The extent of home health coverage under employer- sponsored health insurance plans is not well known. A 1998 –1999 study of commonly sold health maintenance organization and preferred provider organization prod- ucts in each state found that almost all plans covered home health services. However, 83% did not cover pri- vate-duty nursing, 45% did not cover home health aides, and more than one third did not cover home- based physical, occupational, or speech therapy. In this study, almost half of the plans imposed visit (typi- cally 60 visits) or monetary limits, and the most often used cap was $5000. Condition exclusions were also imposed in two thirds of plans, usually for impairments not caused by illness or injury and less often for devel- opmental disabilities and neurologic or mental health disorders. 10
participate in the study. They served as the liaison to facilitate the contact list of the users of the services who either choose the services or were referred by medical doctors. The research team (Principal Investigator and Co-investigators) contacted all subjects and screened them to determine their eligibility for the study. Those who met the inclusion criteria were invited to participate in the study and asked to sign the informed consent form. Families/users of home health care services who met the inclusion criteria were informed that data will be col- lected through self-administered questionnaire that measures their perception of quality of care provider by the home health care agencies. They were informed where to pick and return the package that included two forms; the demographic form and the Home Health Care CAHPS survey. The package also included a cover letter that includes information about the purpose of the study and what was expected from them and where to return the packages, and that the study is anonymous. In addition, the cover letter included contact information of the prin- cipal investigator and co-investigator for any further information and for answering the questions related to the study. The interested participants were asked to sign the cover letter in which a statement made at the end of the cover letter says explicitly that their participation in the study was voluntarily and their decision is of their own choice without any direct or indirect influence. Human participants’ right to confidentiality, privacy and safety were securely protected throughout the project. Files were kept in locked cabinets at the Jordanian Nursing Council. All projects’ electronic versions were kept only in the primary investigator’s computer. No names or any identifying information were used that may cause harm to participants at any stage of participation. An ap- proval from the Academic Research Committee at Philadelphia University was obtained prior to data collection at the beginning of the research project.
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However, deficiencies in the home health care deliv- ered to those living in ordinary housing are reported in many countries [9, 10]. Deficiencies have been attributed to fragmented home visits [11, 12], the staff’s lack of time [13–15], and visits that are too hasty . The care can focus on “doing,” where daily tasks are performed mechanically without regard to the person’s individual needs . People who are dependent on home health care are not always getting the help they need . Older people have to move to nursing homes because in their ordinary housing they lack a sense of security; fur- thermore, due to physical or cognitive impairment, they can have difficulty managing routine activities and keep- ing up with daily life . Their sense of insecurity may be relative to the time of day, with the greatest levels oc- curring in the evenings and nights. However, there is a lack of knowledge regarding this, as only a few national and international studies have focused on the evenings and nights, and most of these are from nursing homes . The challenges in nursing homes with older people with dementia and perceived sleep disturbances at night are exacerbated by insufficient staffing levels . Older persons often have to adapt to the staff’s working hours, which means they get up early, and those requiring the most assistance spend more than the average 11 h in bed at night and significantly more hours awake in bed .
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Pediatric home care involves the delivery of medical care in the home to children with serious and often complex medical conditions or with developmental disabilities. Some of these children depend on technological assistance for survival. The number of children who can benefit from home health services is steadily increasing as medical providers and parents express concerns about significant gaps in existing services. To advocate for continued improvements in pediatric home care, the AAP has developed the following set of recommendations pertaining to regulatory oversight, care delivery systems and payment, and further research. Implementation of these recommendations is critical so that children and families will have enhanced access to high-quality medically necessary services and all
Similarly, a home infusion service provider is defined as an organization that continues or completes a patient’s parenteral medication in the home or at an alternate site after the patient is released from a hospital. In the 70s, the health care system had dramatically changed as ill patients started moving out of hospital to their home to lower costs and improve health outcomes. According to Shang et. al (2014), in the United States, more than $72.2 billion was spent on Home Health Care (HHC) during 2009 alone and approximately 12 million Americans, older than age 65 years, received care from more than 33,000 home health care providers. The demand for HHC is expected to increase as the population continues to age, with an estimate that 20% of Americans will be older than age 65 years in 2030. While health centers provide primary and comprehensive healthcare to more than 17.1 million people. Together, uninsured and
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An important quality of care metric in home health is continuity of care. With continuity of care, patients are always seen by the same care-giver, resulting in saved time and effort associated with familiarizing new care-givers with patients’ histories and care plans, as well as fostering close relationships and trust between patients and their care givers. Continuity also has other benefits. In the meta-analysis by Cabana & Jee (2004) in a general health-care setting, the authors found that continuity of care over time resulted in reduced hospitalizations, improved patient satisfaction and improved receipt of preventive services such as mammograms and MMR vaccinations. One challenge that maintaining high levels of continuity of care presents to agencies is that once a care-giver (henceforth referred to as a nurse) is assigned to a patient, that assignment should remain fixed for the remainder of the care period. With periods of care typically lasting 2-3 months, this means that the scheduling decisions made by an agency have a long-term impact on their daily costs. However, agencies rarely consider this long-term impact when making scheduling decisions and research related to the scheduling problem faced by home health care agencies rarely considers planning horizons longer than one week.
