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Supportive care for older people with dementia: socio-organisational implications
- Authors:
- MIELE Francesco, et al
- Journal article citation:
- Ageing and Society, 42(2), 2022, pp.376-408.
- Publisher:
- Cambridge University Press
For many years, dementia care has been dominated by the standard medical approach, in which dementia is treated mainly with drugs, such as anti-anxiety, antidepressant and anti-psychotic medications. With the aim of seeking effective treatments for patients with dementia, over the last years, several contributions have criticised the pervasive use of drugs for the management of behavioural and physiological symptoms related to dementia, proposing personalised interventions aimed at supporting patients and their relatives from diagnosis until death. With particular reference to long-term settings, this work is aimed at understanding the organisational implications of three types of interventions (labelled supportive care interventions - SCIs) that have characterised this shift in dementia care: person-centred, palliative and multi-disciplinary care. Conducted by following the integrative review method, this review underlines how SCIs have controversial consequences on the quality of care, the care-givers’ quality of life and cultural backgrounds. After an in-depth analysis of selected papers, this paper offers some considerations about the implications of SCIs for long-term care organisations and future research directions. (Edited publisher abstract)
A multidisciplinary, community-based program to reduce unplanned hospital admissions
- Authors:
- WAN Ching Shan, MITCHELL Jade, MAIER Andrea B.
- Journal article citation:
- Journal of the American Medical Directors Association, 22(6), 2021, pp.1331.E1-1331.E9.
- Publisher:
- Elsevier (for the American Medical Directors Association)
Objectives: To evaluate the effect of Hospital Admission Risk Program (HARP) on unplanned hospitalization, bed days, and mortality of enrolled individuals and to evaluate the cost-effectiveness of HARP. Design: A retrospective longitudinal analysis of hospital administrative data. Intervention: Individuals at risk of hospitalization were provided with multidisciplinary, community-based care support managed by care coordinators including integrated care planning, education, monitoring, service linkages, and general practitioner liaison over 6-9 months. Setting and Participants: Individuals who were enrolled into 1 of 8 HARP chronic disease management programs between July 1, 2017, and June 30, 2018, at the Royal Melbourne Hospital, Australia. Methods: Hospital admissions between 18 months before and 18 months after HARP enrollment were analyzed. Total hospital costs were compared between 18 months before and 12 months after HARP enrollment. Results: A total of 1553 individuals with a median age of 71 years (interquartile range 60-81), 63.4% males, were admitted to HARP. Both unplanned hospitalizations and bed days were reduced during the HARP intervention compared to within 3 months before enrollment in each of the HARP management programs. After the HARP intervention, cardiac coach, cardiac heart failure, chronic respiratory, diabetes comanagement, and medication management programs had higher hospitalizations and bed days than individuals’ baseline of at least 3 months before HARP enrollment. Individuals in cardiac heart failure and chronic respiratory management programs had a higher mortality rate than other HARP chronic disease management programs. Individuals in cardiac coach, diabetes comanagement, and medication management programs had lower hospital costs during the HARP intervention compared to within 3 months before HARP enrollment. Conclusions and Implications: HARP reduced unplanned hospitalization and bed days but did not return individuals’ hospital use to baseline before the intervention. The variations in mortality between HARP chronic disease management programs implies that condition-specific goals between programs is preferable. (Edited publisher abstract)
Advancing the evidence base for social work in long-term care: the disconnect between practice and research
- Authors:
- SIMONS Kelsey, SHEPHERD Nancy, MUNN Jean
- Journal article citation:
- Social Work in Health Care, 47(4), 2008, pp.392-415.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This systematic review examines primarily North American literature on social work practice in long term care settings for older people: nursing homes; hospitals; home health care; and primary care. It also looks at the literature in terms of care mode: case or care management; Geriatric Evaluation and Management (GEM) teams; and Program of All-Inclusive Care of the Elderly (PACE). Particular efforts had been made to identify studies on GEM and PACE. The evidence supports the efficacy of social work services in these interdisciplinary models of intervention and in the context of community-based case management. However, there is less robust evidence on the value of social work within nursing homes and hospitals. The implications for social work practice in nursing homes are discussed.
Japan's search for a seamless care package: is the micro-multifunctional community facility providing total care for older people the answer? And would it meet the needs of an ageing population in the UK?
- Author:
- HAYASHI Mayumi
- Publisher:
- Housing Learning and Improvement Network
- Publication year:
- 2014
- Pagination:
- 7
- Place of publication:
- London
This case study takes a detailed look at the challenge of meeting the unprecedented demand for long-term healthcare and social care for Japan’s ageing population. It offers some fresh insights into recent and current measures taken, particularly the micro-multifunctional community facility for a total care package with some appreciation of both the impact and remaining challenges in this field. The micro-multifunctional facility model aims to provide core day care provision, planned and emergency day/overnight respite care, regular and on-demand health care, personal care and domestic support. Each facility caters for a maximum of 25 registered, eligible older people with various levels of assessed need still living at home in the local community. The paper argues that more evaluative evidence from the Japanese experience is required to determine whether similar models for total care packages would work in the UK. However, it notes that they could represent an answer to the increasing demand for home care and extra care provision. (Edited publisher abstract)
Paradoxes in the care of older people in the community: walking a tightrope
- Authors:
- JANSSEN Bienke, ABMA Tineke A., van REGENMORTEL Tine
- Journal article citation:
- Ethics and Social Welfare, 8(1), 2014, pp.39-56.
