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19 Cards in this Set

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evolution of elder care
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
What are the key points of Article IV?
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.
Community HC Programs models of Care
-- Maintenance and prevention (promote independent living)

–  Long-term care substitution (avoid long term care)

–  Acute care substitution (avoid acute care)
CHCP funding
Government funded (85%)
with user fees (10%) and
third party payers (5%) –

but user fees increasing
primary objectives of HC reform
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
definition of home care
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
coordinated home care program definition
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
CHCP general objectives
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
maintenance and preventitve model
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
long-term care substitution model
home care services for persons who would otherwise require long-term institutionalization

both hospital and community referral
acute care substitution model
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
CHCP location administration styles
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
CHCP models of delivering services
CHCP staff

Purchase from external agencies

Combo of delivering through CHCP staff and purchasing (most common)
CHCP initiatives to enhance delivery of services
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)
Current Home Care Issues
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
Community Care Access Centres
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
Elder Care Shortcomings
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
Distance decay
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)
SIPA model
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