Most OECD governments have set up collectively-financed schemes for personal and nursing-care costs. One third of the countries have universal coverage either as part of a tax- funded social-care system, as in Nordic countries, or through dedicated social insurance schemes, as in Germany, Japan, Korea, Netherlands and Luxembourg, or by arranging coverage mostly within the health system, as in Belgium. While not having a dedicated “LTC system”, several countries have universal personal-care benefits, whether in cash (e.g., Austria, France, Italy) or in kind (e.g., Australia, New Zealand). Finally, two countries have ‘safety-net’ or means-tested schemes for LTC costs, namely the United Kingdom (excluding Scotland, which has a universal system) and the United States.
The larger issue to address is the development of a culture of openness and safety in every long-termcare home. In our view, such a culture must be developed to replace the current culture of fear and complaint-based system that remains in which staff are reluctant to speak out in fear of retribution. We will talk further about stronger whistleblower protection below, but here we want to highlight the cultural transformation that must take place from the top levels of long- termcare organizations to the leadership in each long-termcare home. 10 However, this retribution may also occur from co-workers versus home management and this can be more damaging if the reporting staff are not supported by management.
It was understood early on in the development of the project that staff involvement would be a critical determinant of its success. It has often been noted that guideline implementation is typically done “from the top down” , where management selects areas for improvement and implements changes [14,20]. Top-down decision making is prevalent in many organizations, but it reduces staff participation in the process and thus often limits staff buy-in to projects [14,21]. One way to address this concern is an approach called participatory action. Using this process, researchers collaborate with participants to identify major issues, conduct research, formulate actions, and study the results [22,23]. The process is cyclical and iterative, ensuring ongoing input and guidance from the participants. After studying the results, the information is used to re-evaluate the issue and recommence the cycle [22,23]. Because it is less hierarchical and more inclusive than traditional guideline imple- mentation models, participatory action can lead to a gradual culture shift in an organization and may improve buy-in for change across many levels of staff. For this project we used a participatory action approach, facilitating optimal participation of all stakeholders in the different stages of the initiative within the limitations of clini- cal and program resources.
The data collection process once again demonstrates the scarcity of long-termcare data suitable for international comparisons, despite the growingneed for planning and coordination in order to cope with demographic change. It turned out to be very difficult to collect precise quantitative information on LTC according to predefined definitions for a large selection of European countries. As could be expected, data collection was more problematic for the new member states. However, the project team also encountered serious problems for old member states. This problem was aggravated by the well-known problem that definitions of different settings of care vary considerably between countries, last but not least due to differences in historical development of the national systems. Therefore, one has to be cautious when using data from different national data bases within one analysis/approach. Qualitative data on system characteristics, 2 however, are more readily available. Overall, the problems encountered during this project led the project team to believe that the task of data collection/generation would constitute a project in its own right.
Long-termcare encompasses services that are provided to individuals who are suffering from a chronic illness, a disabling condition, or a cognitive impairment (such as Alzheimer’s). Under these circumstances, services are needed for an extended period of time and may not “cure” or “heal” the patient. Such services are designed to help the individual with routine activities, such as bathing, dressing, or even eating. Depending on need, services may be provided in a skilled nursing facility, an alternate living facility, an adult day care facility, or at home.
“Although situations of dependency on others and vulnerability are complex: older people themselves, their families, and professional and voluntary caregivers, should all respect the stated rights. The Charter aims to enable everyone to facilitate older people’s access to their fundamental rights.” The aim of the Charter is to complement and support the charters and other measures which are already implemented in some countries of the European Union and not to replace them. The Charter also aims to raise awareness among a wider public, to stress the rights of the increasing number of people receiving long-termcare, and to foster best practices in Member States and beyond. These rights are not fully respected today but our ambition is to fulﬁ l them.
understood through education include long-termcare, Medicare supplement, Medicate Part D, and short term and long-term disability. The insurers selling these products will need to be closely monitored for solvency and correct premium pricing. Their sales staff and producers/agents will need better training and understanding of the products to better understand suitability of client with product.