- Publisher:
- Taylor and Francis
- Place of publication:
- Abingdon
The expansion of the older population suggests that there will be significant numbers in need of care and support in their own home environment. Yet, little is known about the kind of situations professionals are faced with and how they intervene in the living environment of older people. Qualitative data were collected over a period of 1.5 years from a multi-disciplinary community-based geriatric team in the Netherlands, and participant observations carried out. Forty-two cases discussed within the team meetings were analysed. Results demonstrate that providing care to older people is a dynamic process and revolves around various paradoxes as experienced by professionals. This is illustrated by presenting three paradoxes that emerged within the data: respecting autonomy versus preserving safety; the care needs of the care recipients versus the capacity of their informal carers to cope; and holding a formal orientation versus a tailored orientation on tasks. Providing care in the home environment of older people requires from professionals a continuous anticipation of (un)expected evolutions in situations of their care recipients. In order to optimally support older people professionals need ‘professional discretion’. They must be supported to systematically reflect on and legitimize their intervention strategies. (Publisher abstract)
Team performance and risk-adjusted health outcomes in the program of all-inclusive care for the elderly (PACE)
- Authors:
- MUKAMEL Dana B., et al
- Journal article citation:
- Gerontologist, 46(2), April 2006, pp.227-237.
- Publisher:
- Oxford University Press
The Program of All-Inclusive Care for the Elderly (PACE) is a community-based program providing primary, acute, and long-term care to frail elderly individuals in the United States. A central component of the PACE model is the interdisciplinary care team, which includes both professionals and non-professionals. This study examined the association between the team's overall performance and the risk-adjusted health outcomes of program enrolees. The study included interdisciplinary teams in 26 PACE programs and 3,401 individuals enrolled in them. The researchers combined information about individuals' health, functional, and mental status from DataPACE with an overall measure of team performance. Multivariate regression techniques were used to test the hypothesis that better team performance is associated with better risk-adjusted health outcomes: survival and short-term (within 3 months of enrolment) and long-term (within 12 months of enrolment) improvements in functional status and in urinary incontinence. Results found that team performance was significantly associated with better functional outcomes (both short and long term) and with better long-term urinary incontinence outcomes. There was no significant association with survival. This study provides empirical evidence for the relationship between team performance and patient outcomes in long-term care. It suggests that PACE programs can improve patient outcomes by improving the functioning of care teams.
Family caregivers, health care professionals, and policy makers: the diverse cultures of long-term care
- Author:
- LEVINE Carol
- Journal article citation:
- Journal of Social Work in Long-Term Care, 2(1/2), 2003, pp.111-123.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Although families and health care professionals have similar goals for the health and well-being of a patient or client, they approach care, especially long-term care, with different assumptions, values, attitudes, and behaviors. Using the popular understanding of the term, they have different “cultures.” Professionals are also subject to societal and cultural influences beyond their own disciplines. In the evolving health care economy professional values have been forced to adapt to the demands of the marketplace in health care, which is governed by a corporate or bureaucratic culture. Social work's tradition of concern for the whole family and for justice in society make this discipline well suited to advocate for policies and practices that bridge these gaps.
Tele-medicine and the reduction of psychiatric admissions for dementia patients - social work as the core discipline
- Authors:
- ROQUES Carmel, HOVANEC Linda
- Journal article citation:
- Journal of Social Work in Long-Term Care, 1(1), 2002, pp.35-41.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Persons with dementia when transferred between care settings are at risk for their condition to deteriorate. Maintaining continuity across the continuum of care is essential for the well being of these individuals. To enhance the continuity of care for hospitalised for psychiatric symptoms, Copper Ridge and Johns Hopkins Hospital developed a Tele-medicine programme to link clinical teams at each facility. Positive findings after one year include a reduction in the number of hospital stays, a reduction in the length of hospital stays, and improved care planning. Tele-mdeicine programme was under the leadership of the social work staff.
Decision-making and moving into long-term care
- Authors:
- HUGHES Mark, MAYES Deborah, LE RICHE Pat
- Journal article citation:
- Generations Review, 11(2), June 2001, pp.10-12.
- Publisher:
- British Society of Gerontology
One of the important outcomes from the Royal Commission on Long Term Care will be the increase in rehabilitation offered to older people thorough the development of intermediate care services. This research looks individuals opportunities to participate in the assessment and care planning process, and the role played by multi-disciplinary panels, composed of health and social services, in agreeing care managers' placement recommendations. The research was funded by the London Borough of Greenwich in a commitment to evidence-based practice.
The case of developing collaborative purchasing and provision at the locality level
- Author:
- WADDINGTON Paul
- Journal article citation:
- Community Care Management and Planning, 4(6), December 1996, pp.203-210.
- Publisher:
- Pavillion
The implementation of care in the community and controversy aroused subsequently by the Continuing Care debate have stimulated the development of joint commissioning between Health Authorities (HAs) and Social Service Departments (SSDs). Examples of collaboration at inter-authority strategic level have become relatively commonplace. Discusses the issues surrounding the development of joint purchasing and provision and forecasts potential directions this may take in relation to the political climate.