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The relevance of Marjory Warren’s writings today
- Authors:
- ST. JOHN Philip D., HOGAN David B.
- Journal article citation:
- Gerontologist, 54(1), 2014, pp.21-29.
- Publisher:
- Oxford University Press
Marjory Warren was one of the initial geriatricians in the United Kingdom. She established specialised geriatric units, held important administrative positions, and wrote influential papers where she argued for the need of the specialty of geriatric medicine and outlined principles for inpatient care of older adults with chronic illness. The authors compare and contrast Warren’s early papers describing these principles with contemporary models for improving inpatient care of older adults and the need for the specialty of geriatrics. Warren’s writings on the inpatient care of older adults presage the principles of both Hospital Elder Life Programs and Acute Care of the Elderly units. The importance of multidisciplinary teams, the physical environment, attention to diverse issues (medical, social, functional), early ambulation, and the active involvement of the older person in their daily routine are present in Warren’s writings and in contemporary approaches. Warren’s arguments for both the specialty of geriatric medicine and increased training of nonspecialist physicians and other health professionals are remarkably similar to those made in a recent Institute of Medicine report. Across time and place, there has been consistency in the general principles perceived as required for the effective cares of older persons, but challenges persist in implementing and sustaining them. (Publisher abstract)
Making a real difference
- Author:
- LEWIS Janet
- Journal article citation:
- Community Care, 24.6.99, 1999, p.8.
- Publisher:
- Reed Business Information
Argues that we need a model of continuing care that moves beyond existing, inadequate levels of provision and seriously addresses unmet need, and asks why the Royal Commission on Long-Term care was unable to provide it.
A conceptual model for the mobility patterns of nursing home admissions
- Authors:
- McAULEY William J., USITA Paula M.
- Journal article citation:
- Gerontologist, 38(6), December 1998, pp.726-734.
- Publisher:
- Oxford University Press
This article draws from the literature in long term care, demography and geography to develop an initial conceptual framework to explain variations in the patterns of nursing home moves in the USA. The conceptual framework is bolstered by preliminary data from state censuses of nursing homes that asked about the origins of current nursing home residents. The data suggest that a relatively high proportion of nursing home residents move to a different county in the process of moving to a nursing home. The research and applied implications of the framework are discussed.
A preference-based model of care: an integrative theoretical model of the role of preferences in person-centered care
- Authors:
- HAITSMA Kimberly Van, et al
- Journal article citation:
- Gerontologist, 60(3), 2020, pp.376-384.
- Publisher:
- Oxford University Press
Knowledge of individuals’ everyday preferences is a cornerstone of person-centered care (PCC). Initial evidence demonstrates the positive impact of honoring preferences in care for older adults receiving long-term services and supports (LTSS). Yet, the mechanisms through which preference-based care affects individual well-being remain poorly understood. This article proposes a theoretical model of PCC entitled the Preference-Based Model of Care that integrates the Theory of Human Motivation, Self-determination Theory, the Competence-Press Model of person and environment fit, the Living Systems Framework, and the Broaden-and-Build theory of positive emotions to deepen our understanding of the processes through which preference-based care affects well-being among older adults receiving LTSS. The Preference-Based Model of Care illustrates how goal-directed behaviors facilitate need fulfillment through the expression of individual preferences and how these behaviors mediate the relationship between person–environment fit and affect balance within a particular social, cultural, and political context. The Preference-Based Model of Care can advance research on PCC in LTSS and can inform LTSS clinical practice guidelines for older adults, regardless of functional or cognitive capacity. (Publisher abstract)
The U.S. long term care system: development and expansion occurring retirement communities as an innovative model for aging in place
- Authors:
- GUO Kristina L., CATILLO Richard J.
- Journal article citation:
- Ageing International, 37(2), June 2012, pp.210-227.
- Publisher:
- Springer
- Place of publication:
- New York
This paper describes the importance of naturally occurring retirement communities (NORCs) in the United States to promote the health and mental well being of older individuals through the collaborative efforts of formal and informal home and community based services and support. NORCs are considered a crucial model for aging in place since older adults prefer to remain in the comfort of their homes, and services can be provided in a much more efficient and cost effective manner. This paper examines the strengths, opportunities, and challenges of existing NORCs and discusses the need for the development and expansion of additional NORC programs as an innovative and viable solution for older adults aging in place.
Impairment and abuse of elderly by staff in long-term care in Michigan: evidence from structural equation modelling
- Authors:
- CONNER Tom, et al
- Journal article citation:
- Journal of Interpersonal Violence, 26(1), January 2011, pp.21-33.