minimum definition for ADLs and a minimum gate keeper trigger – 50% of cover for 3 ADLs (see attached). There is also a requirement that premiums are level from age 65 (YRT basis is popular for younger ages) and a paid-up option should be included in the policy (but not a surrender option). For group policies there is a requirement for continuation of the cover on a private basis if the insured leaves the group or the policy is not renewed. Premiums are not guaranteed but the companies need
Clinical scales currently used for spasticity assessment are not well suited for screening in the primary care setting, as they must be administered by subspecialty-trained clinicians. 14,20 Likewise, biomechanical and electrophysiological methods of spasticity measurement have limited clinical usefulness 20 and are not suitable for use as screening tools. At present, there are no instruments available speci ﬁ cally designed to screen for the presence of spasticity in patients who have not yet received a diagnosis. 21 Our results further establish the urgent need for a simple assessment like the one used in this study: half of the subjects with spasticity had no prior evidence of a diagnosis in the medical record, and four out of ﬁ ve subjects who would likely bene ﬁ t from available therapies were not receiving any treatment. This ﬁ nding is in line with prior research, which indicates that spasticity is under-diagnosed in the long-termcare setting, 1–3 despite the availability of multiple scales for spasticity measurement. 14,15,22
of LTCI users is 1.27 days greater than the LoS of non- LTCI users. There are two main reasons for this result. Firstly, the admission days of level 3 beneficiaries are not expected to be reduced because they are not permitted to use the institutional care services provided by the Korean LTCI program except in the case that they have no family support or live in an inadequate housing con- dition. With respect to the medical conditions of LTCI beneficiaries, the primary disease in each level is demen- tia. Level 1 beneficiaries account for 22%, level 2 ac- counts for 26.9%, and level 3 accounts for 22.6% . Those beneficiaries whose main disease consist of a stroke accounted for 33.3% in level 1, 25.4% in level 2, and 23.2% in level 3 . Concerning the need for long- termcare, most notably nursing care, there is no differ- ence between the three levels . Under the circum- stance in which the need for nursing care services among the LTCI beneficiaries is equal, level 3 beneficiaries should use services provided by long-termcare hospitals because they are not permitted to use the institutional care services in the Korean LTCI policy.
A: The “Benefi t Wait Period” is similar to a deductible. Our longtermcare insurance policy has a 90 calendar day waiting period, which is the number of days after you are verifi ed as Chronically Ill until you are able to begin receiving benefi ts. The Benefi t Wait Period need only be met once during your lifetime, and you are not required to start receiving paid services in order for it to be satisfi ed.
care insurance is the most popular option for people concerned about nursing facil- ity and other potential expenses, it is not the only option. A number of life insur- ance providers offer whole life or univer- sal life policies with riders that accelerate benefits for long-termcare, if you need it. These “linked-benefit” policies typically offer a 90-day elimination period, and some may also offer inflation-protection options. Some policies are available on a single-premium basis, while others require annual premium payments. In addition, linked-benefit policies can:
The resident bedroom is the centre of a resident’s personal space. It is the place where the most private activities take place: e.g., sleeping, grooming and dressing. Its design must meet each resident’s need for comfort and safety, promote the resident’s independence and, provide for resident privacy. Each bedroom must be designed to maximize a sense of familiarity for residents and support direct care staff in the safe delivery of quality resident care.
Results: We interviewed representatives of 30 PCOs with diverse demographic profiles planning a range of models of care. Although the primary driver was consistently identified as the need to respond to a central policy to shift the delivery of care for people with long-term conditions into the community whilst achieving financial balance, the design and implementation of services were subject to a broad range of local, and at times serendipitous, influences. The focus was almost exclusively on the complex needs of patients at the top of the long-term conditions (LTC) pyramid, with the aim of reducing admissions. Whilst some PCOs seemed able to develop innovative care despite uncertainty and financial restrictions, most highlighted many barriers to progress, describing initiatives suddenly shelved for lack of money, progress impeded by reluctant clinicians, plans thwarted by conflicting policies and a PCO workforce demoralised by job insecurity.
In this study, two dependent variables were used to represent the two main concepts of LTC availability in disabled elderly people. 23 LTC availability includes: a) “ the availability of social care ” represents the extent to how disabled elderly people receive help to meet their daily needs. (Question: Are you satis ﬁ ed with the help you receive when you encounter dif ﬁ culties in your daily needs? All the answers are processed into two levels: Mild satis ﬁ ed /dissatis ﬁ ed; Highly satis ﬁ ed). b) “ the availability of health care ” represents the primary source of care for elderly people once they become ill. (Question: Who do you get help from when you are sick?) The answers included three types: no health care at all, informal care providers such as a family member or friend, and formal care such as public or private social care suppliers need to pay for. It should be pointed out that the dependent vari- able was only included the availability of social care and
Our finding of a reduced subsequent need for home care for nearly 5 years is potentially generalizable to other services and situations, noting that evidence for this effect being sustained for at least 2 years already exists in differ- ent countries and service contexts. Generalizability in terms of cost savings for different services and different contexts is, however, impossible because the potential for savings is influenced heavily by the cost of the reablement service delivery model as well as the costs of the services that it is offsetting. Silver Chain’s reablement model was developed within the context of HACC services, which in Australia are funded to be low level services targeted at people need- ing small amounts of assistance. The HIP service delivery model was therefore developed with this in mind, and it is cost effective because it uses an interdisciplinary approach