ergonomic study of workloads, a telephone survey of resident care staff, manager-staff interviews, and focus groups. Pearson product-moment correlation coefficients identified associations between variables. Analysis of variance and t tests were used to determine differences between low and high staff injury rate facilities. Content analysis guided the qualitative analysis. RESULTS: There were no significant differences between low and high staff injury rate facilities in terms of workers' characteristics, residents' characteristics, and per capita public funding. The ergonomic study supported the survey data in demonstrating a relation among low staffing levels, greater muscle loading, and greater risk of injury. As compared with facilities that had high staff injury rates, facilities with low staff injury rates had significantly more favorable staffing levels and supportive work environments. Perceived quality of care was strongly correlated with burnout, health, and satisfaction. CONCLUSIONS: Safer work environments are promoted by favorable staffing levels, convenient access to mechanical lifts, workers' perceptions of employer fairness, and management practices that support the caregiving role.

Allied Health Personnel↗
PubMed1980

Assessing the need for pharmacist-conducted drug regimen reviews in skilled nursing and intermediate care facilities.

Federal regulations operating since 1974 require monthly patient drug reviews by pharmacists in skilled nursing facilities (SNFs), but intermediate care facility (ICF) reviews are only required quarterly and can be done by nurses. Based on a few previous reports, the hypothesis of this research was that there is no difference in the need for pharmacist monitoring in SNFs, ICFs, and ICF-mentally retarded (ICF-MR). Stratified by level of care, 353 patients were randomly selected from 24,770 Medicaid recipients in nursing homes throughout Minnesota. Full Medicaid claims profiles were generated for 3 months of service. An interdisciplinary expert panel defined need with explicit criteria for several parallel measures including need for pharmacist monitoring, likelihood of formal chart comment, frequency of monitoring, time per visit, and rationality of therapy. Two judges, experts in drug monitoring, used the criteria to separately score the profiles with significant correlation in the two sets of scores (p < 0.001). Using analysis of variance on the several measures for need, there was no difference between SNFs and ICFs, but ICF-MRs were significantly lower in need scores. It is expected that the explicit monitoring criteria developed in this study will be useful to practitioners in their drug review activities.

Drug Utilization↗
PubMed1999

Clinical characteristics and service use of persons with mental illness living in an intermediate care facility.

OBJECTIVE: The study examined the characteristics of residents living in a 450-bed intermediate care facility for persons with severe mental illness in Illinois and sought to determine the factors predicting their utilization of mental health services. METHODS: Data on 100 randomly selected residents with a chart diagnosis of schizophrenia were collected using chart review and interviews. Data for 78 residents whose diagnosis of schizophrenia or schizoaffective disorder was confirmed using the Structured Clinical Interview for DSM-IV were included in the analyses. RESULTS: Fifty-three percent of the residents used facility-based specialty mental health services beyond medication management, such as group therapy or a day program. Persons with the least severe psychiatric illnesses and with higher levels of motivation for overall care used the most mental health services. Thirty-five percent of the residents had been discharged to an inpatient psychiatric unit during the previous year. Residents most likely to be discharged to those settings were young men with a history of homelessness who refused facility-based health services. CONCLUSIONS: Despite recent policy-driven efforts to improve care in this intermediate care facility for persons with mental illness, the facility continues to have problems addressing the mental health needs of the residents.

Adult↗
PubMed2001

[Study of methicillin-resistant Staphylococcus aureus colonization among intermediate-care facility patients].

PURPOSE: Prevalence of methicillin-resistant Staphylococcus aureus is high in the Poitiers teaching hospital, particularly in the intermediate care facilities. We performed a survey of methicillin-resistant Staphylococcus aureus colonization in the intermediate care facilities and 265 patients were included. METHODS: Nasal, cutaneous and wound swab cultures were done at the time of admission and at the time of the patients' departure. A decolonization procedure of methicillin-resistant Staphylococcus aureus carriers was performed using nasal application of fusidic acid and different soaps for the skin. At entry, 17.7% of patients were methicillin-resistant Staphylococcus aureus carriers (of at least one location). At departure, 30.4% were methicillin-resistant Staphylococcus aureus carriers. Among methicillin-resistant Staphylococcus aureus non-carriers at entry, 24.3% became methicillin-resistant Staphylococcus aureus carriers. RESULTS: The principal risk factor of carriage was the initial presence of a wound (RR = 3.6). The incidence rate of methicillin-resistant Staphylococcus aureus infection among the 265 patients included was 3%. CONCLUSION: The systematic screening of patients at the time of admission is expensive and isolation technically hard to manage in the intermediate care facilities. The risk factor we found in this study allow us to propose a 'light' screening limited to patients with wounds.

