The women who participated in this study did NOT identify the long-term care institution they found themselves in as their ‘home’. Rather – ‘home’ for them is a space that exists ‘elsewhere’ – in memory, in daily ‘musings’, in social relationships with family members (located outside of the institution), in books, or in spatialities that are not physically located within the ‘concrete’ walls of the long-term care facility. Home, for them is ‘elsewhere’. Home is displaced and is a ‘state’ of displacement. These women are not ‘traversing’ from one home (their personal ‘home’) to another (the institutional ‘home). The end goal for them is not to ‘feel at home’ in their institutional homes. Rather they exist in a perpetual state of ‘displacement’: neither materially and immaterially here nor there. They live with the knowledge that their home exists but its ‘site’ has no physical location. Their ‘home’ exists as a loss. It is lost in time. Though traces of it exist in the past or in memory, time itself seems to have no substance. It is ‘forgotten’. However, most interestingly, home also has an intimate and complicated relationship with the body: the aging, changing, unstable geography of the body. The meanings attached to the ‘home’ are constructed by understandings of the ‘body’. In this way both concepts construct one another. But not as separate entities, but rather both meanings twist and turn, weaving a complex fabric of understanding for each participant. If “place is an organized world of meaning” (Tuan, 2008: 179), then that understanding is bound up with meanings attached to the body.
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This article analyzes the perceptions of accompanying family members and health professionals about the experiences of elderly women who chose to live in a Long - Term Care Institution (LTCI) in light of the Aging in Place (AIP) phenomenon, imbricated to the Lifespan Theory. This is a qualitative study in which a biosocioeconomic questionnaire and an interview with a semi- structured script were used. For the systematization of the results, the technique of content analysis and thematic coding were used. Four companion relatives and four health professionals from the institution were interviewed. The results were arranged in four thematic categories: (I) Identification, belonging to the site and satisfaction with housing, (II) Maintenance of independence and autonomy, safety and health conditions, (III) Social participation and needs (IV) Positive vision, plans and learning. The interviewees believe that these elderly women experience the cycle of old age in a positive way and in a place that, according to characteristics listed, refer to the aging in place phenomenon with a leading role and social support and in a successful way.
Over the years since the introduction of LTCIP, while the growth in the number of beneficiaries outpaced the growth of the elderly population in Israel, the character of the population of beneficiaries changed reflecting changes in the elderly population in the country as a whole. The relative share of men and women among the beneficiaries has slightly changed and the share of the aged who are more dependent has increased, reflecting the aging of the Israeli elderly in general. LTCIP’s legal rules were amended numerous times, especially in the last decade, and the administrative orders that guide its day-to-day implementation are constantly under review and adapted to meet requests from the public. Even though legal changes and administrative procedures may be meaningful in individual cases for beneficiaries, for- mal caregivers or service providers, most changes in LTCIP have been rather gradual, and not radical  a.k . These two aspects – of the law and of the beneficiaries – demonstrate the basic resilience and stability of this wel- fare state program.
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Improving physical fitness is a factor of improving healthy expectancy. Pre- vious researches indicated the relationship between physical fitness and disease or mortality. Sun Q et al . traced 13,535 women who survived to at least 70 years, and “successful survivor” was defined no history of 10 major chronic diseases or coronary artery bypass graft surgery and no cognitive impairment, physical im- pairment, or mental health limitations. The women whose walking pace was brisk or very brisk (≥3.0 mph) had 2.68 fold increased odds of successful survi- vor compared with the women who walked easy pace (<2.0 mph) as reference . Leong DP et al . conducted longitudinal study with 139,691 men and women in 4 years, and found that hazard ratio per 5 kg of reduction in grip strength was 1.16 of cardiovascular mortality, 1.17 of non-cardiovascular mortality, 1.07 of myocardial infarction and 1.09 of stroke . A systematic review and meta- analysis by Cooper et al . suggested that the hazard ratio of mortality comparing the lowest quarter with the highest quarter was 1.67 in grip strength, and 2.87 in walking speed . In addition, Kishimoto et al . reported that highest tertile of grip strength had 0.49 of hazard ratio for all-cause mortality compared with lowest tertile in a 19-year longitudinal study with 2,527 Japanese men and women . As above, there will be no more doubting that the relationship be- tween physical fitness and disease or mortality.