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home health care. The study was approved by the Canton’s human research ethics committee in June 2014 (CCVEM 020/14). Participation in the study was voluntary; home- dwelling older adults in declining health who were asked to participate were under no obligation to do so. Older patients with a medical prescription for home health care, independent of their degree of physical or cognitive impairment, were eligible to participate if they met the following criteria: 1) aged 65 years or above; 2) had received at least 3 months of home health care without interruption during the length of the IWSS trial; 3) independent despite their degree of physical and cognitive impairment; and 4) capable of understanding and answering questions in French. The exclusion criteria were: 1) they were at the end of life; 2) they had received lesser than 3 months of home health care in one go; and 3) they were incapable of answering questions in French (language barrier).
99374 Physician supervision of a patient under care of home health agency (patient not present) in home, domiciliary or equivalent environment (eg, Alzheimer’s facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with other health care professionals involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15–29 minutes.
The aging population is growing at a rapid pace and expected to reach over 1.6 billion by 2050 (He, Goodkind, & Kowal, 2016). Depression is less prevalent among the aging population when compared to the younger adult population; however, depressed elderly adults are more likely to commit suicide than depressed younger adults (Djernes, 2006; Venkatachalem et al., 2018; Fiske, Wetherell & Gatz, 2009). Nearly 5% of adults age 50 or older reported major depressive episode in 2016 (National Institute of Mental Health, 2017). Depression is more prevalent in elderly women than elderly men; however, this could be due to men being less willing to reveal symptoms of depression to health care providers (Venkatachalem et al., 2018). Geriatric depression can be caused by a combination of biological, social, and psychological factors such as worsening cognitive function, disease comorbidities, lack of social interaction, and physical functioning decline due to age or illness (Venkatachalem et al., 2018).
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’Directly observed therapy’ (DOT) is one component of a wider WHO strategy called ’Directly Observed Therapy Short course’ (DOTS). This strategy incorporates wide ranging health sys- tem improvements, political commitment to improving TB pro- grammes, improved TB laboratory services, free TB drugs for all TB patients, and accurate documentation and monitoring of TB diagnosis and treatment outcomes (WHO 2002). The DOT com- ponent is an attempt to improve adherence by active monitoring and recording of the consumption of each and every drug dose by an ’observer’ acceptable to the patient and the health system (Hopewell 2006). This approach was first adopted in studies in Madras, India and Hong Kong as early as the 1960s (Bayer 1995), and is now considered a core component of TB programmes by the WHO to ensure cure and prevent the emergence of drug re- sistance (Chien 2013; Hirpa 2013). Proponents of DOT argue that the close monitoring has a social effect and acts as a peer pres- sure which leads to behavior change towards improved adherence (Macq 2003) and it has strong proponents (Chaulk 1998; Frieden 2007). However, to opponents it has been seen as a coercive model which leaves the patient as a passive recipient of therapy thereby eroding the gains made in involving patients in management of their own health (Zwarenstein 1998 ZAF).
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Home Office, NHS England, Serco and G4S. Serco offers G4S a standing invitation to its resident forums, while G4S gives Serco relevant information from its own patient forums. Both commissioners and contractors told us that these joint platforms provided useful opportunities to address issues at a senior level. However, our conversations revealed there are still concerns about the working relationships between front-line Serco officers and healthcare staff, which can create tensions. Staff gave us examples of behaviour that was viewed as divisive and not conducive to joint working. This included an unwillingness to participate in research if orchestrated or managed by the other contractor.
