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At least 19 recordsLinked to original sources
PubMed1995

Continuing care retirement communities: prospects for reducing institutional long-term care.

Continuing care retirement communities (CCRCs) combine housing and long-term care (LTC) services, including personal and nursing home care. The amount of LTC that is prepaid varies by type of CCRC, with one-third offering extensive (fully prepaid) contracts for LTC. CCRCs are a potentially promising model for LTC delivery because they offer a full continuum of services and can substitute less expensive supportive care for institutional care. Using data on CCRCs, we tested one central hypothesis: Provision of supportive services, particularly when combined with capitation, reduces use of nursing home care. To test this hypothesis, we studied the effect of various contract types for LTC services offered by CCRCs and provision of support services on utilization of nursing home and personal care units. Compared with other types of CCRCs, those offering completely prepaid LTC coverage reduced use of nursing home care by 13 percent and personal care by 5 percent. CCRCs with prepaid LTC coverage did not use more stringent health screening at entry, so "cream-skimming" does not appear to explain this result. However, affordability is an important issue: CCRC residents with extensive contracts were wealthier than were other CCRC residents.

Aged↗
PubMed1978

Extension of emergency medical care: continuing emergency care clinic.

An alternative follow-up system, a Continuing Emergency Care clinic (CEC) was developed at The Medical College of Pennsylvania in an attempt to increase emergency department patient compliance for follow-up. One year after the CEC was in operation, in an attempt to determine variables influencing the effectiveness of the clinic, a total of 375 emergency department patients given follow-up appointments to the CEC were studied. Results showed that a change in the structure of the clinic appointment and a shift in the line of responsibility for follow-up care directly to the emergency physician are two major variables positively affecting patient compliance.

Adolescent↗
PubMed1991

Special report. Integrating managed care. Continuity of care: integrating the components.

Although illnesses may attack specific parts of the body, treating anything less than the whole man can lead to serious problems. Catastrophic illnesses, for example, are often accompanied by depression. Employees being treated for alcohol or substance abuse may also be suffering from psychiatric disorders. Irrespective of which came first, the alcoholism or the depression, the conditions are intertwined. And their treatments need to complement one another. As companies contract with increasing numbers of specialty providers in an attempt to manage health care costs and utilization, communication among vendors can break down. Treatments may be repeated. Therapies can contradict one another. Employees sometimes fall through the cracks. What's needed is care that is comprehensive and continuous. The following series of stories examines the positive changes that may accrue when managed care techniques are applied in a synoptic fashion.

Continuity of Patient Care↗
PubMed1989

Patterns of nursing home use in a prepaid managed care system: the continuing care retirement community.

The use of nursing home services among 3,316 residents of six continuing care retirement communities (CCRCs) was compared with that of the general elderly population. CCRC residents have a greater lifetime risk of nursing home entry and repeat entries. CCRC resident's length of stay per admission, however, is shorter. Findings from this comparative analysis provided insight into nursing home use in an insured and managed long term care program for a closed population.

Aged↗
PubMed1993

Resident medical care utilization patterns in continuing care retirement communities.

This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts: one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533).

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PubMedDate not supplied

Bankruptcy risk and state regulation of continuing care retirement communities.

Continuing care retirement communities (CCRCs) often require substantial financial investment from residents, prompting concern about potential losses to residents in the event of a CCRC's bankruptcy. State governments have responded to this concern with varying levels of regulation. Overall, CCRC bankruptcy rates are very low (.3% per year). We found that measures of varying regulation stringency had no effect on indicators of CCRCs' financial performance relating to bankruptcy risk. CCRCs that offer extensive contracts, including unlimited long-term care in addition to housing, have less positive indicators of financial strength than other types of CCRCs. When measured by traditional health care industry standards of financial strength, CCRCs appear less profitable than other types of health care facilities. This raises the question of whether CCRCs can continue to attract the needed capital from private markets and because of that, suggests that their future growth may be limited.

Bankruptcy↗
PubMed1992

Self-reported functional status predicts change in level of care in independent living residents of a continuing care retirement community.

OBJECTIVE: To test the hypothesis that self-reported functional status predicts change in level of care from independent to dependent in residents of a continuing care retirement community (CCRC). DESIGN: Two-year longitudinal descriptive study of change in level of care and survival. SUBJECTS: One hundred fifty-two residents in the independent-living unit of a non-profit CCRC. Mean age at initial evaluation was 82.3 years, SD 6.2. MEASUREMENT: Predictor variables assessed at baseline were age, sex, physician estimate of functionally significant disease, self-reported functional status, and performance-based hand function. Criterion variables collected at 2-year follow-up were level of care (independent/dependent) and survival (alive/dead). MAIN RESULTS: Self-reported functional status (P less than 0.01) and age (P less than 0.05) were significant predictors of change in level of care in a logistic regression analysis containing all predictor variables. No variable predicted survival. CONCLUSIONS: Self-reported functional status may help to predict dependency in older adults in good health who have few markers of dependency risk.

Activities of Daily Living↗
PubMed1998

Credit analysis of nonprofit continuing care retirement communities.

The continuing care retirement community (CCRC) industry's growth has gained the attention of the financial community. As the industry's financial and regulatory environments change, credit analysts are developing analytical tools to evaluate these changes. The following article discusses some of these tools, provides a sample credit profile of a CCRC, and reviews recent accounting changes that will affect CCRC credit analysis.

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PubMed1998

Continuing care: developing a policy analysis for nursing.

Continuing care: developing a policy analysis for nursing Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing specialty, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action.

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