A two-echelon responsive health analytic model for triggering care plan revision in geriatric care management

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults’ needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the Internet of Medical Things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities.

Resistome and Virulome of Multi-Drug Resistant E. coli ST131 Isolated from Residents of Long-Term Care Facilities in the Northern Italian Region

Long-term care facilities (LTCFs) are important reservoirs of antimicrobial-resistant (AMR) bacteria which colonize patients transferred from the hospital, or they may emerge in the facility as a result of mutation or gene transfer. In the present study, we characterized, from a molecular point of view, 43 E. coli strains collected from residents of LTCFs in Northern Italy. The most common lineage found was ST131, followed by sporadic presence of ST12, ST69, ST48, ST95, ST410 and ST1193. All strains were incubators of several virulence factors, with iss, sat, iha and senB being found in 84%, 72%, 63% and 51% of E. coli, respectively. Thirty of the ST131 analyzed were of the O25b:H4 serotype and H30 subclone. The ST131 isolates were found to be mainly associated with IncF plasmids, CTX-M-1, CTX-M-3, CTX-M-15, CTX-M-27 and gyrA/parC/parE mutations. Metallo-β-lactamases were not found in ST131, whereas KPC-3 carbapenemase was found only in two ST131 and one ST1193. In conclusion, we confirmed the spread of extended-spectrum β-lactamase genes in E. coli ST131 isolated from colonized residents living inside LTCFs. The ST131 represents an incubator of fluoroquinolones, aminoglycosides and other antibiotic resistance genes in addition to different virulence factors.

The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China

Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.

Developing a Scale of Care Work-Related Quality of Life (CWRQoL) for Long-Term Care Workers in England

Background: Long-term care (LTC) workers are subjected to structural and inherent difficult conditions that are likely to impact their quality of life at work; however, no agreed scale measures it. This study aims to develop a scale to measure the work-related quality of life among LTC workers in England (CWRQoL). The study establishes the domains/sub-domains of CWRQoL, investigates the tool’s utility and collates information on existing supporting strategies for CWRQoL. Methods: We adopt a mixed-methods approach employing inductive/deductive processes at three stages: (1) a scoping review of the literature; (2) interviews and focus groups with frontline LTC workers, managers and LTC stakeholders; and (3) a content validity consensus survey. Results: CWRQoL is composed of seven domains (and 23 sub-domains). Additional domains to those in the literature include financial wellbeing, sufficient time for building relations, managing grief and emotions associated with client death and end of life care. Stakeholders identified several benefits and challenges related to the CWRQoL tool’s utility. COVID-19 significantly impacted LTC workers’ mental wellbeing and spillover between work and home. Conclusions: The study highlighted the complex nature of CWRQoL and provided a solid ground for developing and validating a CWRQoL scale.

Content Comparison of Long-Term Care Instruments Based On The International Classification of Functioning, Disability And Health (ICF)

Background: Aging crisis is proposing a huge challenge to the whole Chinese social welfare system, however a national Long-term Care (LTC) Instrument has not established yet. The objective of this study was to analyze and compare the content of six selected LTCs based on the linkage of the International Classification of Functioning, Disability and Health (ICF), so as to provide insights for the development of Chinese national LTC instrument in the future. Methods: Two trained health professionals performed the linkage according to the refined ICF linking rules. The main concepts included in the items of three international LTC instruments, namely Minimum Data Set 3.0 (MDS 3.0), Initial Assessment Instrument(IAI), and New Assessment Tool for Determining Dependency on Nursing Care (NBA), as well as three Chinese instruments, namely Disability Assessment of Long-Term Care (DA-LTC), Specification for Elderly Care Unified Need Assessment in Shanghai Version 2.0 (SEC-UNA 2.0), and pictorial-based Longshi Scale (LS) were selected and linked to the ICF categories. The six selected LTC instruments were analyzed and compared at the levels of ICF components, chapters, and categories. Results: The main concepts of 340 valid items of the six LTC instruments were linked to 112 different ICF categories. Within the ICF framework, the “Activities and Participation” component was most frequently addressed in the LTC instruments followed by the “Body functions” component, and the percentages were 0.52 and 0.38, respectively. At the ICF chapters level, “b1 mental functions,” “d4 mobility,” and “d5 self-care” were the core of the LTC instruments. In addition, the contents of the six selected LTC instruments differed greatly. Conclusions: The ICF provides a useful external reference for the analysis and comparison of different LTC instruments. The findings suggest that key elements to determine eligibility for LTC in China need to be further identified. It is anticipated that this study will provide new insights for the development of Chinese national LTC instruments.

