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19 Cards in this Set
- Front
- Back
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evolution of elder care
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pre-formalized medicine: pre 1950 - Prior to public insurance, most health care was provided in the home
medical/institutional complex 1950-1990: Home care transferred to hospital and institutional care Era of cost shifting: Home care transferred to hospital and institutional care |
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What are the key points of Article IV?
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Even while in captivity we are to carry out our responsibilities and exercise our authority. The senior person, regardless of the branch of service, must take command. Without discipline, camp organization, resistance, even personal survival may be impossible. Communication breaks down the barriers of isolation that an enemy may attempt to construct. The guidelines for Article IV of the Code of Conduct pretty much pertain to peacetime internment also.
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Community HC Programs models of Care
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-- Maintenance and prevention (promote independent living)
– Long-term care substitution (avoid long term care) – Acute care substitution (avoid acute care) |
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CHCP funding
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Government funded (85%)
with user fees (10%) and third party payers (5%) – but user fees increasing |
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primary objectives of HC reform
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more emphasis on prevention and health promotion
decentralization of decision making (greater public involvement and accountability) expansion of community care at expense of hospital care integration of services, programs and service agencies greater consumer involvement better management/better value for HC dollar |
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definition of home care
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an array of services which enables clients incapacitated in whole or in part to live at home often with the effect of preventing, delaying or substituting for long-term care or acute care alternatives
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coordinated home care program definition
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a government funded program with an official mandate to coordinate and deliver quality home care services within a specific geographical area of a municipality, region or province
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CHCP general objectives
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enable people to remain in or return to their homes
ensure that people function as independently as possible at home sustain the health and involvement of the family |
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maintenance and preventitve model
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serves people with health and functional deficits in home setting by maintaining their ability to live independently and preventing health and functional breakdowns and eventual institutionalization
least restrictive eligibility emphasizes medical and social support needs clients primarily from community |
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long-term care substitution model
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home care services for persons who would otherwise require long-term institutionalization
both hospital and community referral |
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acute care substitution model
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aka medical model
people who would otherwise have to enter or remain in acute care facilities most restrictive eligibility referal/authorization from doc frequently limited to number of hospital days replaced |
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CHCP location administration styles
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Hospital-based: target clients with specialized needs, requiring comprehensive clinical care
community-based: target widest range of clients, associated with all three models of care of 400 in Canada, 381 community-based |
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CHCP models of delivering services
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CHCP staff
Purchase from external agencies Combo of delivering through CHCP staff and purchasing (most common) |
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CHCP initiatives to enhance delivery of services
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Single-entry case management approach: responsible for assessment and arrangemet of all services required in a designated geo area
Self-managed care: envelope of funds to hire, purchase, monitor and manage own care rather than case managed Gatekeeper into long-term care: reduces inappropriate nursing home placements and frees active tx beds informal support recognition (Que) - tax deduction Quick response teams (BC) |
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Current Home Care Issues
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Lack of common standards, terminology and database
Impact of health care reform Role of Private sector? Realignment of incentives (encourage less costly home care over institutionalization) 24/7 coverage Hospital relationships (competing for funding) Resource reallocation |
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Community Care Access Centres
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Responsible for coordinating care in a defined geographic region
Single point of entry Care coordinator assesses the situation and organizes a care plan Services – Nursing – Personal Care (maximum 30-40 minutes per day) – Physiotherapy/Occupational Therapy – Speech – Nutritional counseling – Social work – Medical supplies and equipment |
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Elder Care Shortcomings
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No home care system, per se (services fragmented)
Lack of data for monitoring and quality assurance Lack of or unreliability of weekend coverage Service caps may be insufficient for needs of frail elderly Quality of care dependent on adequate resourcing Implicit assumption that family (women) will provide majority of home care |
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Distance decay
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80% of home care is provided informally by family members (4.5 hours per
week for women and 3 hours for men) – Distance-decay (for males) – 66% of women work - burden of care for working women As frequency of provision decreased, distance increased - but not as affected if health status worse Avg hours per week of females doesn't decrease with distance, but does for men Women more apt to travel further, more often than men Men do household work and finances, women do cooking, bathing (ADLs) |
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SIPA model
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Intended to address shortcomings (fragmentation, lack of responsibility and accountability, negative incentives)
One centre responsible for entire population of frail elderly in a given region Serve as single entry point – eligibility criteria Interdisciplinary teams Empowerment and choice – choice of providers Budget based on # enrolled, SES and demographics Independent evaluations based on (1) impact on elderly population within catchment, (2) quality of care and services provided, (3) administrative operations |