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Health care organizations are willing to inno- vate on the application of assistive technology. The appliance of technology is seen as one of the solutions to meet the strong growing need of health care, combined with a decrease of health care professionals. The organizations struggle about the most successful implemen- tation strategy. On the other hand, health care professionals seem not that eager to accept those technologies. We need more practice based knowledge and spread the word, how to implement technology in health care? In this paper the influence of privacy, trust and power on the willingness of care employees to adopt camera surveillance is explored by a semi-structured interview. The results show that the violation of privacy is not a big issue, acceptation depends on the way the technology will be implemented. Trust and power are of more importance. In conclusion, always ap- proach the concepts privacy, trust and power together by imposing such a radical change in health care process. Consider the care giver as a key player as the change agent. Practi- ce implications: to accept the technology in a broad spectrum spread practice based eviden- ce about the technology and use trust to make a positive trade-off between relative advantage and the violation of privacy. This study provides a new view on the implementation of camera surveillance. The protection of privacy seems not of that great importance and is concerning the acceptation of technology not an auto- nomous term. The concepts trust and power prove to be important players in this arena.
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The questionnaire was used as a screening instrument and also served as a baseline measurement for the participants of the trial. Among the respondents (n = 3,689, see figure 1), we found 872 persons who reported their health status as poor (on a scale ranging from 1–10 points, report marks 1–5 are considered poor, 6–7 fairly good, and 8–10 good). Our previous home visitation study indicated pos- itive effects for this subgroup. Five persons did not sign the informed consent form and 273 persons with a poor health status did not want to participate in the study. Of the remaining 594 persons, we excluded those who already received home nursing care at baseline, in order to avoid contamination of (other) nursing care. Referral to nursing services after the start of the intervention period has no consequences for the scheduled home visits in the intervention group. It is regarded as a possible effect of the intervention and it is registered as outcome in terms of service use. Persons on a waiting list for admission to nursing homes or homes for the elderly were also excluded. The local independent committee dealing with applications for the use of care services already granted them this service. It is likely that most of them already receive regular supervision of professional caregivers. Six persons were excluded on the advice of their GPs. They were severely or terminally ill and would probably die within 6 months. On the basis of these exclusion criteria, a total of 102 persons were excluded.
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Participant selection is a feature of community interven- tion models for elderly people that received much atten- tion in literature. This discussion focuses on two matters: participant selection on the basis of age and on the basis of participants' needs. Age as a selection criterion is not discussed much, but causes controversy. Some authors state that home visits are more effective in persons aged 75 and over, compared to younger individuals . One meta-analysis did not find an age effect, and another meta-analysis concluded most benefits are to be expected in the youngest old [13,20]. Frailty has received much more attention than age with respect to targeting these health services models to those who will benefit most. Most authors agree that too healthy elderly persons should be excluded, because both preventive home visits and comprehensive geriatric assessment are ineffective in these sprightly people [13,21]. There is more dispute about the effectiveness of these models in frail older per- sons. While some exclude the frailest participants, because in these persons there are too few possibilities for reversi- bility, other authors stress the importance of including the frailest [8,13,21,22]. Combining the evidence on the rele- vance of both age and frailty for participants selection Stuck concludes that health risk appraisal with individual reinforcement is beneficial to healthy persons aged 60 to 75, preventive home visits should focus on independent people aged 75 and over, and that other types of (institu- tional) services are needed for the frailest .
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An architectural inference system for health monitoring based on the Internet Of Things is mainly intended to secure IoT based health systems. It pro- vides security solutions for protecting private data on the mobile phones of patients. It satisfies major security requirements like data confidentiality, data integrity, data freshness, data availability and secure localisation. When using cognitive computing archi- tecture, there is a potential to improve the quality of life and life expectancy of people. The interaction between health care IoT devices and software com- ponent requires widely accepted standards for IoT architecture and security solutions. The principal concept of IoT is low power consumption. It pro- vides a long lifetime for the network. An IoT solution makes an intelligent and reliable monitoring system. The system is proposed to implement intelligence on body sensors by applying an inference system which reduces unnecessary transactions and helps to save resources. From the comparative study, the cognitive architecture performs better security, and it is afford- able for the local users.
