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Distribution and utilization of home- and community-based long-term care services for the elderly in North Carolina
- Authors:
- GOINS R. Turner, HOBBS Gerry
- Journal article citation:
- Journal of Aging and Social Policy, 12(3), 2001, pp.23-42.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Provision of home- and community-based long-term care is a growing concern in the USA. As more persons grow old, the need for these services is expected to rise. Presented in this article the analysis examines the distribution and utilisation of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilisation among the elderly. Great variability was found in number of elderly utilising the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilised the programs. Multivariate modeling for associations to service utilisation was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilisation. Percent of persons 85 years or older and the ratio of institutionalised long-term care beds were negatively associated with utilisation. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.
Guardianship capacity evaluations of older adults: comparing current practice to legal standards in two States
- Authors:
- DUDLEY Kenneth C., GOINS R. Turner
- Journal article citation:
- Journal of Aging and Social Policy, 15(1), 2003, pp.97-115.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
This American study examined the evaluations of capacity of alleged incapacitated persons (AIPs) between two states and compared the thoroughness of the evaluations to state law. These evaluations are frequently the only source of information on cognitive and psychiatric symptoms, functional abilities, and current treatments. One hundred nineteen evaluations of capacity were reviewed using the Guardianship Evaluation Review Instrument. Findings indicated that states differed on the AIP's age, presence at the court hearing, and description of current treatments. Overall, data suggested that evaluation thoroughness was substandard. In over 75% of cases, full guardianship was granted. Issues on terminology, concern regarding evaluators and courts, and ways for evaluators and the court to fulfill their responsibilities to older adults are discussed. (Copies of this article are available from: Haworth Document Delivery Centre Haworth Press Inc., 10 Alice Street Binghamton, NY 13904-1580)
Telemedicine, rural elderly, and policy issues
- Authors:
- GOINS R. Turner, KATEGILE Upendo, DUDLEY Kenneth C.
- Journal article citation:
- Journal of Aging and Social Policy, 13(4), 2002, pp.53-72.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Rural health care is often faced with a shortage of health care specialists, facilities with inferior equipment, and insufficient resources compared to health care in more urban areas. It is anticipated that the use of telemedicine will help address many of the problems facing the deliveryof health care services to rural elderly. This paper reviews some innovative projects delivering services to the elderly. Also, the paper discusses several issues that need to be addressed before telemedicine can reach its full potential in improvingaccess to health care, including reimbursement policies, patient and provider liability and confidentiality, and the infrastructure supporting telemedicine. Although telecommunicationshas tremendous potential to address the care needs of frail isolated elderly, without comprehensive reimbursement policies, guidelines for ethical conduct of a teleconsultation, acceptable security measures of patient records, and adequate as well as compatible infrastructure, that potential cannot becompletely realised.