- Publisher:
- Sage
A number of risk factors are known to be associated with elder abuse in long-term care. This study aimed to provide a model to place these risk factors in a causal structure that relates the factors to each other and to whether abuse occurs. Nine hypotheses focusing on cognitive impairment, physical impairment, behaviour problems, and age were generated regarding the susceptibility to abuse among the elderly in long-term care. In 2006, a random digit dial survey in Michigan was completed by 1,002 respondents who were knowledgeable relatives of, or adults responsible for, a person in long-term care. The survey measured the level of impairment of the person in long-term care, covering various health-related problems and the ability to do activities of daily living. The survey also asked about the incidence of staff abuse over the previous 12 months, including physical, caretaking, verbal, emotional, neglect, sexual and material abuse. The results were used in the construction of a structural equation model which corresponds to the 9 hypotheses and specifies the relationships between factors and from factors to susceptibility to abuse. In this model, susceptibility to abuse, physical impairment, and cognitive impairment are latent variables, and behaviour problems and age are directly measured. The article concludes by discussing the pattern of relationships between these risk factors for abuse.
Securing good care for older people: taking a long-term view
- Author:
- DAVIES Bleddyn
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
The paper aims to explain and evaluate two key features of Securing Good Care for Older People, the Wanless Report on alternative mechanisms for funding long-term care of older people. The first is the new elements of the methodology for evaluating the alternatives. The paper argues that more successfully than previously and analyses in other countries, these elements focus attention on what are really the core issues: the means and ends which are the unique foci of long-term care, and estimates of the consequences of alternatives for them. By doing so, the report faces the politicians and policy analysis and research communities with a formidable challenge, to master and contribute to the development of the new framework and evidence. Failure to meet the challenge will increases the risk that the policy system will reinforce rather than weaken causes of gross inequity and inefficiency caused by the under-funding of long-term care seemingly unanswerably demonstrated by the report. The second key feature is the type of funding model the Report recommends given expected changes in the balance between demands and public expenditure. It is argued that the report’s analysis as successfully transforms the state of the argument about this as much as about the framework, methodology and evidence for evaluating alternatives, demonstrating the relative weakness of models widely advocated a decade ago. Part 2 discusses how to build on the Report. It discusses the framing of issues and the analysis of evidence for each of the key foci of the report’s main contribution to evaluation methodology. Finally the paper discusses whether the recommended model would be the wisest choice given the environment likely during the next few decades.
Household composition and the dynamics of community-based social care in England
- Author:
- IPARRAGUIRRE Jose
- Journal article citation:
- Ageing and Society, 40(8), 2020, pp.1631-1646.
- Publisher:
- Cambridge University Press
Little is known about the dynamic relationship between the different funding sources of community-based social care in England. Using Waves 2–6 (2004–2013) of the English Longitudinal Study of Ageing survey, the author estimated dynamic multi-level cross-classified mixed-effects logistic regression models to investigate whether receiving services by one source is more or less likely if an older person was already receiving services funded by the same source or another in the previous period. Four hypotheses between formal privately and publicly funded help and informal help are tested: substitution, complementarity, compensation and task-specificity. The author also reports evidence that older people on low incomes residing in local authorities that reduce social care spending are especially affected. (Edited publisher abstract)
An international comparison of long-term care funding and outcomes: insights for the social care green paper
- Author:
- INCISIVE HEALTH
- Publisher:
- Incisive Health
- Publication year:
- 2018
- Pagination:
- 49
- Place of publication:
- London
This report, commissioned by Age UK, highlights different approaches to long-term care taken by five countries in the developed world, and looks at how they compare to the system in England. These five countries have very different systems, but face similar demographic and financial challenges to those in England. The countries are France, Germany, Spain, Italy and Japan. The report compares the approaches in relation to: service structures, funding levels, funding models, and outcomes. The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries. However, it finds that the financial deal for citizens with care needs is often more generous in other countries in comparison to England, with other nations generally either providing some non-means tested basic level of support, and/or cap the amount of co-payment to be made, and/or use a more gradual means-test. Profiles for each of the five countries are also included. (Edited publisher abstract)
No place like home?
- Author:
- TRIVEDI Shreshtha
- Journal article citation:
- Health Service Journal, 124(6393), 4 April 2014, p.28.
- Publisher:
- Emap Healthcare
US community based residential care provides a model that the English health and social care system ought to consider in the future. This article looks briefly at the work of Dr Bill Thomas who was founder of Eden Alternative and the Green House project, both innovative models of care that focused on de-institutionalising long term care and focusing on the emotional wellbeing of residents. Dr Thomas is now also collaborating with Evermore, a UK community based environment for older people where residents live in small households of 10-12 people. (Original abstract)