The joint Chief Inspectors’ report indicated that one of the obstacles to the effective operation of ACPCs was lack of resources (Chief Inspector of Social Service et al., 2002). The Children Act 2004 makes provision for payments towards expenditure incurred by, or for purposes connected with, a Local Safeguarding Children Board (Section 15(1)). Bodies may also provide staff, goods, services, accommodation or other resources (Section 15(2)). Working Together acknowledges that LSCBs need to be adequately resourced to function effectively (HM Government, 2006: Section 3.74, 3.75 and 3.76). However, the level of funding required to operate effectively and the contribution that individual agencies should make are not prescribed. As a result, there are considerable variations in LSCB budgets and expenditure (DfES, 2007b; France et al., 2009). Local Safeguarding Children Boards: A Review of Progress (DfES, 2007b) found that in 2006-2007 the average funding level for LSCBs was approximately £150,000, compared with about £95,000 for ACPCs in 2004-2005 (p.48). Staffing, followed by training accounts for the highest proportion of LSCB expenditure (p.54). Local Authorities consistently contribute the majority of costs, followed by health bodies and the Police (p.51-2). This funding allows the LSCBs to appoint staff, such as Independent Chairs and Business Managers, who comprise the infrastructures of the LSCBs and enable them to operate. Costs of a different kind arise in connection with the meetings that are held by LSCBs and their subgroups, in that the members who attend them take time off from their normal duties to enable them to attend.
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Health care professionals and home care workers feel that they have a responsibility towards the health of someone living at home with dementia. This was termed a ‘duty of care’ by some participants, who viewed it as an integral component of their professional role. This is im- portant because health care, particularly nutritional care, often involves uncertainty and risk for individuals who are reliant on the competence of the health care profes- sional . Trust within health care relationships is thought to be reliant on health care professionals being non-judgemental listeners and ‘acting as a mirror for family strengths’ . Surveys have found that older people in the UK feel that they are not involved in the wider home care system, which they find difficult to understand, and does not make the effort required to tailor care to their health needs . Future service de- velopment must recognise that health systems are com- plex, and require integration of trust to enable successful outcomes .
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Volunteer PMs were aged 60 years or older and lived near the participants and were trained using the Senior Peer Mentor Physical Activity Programme for Older People . Volunteers were recruited through word of mouth and from the University of the Third Age (U3A) in Manchester . Before they agreed to take part they were informed about the study and the inclusion criteria. Inclusion/exclusion criteria for PMs: PMs needed to be physically active, cognitively intact, willing to have a criminal record check as they would be working with vulnerable older people, and willing to commit to the study for 6 months. Seventeen mentors were recruited, 16 attended training following which four withdrew explaining, for example, that they did not have the time. A 2-day training course was run by members of the re- search team (RMEL and DAS). The training included spe- cific guidelines on home visits to aid adherence and also how to join the participants in the exercises (PMs did not instruct on the actual exercises nor offer advice on HS modifications). PMs were indemnified by the sponsor or- ganisation. PMs received a fee for attending meetings and training days and could claim for travel expenses . Each mentor was assigned one or two participants. The acceptability of the interventions
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In the present study the type of family, suicidal ideation and previous suicide attempt were found to have a significant affect on the total difficulties score. Suicidal ideation in itself is a sign of an unhealthy mental status. More than 50% of those who attempted for suicide previously show a borderline or abnormal TDS. SDQ can help as a screening tool to help in early detection of mental health problems and also the area in which an adolescent needs the maximum support. A screening of mental health might give us a better insight into the psychological needs. This will in turn help in planning of management action for the betterment of the mental health of the adolescents.
new directions that support achieving high-functioning systems of care. Rank 1 topics reveal how our results could promote CYSHCN research advances. For example, directly supporting CYSHCN caregiving at home emerged as a top research priority. From topic development to discussion during RAM, our process framed caregiver challenges in terms of resilience and adaptability, providing a more positive orientation than studies that are focused on caregiving stresses and burdens. 23–30 This frameshift also aligns with recent research suggesting that strategies to support family caregivers may improve CYSHCN health. For example, emerging data support the theory that child and caregiver health are tightly
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