Social interactions in long-term care

Современное общество становится все более сложным, меняются не только технологии, но и его социально-возрастная структура. Человечество впервые столкнулось с ситуацией, когда пожилых больше, чем молодежи, и оказалось к этому не готово. Возникает новая задача - согласование взаимодействий и интересов множества субъектов социального взаимодействия в интересах пожилых. Традиционных управленческих воздействий государства становится недостаточно, постепенно складываются механизмы самоорганизации общества и автономности граждан. Новой проблемой стало не только быстрое старение общества, но и увеличение числа пожилых, требующих постоянного ухода в последние годы жизни. Уже сложившиеся «закрытые институты» - дома престарелых - сегодня все менее популярны у населения. В статье предложен обзор российского законодательства о долговременном уходе за пожилыми, а также анализ успехов и барьеров взаимодействия в организации ухода государства, коммерческих и некоммерческих учреждений в Санкт-Петербурге - городе пожилого населения и развитого социального обслуживания пожилых. Поэтому мы вправе сделать вывод, что социальное обслуживание в Петербурге может рассматриваться как перспективная модель развития долговременного ухода за пожилыми. Цель статьи - анализ особенности взаимодействий различных субъектов складывающейся в Петербурге системы долговременного ухода за пожилыми. Нас интересуют ситуации, когда имеющихся правовых норм/регулирования/вмешательства во взаимодействия достаточно, чтобы задачи ухода решались, а участники не страдали, и наоборот - когда имеющихся регулятивов недостаточно и либо задачи не решаются, либо потерпевшей стороной оказывается пожилой человек или его семья. Modern society is becoming more and more complex, not only technologies are changing, but also its socio-age structure. For the first time, mankind found itself in a situation where there are more elderly people than young people, and it turned out to be not ready for this. A new task arises - the coordination of interactions and interests of many subjects of social interaction in the interests of the elderly. The traditional administrative influences of the state are becoming insufficient; mechanisms of self-organization of society and the autonomy of citizens are gradually taking shape. A new problem has become not only the rapid aging of society, but also an increase in the number of elderly people requiring constant care in the last years of their lives, since the already existing «closed institutions». Nursing homes are less popular today. The article provides an overview of Russian legislation on long-term care for the elderly, as well as an analysis of the successes and barriers to interaction in organizing care for the state, commercial and non-profit institutions in St. Petersburg. Petersburg is a city of the elderly population and developed social services for the elderly. Therefore, we have the right to conclude that social services in St. Petersburg can be viewed as a promising model for the development of long-term care for the elderly. The purpose of the article is to analyze the peculiarities of interactions between various subjects of the system of long-term care for the elderly that is emerging in St. Petersburg. We are interested in situations when the existing legal norms/regulation/interference in interactions are sufficient for the tasks of care to be solved, and the participants did not suffer. And vice versa, when the existing regulations are insufficient, and either the tasks are not being solved, or the injured party is an elderly person or his family.

The Public Economics of Changing Longevity

Our societies are witnessing a steady increase in longevity. This demographic evolution is accompanied by some convergence across countries, but at the same time substantial longevity inequalities persist within nations across income classes. This Element aims to survey some crucial implications of changing longevity on the design of optimal public policy. For that purpose, it first focuses on some difficulties raised by risky and varying lifetime for the representation of individual and social preferences. Then, it explore some central implications of changing longevity for optimal policy making, regarding prevention against premature death, pension policies, education, health care and long-term care. The author distinguishes between the case when longevity is partially the responsibility of individuals and the case when longevity is plainly exogenous.

The right to care? Social citizenship and care poverty in developed welfare states

PurposeThere are clear theoretical, policy and practice tensions in conceptualising social or long-term care as a “right”: an enforceable choice. The purpose of this article is to address the following questions: Do disabled and older citizens have the right to long-term care? What do these rights look like under different care regimes? Do citizens have the right or duty to *provide* long-term care? It is already known that both formal and informal care across all welfare contexts is mainly provided by women and that this has serious implications for gender equality.Design/methodology/approachIn this article, the author takes a conceptual approach to examining the comparative evidence from developed welfare states with formal long-term care provision and the different models of care, to challenge feminist care theory from the perspective of those living in care poverty (i.e. with insufficient access to long-term care and support to meet their citizenship rights).FindingsDrawing on her own comparative research on models of long-term and “personalised” care, the author finds that different models of state provision and different models of personalised care provide differential citizenship outcomes for carers and those needing care. The findings indicate that well-governed personalised long-term care provides the best outcomes in terms of balancing potentially conflicting citizenship claims and addressing care poverty.Originality/valueThe author develops new approaches to care theory based on citizenship and care poverty that have not been published elsewhere, drawing on models that she developed herself.

Effectiveness of the “Person First – Please” educational intervention for nurses in older people long-term care –protocol for a cluster RCT v1

Aim. To evaluate effectiveness of “Person First –Please” (PFP) intervention in supporting nurses’ collective competence in Person-centred Care (PCC) in Long-Term Care (LTC) of older people. Design. Cluster randomised controlled trial. Methods. Intervention group comprising nurses working on older people LTC will receive PFP Continuing Education (CE) intervention; control group will work as usual. The primary outcomes are nurses’ individual PCC competence and intervention’s effectiveness for collective competence. Secondary outcomes are PCC climate as perceived by nurses, residents and their families. Measurements are conducted three times (baseline, after PFP intervention and after 6-week follow-up) in both groups. Results. The study will provide evidence of PFP’s effectiveness and its influence on PCC climate of older people LTC. If effective, the educational intervention can be used to improve PCC and quality care for older people. Keywords Person-centred care, older people, long-term care, intervention, continuing education, collective competence

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.