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Given the continuous increase in the female labour force participation, providing informal care may imply important economic costs for women in terms of reduced employment or missed opportunity of being employed. Table 1a confirms that women are traditionally the main care providers. Knowing the difficulties that women face to combine care-giving responsibilities with labour market participation, we can verify if there are systematic differences in the way genders respond to the determinants of the probability of being constrained. Nevertheless, in the estimate on women the signs of the significant coefficients do not change, although the size is a bit higher. A couple of variables become relevant: retired persons show a higher probability to be constrained (3%) than working people and economically inactive persons show a lower one (-3%). It is difficult to understand what the positive coefficient for retired people signal. They could have retired because they had to care for somebody or the restraint could concern working activity that they carry out – or would like to carry out – during the time of retirement. In addition, we find some differences in the time and in the country effects: the probability to be constrained in Belgium, Italy and Greece becomes significantly lower than in Spain and in four out of six years, it is lower than in 2001, showing some hardening of the constraints for women in the last year of the considered period.
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practice guidelines in LTC . The most frequently cited barriers to their implementation were provider concerns that guidelines were “checklists” to replace clinical judg- ment, limited facility resources, conflict with family repre- sentatives and facility policies that conflict with guidelines’ recommendations. A more recent survey also demon- strates the need for education and adaptation of osteo- porosis guidelines of front-line staff in LTC in management of osteoporosis . These results underscore the fact that guidelines targeted at community-dwelling men and women cannot be readily applied to those living in residen- tial care, even if these guidelines are updated and broadly disseminated, as OC has done in 2010 . Moving from evidence to practice in the clinical world requires integrated knowledge translation that include taking into consider- ation more than the knowledge to be transmitted but also the context or setting where the this will take place, the tar- get audience and the facilitators (human resources and others) that will ensure changes in clinical practice can take place [10,25].
Participants were selected via purposive sampling. Eligibility criteria included: 1) history of fistula repair surgery at the Fistula Care Centre in Lilongwe, Malawi within the past 1–2 years, 2) age 18 years or older, 3) willingness to have their interview recorded, 4) residence in one of the 9 central Malawian districts, and 5) the ability to locate participants and/or contact them via working phone numbers. As a part of their routine care, women who undergo repair at the Fistula Care Centre are scheduled to complete follow-up questionnaires at one month and three months post repair. Although all of the women we interviewed had previously returned for follow-up, many women have been unable to return due to financial or personal constraints. For this reason and to ensure the women felt comfortable during the interview, we conducted interviews within participants’ homes or at local health centers, whichever they pre- ferred. We estimated a sample size of approximately 20 women was necessary to reach data saturation for our predetermined themes. These themes were based on our previous interactions with patients at the Fistula Care Centre and our research on women’s experiences before and after fistula repair.
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This study utilised administrative insurance claims data from the Statutory Health Insurance (SHI) sample of AOK Hessen (Versichertenstichprobe AOK Hessen/KV Hessen) . Hessen is a state in central Germany that includes the major cities of Frankfurt and Wiesbaden. The population of the state was estimated at six million individuals in 2012; of these, 1.5 million were insured by AOK. The sample available for research (SHI) is ac- quired by drawing a random sample of individuals in- sured by the AOK with a constant selection set of 18.8%. The current SHI sample used in this study included 353,284 persons who were insured in AOK Hessen for at least one day during the five-year period of 2009–2013. The sample is population-based without disease-related selection, with no disease-related dropouts, no recall bias, and a high level of data reliability; this enables patient-based observation and a bottom-up approach to disease costing from the perspective of the health insurance fund. The SHI dataset contains details on healthcare transactions related to insured persons and healthcare providers, including data on care received in general practice, outpatient care (all specialist visits), and hospital care, including emergency visits. Details of this database have been previously published [23, 24].
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Of the 232 young individuals with stroke 150 individuals (65%) filled in and returned the MYS and the EQ-5D questionnaires. The characteristics of the young individ- uals with stroke including stroke related medical factors and personal factors are presented in Table 1. The young individuals’ ratings of disability and reported environ- mental factors are presented in Table 2. A majority (79%) had suffered a mild stroke. Normative EQ-5D data was retrieved from 2661 geographically and age (range) matched individuals in the general population (median 46 years, inter quartile range 38-55 and 54% women). The young individuals with stroke rated significantly lower global health (mean 63, SD 24) than the matched general population (mean 79, SD 18) (p < 0.000). Forty- five percent (n = 67) of the young individuals with stroke as opposed to 15% (n = 392) in the general population rated low global health. The distribution of ratings in the EQ-5D dimensions is presented in Table 3. When differences between groups were explored significantly more individuals with stroke rated disability according to the EQ-5D dimensions: mobility, self-care, usual ac- tivities and anxiety/depression. No significant difference between groups was found in the EQ-5D dimension re- garding pain/discomfort.