Aged↗
PubMed2005

One-year follow-up of persons discharged from a locked intermediate care facility.

OBJECTIVES: This study examined outcomes during a one-year follow-up for persons who were discharged from a locked intermediate care facility in an urban area in California. The purpose of this study was to determine the extent to which persons with severe mental illness can be successfully transferred from an intermediate care facility to lower levels of care. METHODS: A total of 101 persons consecutively discharged were studied by record review and by obtaining information from facility staff members, therapists, case managers, and other community caretakers. RESULTS: During the follow-up period 56 percent of the patients who were discharged from the intermediate care facility were not able to demonstrate even minimal functioning in the community. These persons spent 90 or more days in locked or highly structured institutions that provided 24-hour care (including jail) or had five or more acute hospitalizations. However, 44 percent spent less than 90 days in these institutions and had fewer than five acute hospitalizations. Thirty-three percent were not known to have spent any time in an institution or hospital. CONCLUSIONS: The high rate of recidivism shown in this cohort suggests that the current emphasis on transferring patients from more structured, intermediate inpatient services to lower levels of care is not effective for a majority of patients. Furthermore, the poor clinical outcomes found in this cohort did not seem to be offset by any reduction in overall governmental costs because of the high use of acute and intermediate hospitalization and the costs of the criminal justice system.

Adult↗
PubMed1998

The role of geriatric intermediate care facilities in long-term care for the elderly in Japan.

Geriatric intermediate care facilities (GICFs) were first established in 1987 to help the hospitalized elderly return home within 3 months. Users of the GICFs are the elders who do not require hospitalization, but are mentally or physically impaired. Rather than providing unnecessary medical services, GICFs emphasize nursing care and rehabilitation so that users can carry out their daily tasks independently. Due to the limited supply of institutional and in-home services for the elderly in long-term care systems in Japan, only half of the discharged users were able to return home and a quarter stayed at GICFs for over 1 year, contrary to the initial purpose. This suggests that in addition to serving as an intermediate facility between institutions and private homes, GICFs should enlarge their role of home care supporting facilities in ways that would enable them to provide frail elderly patients at home with respite care and daycare services.

Aged↗
PubMed2000

Quality of life of persons with severe mental illness living in an intermediate care facility.

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Adult↗
PubMed1999

[Characteristics of the clients in a geriatric intermediate care facility located in the suburbs of an urban area and factors related to the discharge destinations desired by family caregivers].

Among the clients in a geriatric intermediate care facility located in the suburbs of Osaka and their family caregivers (72 subjects), the characteristics of the clients and their caregivers, and the discharge destination desired by their family caregivers were investigated, and the associated factors were evaluated. 1. Characteristics of the clients. The clients were elderly females with a low degree of independence, and dementia was observed in about 60% of them. The clients had a relatively large number of children, but many of them lived alone before admission. The rate of admission from hospitals was high (54%), and that of discharge to hospitals was also high (50%). Sixty-seven percent of the clients stayed for a long duration of over 6 months. 2. Conditions of the family caregivers. Most of the family caregivers were daughters or daughters-in-law, and considered themselves to be healthy. Sixty-three percent of the caregivers had jobs. However, most of the caregivers did not have sub-caregiver. 3. Factors related to the discharge destination desired by family caregivers. Not many family caregivers (19.4%) wanted them to go back to their homes after discharge, but their preferred discharge destinations were home (19.4%), hospitals (55.5%), and nursing homes (25.1%). The caregivers of single household clients often desired a nursing home as the discharge destination, and those of the clients from a 2- or 3-generation household often desired a hospital. The factors related to the discharge destination desired by client's family caregivers were that the client not show dementia, the job of the caregiver was a part-time job, there was a sub-caregiver, and the client had the experience of home public health nursing visits. This study showed, the percentage of the clients discharged from the geriatric intermediate care facility to their homes was low, and that of the family caregivers who desired their home as the discharge destination was also low. However, the results suggested that leading the discharge destination to the client's home is possible if social resources are provided such as the use of public health nursing services.

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