Cross sectional data indicate that about four percent of elderly persons reside in nursing homes. Yet many studies, some using death certificates, show actual risk of institutionalization is upwards of 25 percent. This paper presents a death registration study that examined all deaths in North Carolina and analyzed rural and urban differences. The…

Examined clinical and social-structural factors contributing to hospitalization of nursing home residents. Using participant observation and event analysis of acute-illness episodes, concluded that 48.2 percent of nursing home patient (N=215) hospitalizations could have been avoided. Identified insufficient numbers and training of nurses, lack of…

Purpose: We compared inpatient days, nursing home days, and total Medicaid claims for five Medicaid-funded home- and community-based services (HCBS) programs for in-home and assisted living services in Florida. Design and Methods: We studied a single cohort of Medicaid enrollees in Florida aged 60 and older, who were enrolled for the first time in…

Describes program of short-term rehabilitation care provided to elderly patients through collaboration between hospital and nursing home. Discusses program planning and implementation experiences, patient satisfaction, and rehabilitation outcomes. Notes that program, although successful, was discontinued due to financial and interorganizational…

Surveyed discharge planners at 49 acute care hospitals to ascertain problems they perceived in placing elderly patients. Selected hospital characteristics and placement practices and the ways in which they are associated with hospital back-up (sometimes called administratively necessary days) and delays in placement were analyzed. (Author/JAC)

Baccalaureate-prepared registered nurses (RNs) in hospitals appear to have more differentiated roles than nurses in nursing homes or ambulatory care. If employers believe that it is more cost-effective to shift responsibilities from physicians to RNs, demand for nurses with bachelor's degrees will increase. (SK)

Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using…

Examined the prevalence and nature of grief in response to patient suffering, loss, or death among healthcare workers. Skilled nursing facility personnel remembered experiencing bereavement in response to crises of their geriatric patients. Mourning occurred among virtually all general hospital personnel who usually serve younger patients. (Author)

Examination of hospitalizations for 5,854 elderly adults for 1980, 1985, and 1987 revealed significant increases in 60-day mortality and nursing home transfers after Medicare's Prospective Payment System began and hospital stays were shortened. Increases were largely explained by differences in risk factors other than length of stay (age, gender,…

For all the baby boomers who've embraced and adopted healthier lifestyles, including proper diet and exercise, there may be an even more compelling reason. If you get sick or become hospitalized, you may not have the critically needed services of a well-trained nurse. It's been widely reported that there is a nursing shortage in the United States,…

This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…

At the request of Congressman William Green, the General Accounting Office (GAO) evaluated the validity of allegations about deficiencies in the New York State Department of Health's nursing home and hospital inspection processes for certification for participation in the Medicare and Medicaid programs. Health Care Financing Administration and…

Examining the social context within which illness, hospitalization, and convalescence or adaptation occur permits recognition of the alternatives for creative intervention, and provides a framework for understanding the intrinsically disruptive nature of discharge from an acute care setting as well as the dangers and possibilities for change.…

Data are presented describing expenditures for personal health services in Michigan from 1977 to 1981. The rapid growth in expenditures is illustrated, as well as the rates of growth in expenditures, for major categories of health services. Personal health expenditures are defined as payments for care directly provided to patients: specifically,…

The increasing age of the American population and the current emphasis on cost containment in health care make the 1980s an ideal time for building bridges to span the health care needs of elderly persons in acute care and long-term care. While hospitals often discharge patients to nursing homes as an intermediate step between hospitalization and…