The impact o f early institutional experience on the parenting skills o f a group of ex care women was also investigated by Wolkind and Kruk (1985). The sample consisted of three groups of women; those who had been separated from their family through admission into care, those who had experienced disruption through brief periods o f separation from their family in childhood, and those brought up within their family with no disruption (control group). Overall the in-care group gave the least favourable picture, while the disrupted group performed much closer to the control group on most of the measures. 10% of the control group were unmarried, compared to 63% in the other two groups. 22% of the control group were pregnant during their teens, compared to 51% for the disrupted group and 70% for the in-care group. The parenting qualities of the in-care group were poorest as shown by their interaction with their babies; there was less holding when feeding, less maternal stimulation (vocalisations or physical) and least sensitivity to the needs o f the baby. At later ages this in-care group showed higher incidence o f behaviour problems and greater frequency o f admission to hospital. As adults the in-care group were more likely to have poor marriages and to lack support from others. However it was felt that the in-care group institutional experience was just one episode in a generally disharmonious and unsettled childhood, which itself carries high psychosocial risk. Evidence for the transmission o f parental attachment style to their children has also been found in a study by Fonagy, Steele, & Steele (1991), as has evidence for substantial continuity o f attachment status over the period from the age of one to the age o f 20 in early adulthood (Waters and colleagues, 1995).
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The administrator shall ensure that the Health Care Personnel Registry Section of the Division of Health Service Regulation is notified within 24 hours of the health care facility becoming aware of all allegations against health care personnel as defined in G.S. 131E-256 (a)(1), which includes: abuse, neglect, misappropriation of resident property, misappropriation of the property of the facility, diversion of drugs belonging to a health care facility or a resident, fraud against a health care facility or a resident, and injuries of unknown source in accordance with 42 CFR subsection 483.13 which is incorporated by reference.
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continuous months in foster care, children’s chances of leaving foster care rapidly decreased. After 36 to 42 months of continuous time spent in foster care, a child’s chances of leaving foster care are incredibly low. Children who spent this amount of time in foster care were likely to still reside in a foster care placement at the date of the last NSCAW interview. Among all children who spent 36 or more months in foster care, 77% had foster care as their last known placement type. The passage of 12, 18, and 36 or more consecutive months in foster care represents critical junctures for children living in foster care. Permanency planning efforts should ideally begin prior to these junctures to prevent children’s experiences with long-term foster care. Changes in placement were also more common among children with a history of 36 months or more spent continuously in foster care. Children living in this long- term foster care most typically experienced 5 placement changes compared to the median of 3 placement
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The following databases will be searched: PubMed, EMBASE, Scopus, MEDLINE, Psych INFO, CINAHL, Cochrane library, PEDro, and OT seeker. As this is a scoping review, we will not impose a time limit as to the data of publication of the articles to gather as much em- pirical evidence as possible. We will also perform man- ual searches of references of identified articles to search for additional publications. The following key terms will be utilized in search of the literature: “caregivers” OR “care*” OR “mother*” AND “cerebral palsy” OR “physical disability*” AND (“physiotherapy” OR “physical therapy” OR “rehabilitation” OR Occupational therapy) AND “intervention*” OR “treat*” OR “prog*” Outlined in Table 2 is an example of how we will search for the arti- cles in CINAHL database.
Increasing the size of the catchment area for the calculation of the supply variables (Tables B5 and B6) tends to reduce the significance of the estimated association beds supply with the probability of discharge to a care home. This may be because variation in local supply variables is measured less precisely with larger catchment (ie catchment areas of 20 or 30 kms may be too large). The mean price per week is relatively stable across different radii, ranging from £521.85 to £523.21 and the standard deviation around those means falls from £93.05 at 10km to £77.38 at 30km. The absolute number of beds and its standard deviation naturally rises respectively from 2.31 to 12.98 and from 1.79 to 891 as radius increases from 10km to 30km. However, the coefficient of variation (standard deviation divided by the mean), falls from 77.49% at 10km to 68.64% at 30km. The reduced evidence of association in models with larger catchment areas also supports the plausible argument that any effect of beds supply declines with distance: patients are less sensitive to beds supply the further away the beds. This was suggested by the results from the quadratic specification (Table B4).
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Outbreaks of seasonal influenza in LTCFs are well recognised, as are the challenges of preventing and controlling influenza outbreaks in these settings. The development of universally applicable guidance on the prevention and control of influenza and other respiratory viruses in LTCFs is difficult due to the huge variation in the size of facilities, patient characteristics, the intensity of care provided and resources available. Although some countries have produced guidance on infection prevention and control for use specifically in LTCFs 3-11 , most have not. To help fill this gap, the WHO has recently published a best practice guidance document to support managers of LTCFs in the 53 WHO European Region Member States and which can be tailored according to national and local circumstances. 12 (http://www.euro.who.int/__data/assets/pdf_file/0015/330225/LTCF-best- practice-guidance.pdf?ua=1)
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Table 3 shows the results of the factor and reliability anal- yses for the three Experience questionnaires. Explorative factor analyses of the interview questionnaire for resi- dents of somatic wards yielded 18 factors (explaining 58% of the variance), but two factors concerned only single items and some factors showed a similar content (with same items loading on them). Reliability analyses showed that the interview questionnaire comprised seven reliable scales (Cronbach's alpha 0.70-0.83), five scales with a questionable reliability that were provisionally accepted (alpha 0.64-0.69), and three factors that formed no reli- able scale (alpha < 0.60). A similar factor structure was found for the questionnaire on psychogeriatric care, and reliability analyses showed 12 consistent scales and one Table 2: Response and client characteristics per setting and type of questionnaire
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Responses to questions that asked participants to select one response on a 5-point scale (1—not at all important, 2—not very important, 3—neutral, 4—fairly important, 5—very important) were collapsed into 2 meaningful categories. For example, responses to questions on potential barriers to providing palliative care that indicated barriers were “fairly important” or “very important” were coded as “important”; all other responses were coded “not important” by default. For responses rated on the other 5-point scale (1—not at all likely, 2—not very likely, 3—neutral, 4—fairly likely, 5—very likely), which was used for statements about using strategies to improve provision of palliative care, responses indicating “fairly likely” or “very likely” were coded as “likely,” and all other responses were coded “not likely” by default. Descriptive analyses were con-
Paraprofessionals include home health aides, nursing aide/assistants (CNA’s), orderlies and personal and home care aids as well as those employed as independent providers by consumers. CNAs are often called the eyes/ears of the environments in which they work because they see the patients often. Educationally, the standard typically required a CNA to hold a certificate in the state in which they are working and their names need to appear on the State Nurse Aid Registry. According to the Nursing Assistant Guide, there tends to be a high rate of turnover for CNA positions, which makes it easy to find work. The demand for CNAs is high, especially among establishments that supply continuing treatment and assisted living to elderly patients. A CNA will have many tasks and duties because the work will be with patients that have various levels of health.
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The study period was divided into two phases: pre- intervention (7 months) and intervention (7 months). During the pre-intervention phase, baseline informa- tion on facility-level antimicrobial susceptibility pat- terns and antimicrobial utilization were collected from each LTCF. During the intervention phase, the ID pharmacist made weekly site visits to each LTCF to identify residents receiving antibiotics for UTIs which was determined by infection control and nursing ad- ministration records at each site. Individual variables, including resident demographics, comorbidities, vital signs, documented exam findings, laboratory results, and additional antibiotics for each resident on antibi- otics for UTI, were collected weekly by the ID pharma- cist by review of the medical record. The ID pharmacist and ID physician then consulted, and recommendations were formulated utilizing the Loeb clinical consensus criteria for initiation of antibiotics in the LTCF setting as a guideline . For residents not meeting clinical consensus criteria, the ASP team used clinical judge- ment including input from subspecialists and the resi- dent ’ s predisposition for other infections, to determine if antibiotics were indicated and to help formulate recom- mendations. The ID pharmacist subsequently conveyed the ASP recommendations to the primary treating pro- vider via telephone or fax. Fax was utilized a minority of the time with one specific provider who expressed a pref- erence for this form of communication. Implementation of recommendations and clinical course of each resident was recorded at subsequent visits, including vital sign abnormalities, white blood cell count, change in antibi- otics, need to transfer to acute care, or death. Data on facility-level antibiotic susceptibility patterns and anti- biotic utilization was collected, in a similar manner to the pre-intervention phase, for the intervention phase.
Many of the challenges and barriers to research de- scribed above would be similar to studying a frail elderly patient population in acute care or community samples. For example, in terms of recruiting sites from an acute hospital setting, in two recent larger scale clinical trials on subjects of variable age groups, 31% and 43% of hospitals contacted eventually participated [64, 65], and while higher than the LTC site recruitment figures quoted above, these are still low. In terms of under-recruitment and attrition of elderly subjects in clinical studies, this fac- tor is certainly not unique to LTC and is evident in many health care settings [10, 66, 67]. For instance, recruitment rates for clinical studies involving the in community and hospital settings vary greatly, with examples ranging from figures as low as 3.4%, and as high as 89.9% [67 – 72]. Staff time constraint or staff non-cooperation as a barrier to re- search participation is also not exclusive to LTC. For ex- ample, they are common reasons for non-participation in research in hospitals or palliative care facilities as well [65,
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