2011 Jun - Nitschke I, Bär C, Hopfenmüller W, Roggendorf H, Stark H, Sobotta B, Reiber T

Klinik für Alters- und Behindertenzahnmedizin, Zentrum für Zahn-, Mund- und Kieferheilkunde, Universität Zürich, Plattenstrasse 11, Zürich, Switzerland. ina.nitschke@zzm.uzh.ch

Zeitschrift für Gerontologie und Geriatrie

Oral health of long- term care (LTC) residents is often poor. From 30 random German LTC facilities, 242 random residents (Berlin n=75, Northrhine-Westfalia (NRW) n=94, Saxony n=73) (median age: 82 years, female: 78.5%) were interviewed as to their use of dental services, possession of a bonus booklet (BB), and completeness of records. Only 18.6% possessed a BB. Significant regional differences were observed (Berlin=5.3%, NRW=18.1%, Saxony=32.9%) (χ(2) test p<0.01). The number of teeth was higher (Mann-Whitney test p=0.01) and the time since last dental visit shorter (p<0.01) for all residents with a BB. Only 18.6% of people possessing a BB declared not having had a dental appointment within the previous 12 months (LTC residents without BB 51.3%).

2011 May 17 - Olivares-Tirado P, Tamiya N, Kashiwagi M, Kashiwagi K

Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai Tsukuba, Ibaraki, 305-8575 Japan.

BMC health services research

BACKGROUND: In Japan, as the number of elderly covered by the Long- term Care Insurance (LTCI) system has increased, demand for long- term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. METHODS: Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors.

2011 Mar - Hill NL, Kolanowski AM, Milone-Nuzzo P, Yevchak A

The Pennsylvania State University School of Nursing, University Park, PA, USA. : nln101@psu.edu

Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau

Evidence regarding long-term care residents' health outcomes after comprehensive culture change model implementation is inconsistent, and the grade of the evidence makes practice recommendations difficult at this time.However, integrated findings across studies demonstrate potential psychosocial benefits to long- term care residents. CLINICAL RELEVANCE: Nurses working in long-term care play a crucial role in the success of culture change initiatives as well as the health outcomes of residents. Empirical evidence for the effect of comprehensive culture change models on resident health outcomes supports reasonable expectations of their implementation and indicates areas for future research and translation into practice.

2010 Dec 22 - Tomita N, Yoshimura K, Ikegami N

Department of Health Policy & Management, Keio University School of Medicine, Tokyo, Japan.

BMC health services research

BACKGROUND: This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits. METHODS: Health insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance.They had not received long- term care services prior to April 1, 2000 and were newly certified as eligible for Long- Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model.

2010 Oct - Doty P, Cohen MA, Miller J, Shi X

Office of the Assistant Secretary for Planning and Evaluation, Aging, Disability and Long-Term Care Policy, Department of Health and Human Services, Washington, DC, USA.

The Gerontologist

PURPOSE: The purpose of this study was to obtain a profile of individuals with private long- term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. DESIGN AND METHODS: Ten LTC insurance companies contributed a random sample of 1,474 qualified individuals who were interviewed in-person by a trained nurse and then interviewed telephonically every 4 month for a 28-month period. Used in the analysis were descriptive statistics and techniques for analyzing longitudinal panel data. RESULTS: About 96% of those filing claims were approved for payment. At baseline, 37% received home care, 23% assisted living care, 14% were in a nursing home, and 26% had not yet begun using paid care. Few claimants reported that their policies restricted their choice of providers and most care costs were covered.

2010 Sep 29 - Konetzka RT, Luo Y

Department of Health Studies, University of Chicago, Chicago, IL, USA.

Health economics

Expansion of private long- term care insurance (LTCI) is often posited as a potential mechanism to finance long- term care (LTC) for a growing elderly population in the US. One largely ignored issue is lapse or cancellation of policies. Individuals who let a LTCI policy lapse face resumed risk of LTC expenditures while suffering the financial loss of premiums paid. The motivation for lapse has been poorly understood, though some have hypothesized that improvements in health risk may be responsible. We use 1996-2006 Health and Retirement Study data from 3974 respondents who report having private LTCI to estimate baseline and dynamic predictors of lapse and test for ex post adverse selection. Individuals who lapse are generally poorer, less educated, less healthy, and more likely to be racial and ethnic minorities than those who retain their policies. Changes in health status play a relatively small role in lapse, and we find little evidence for adverse selection associated with lapse.

2010 Sep 4 - Pope G, Wall N, Peters CM, O'Connor M, Saunders J, O'Sullivan C, Donnelly TM, Walsh T, Jackson S, Lyons D, Clinch D

Mid Western Regional Hospital, Clinical Age Assessment Unit, Limerick, Ireland.

Age and ageing

OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. Participants: two hundred and twenty-five permanent patients. Intervention: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition.

2010 Aug - Huang HW, Liu SH, Pai YC

Department of Nursing, Taipei Veterans General Hospital, ROC. ycpai@vghtpe.gov.tw

Hu li za zhi The journal of nursing

The proportion of elderly (65 years of age and older) in Taiwan has exceeded 10% since 2008. With more elderly, the number of patients suffering from dementia and disabilities has also been rapidly increasing. Japan also has been facing increasing demand for long-term care due to an aging society. Prior to 2000, social welfare programs in Japan, working to cope with changing needs, typically provided insufficient services, and geriatric patients were hospitalized unnecessarily, wasting medical resources and causing undue patient hardship.In response, Japan launched its long- term care insurance program in April 2000. Under the program, city, town and village-based organizations should take responsibility for providing care to the elderly in their place of residence. The program significantly improved previous financial shortfalls and long-term care supply and demand has been met by existing social welfare organization resources.

2010 Aug - Liang YW, Hsu MY

School of Nursing, Chung Shan Medical University, ROC.

Hu li za zhi The journal of nursing

This paper reports on results of a comparative study of the long-term care systems and relevant laws in Germany and the Netherlands. Information and data used was obtained through articles in the literature. The character of long-term care systems and the major elements of such in both countries are described in detail, including system development, organizational structures, insurance coverage, payment systems, services, delivery systems, and financial mechanisms.Findings-based recommendations are then offered related to Taiwan's long- term care and emerging long- term care insurance systems. Based on the long-term care insurance implementation experiences of these two nations, the authors propose several policy recommendations, including the following: Premiums, taxes, and government subsidies should provide the major sources of funding for the system in order to minimize risk and achieve equity in service.

2010 Aug - Lee JL, Lung CH, Liu LF

Institute of Gerontology, National Cheng Kung University, ROC.

Hu li za zhi The journal of nursing

Long- term care insurance, now being intensively discussed as part of the formal governmental agenda, is widely expected to be inaugurated by 2011. As all entitled citizens will be enrolled compulsorily in accordance with social insurance rules, tight scrutiny in the planning process is strongly advised. Equity of financial mechanisms and the efficiency of the delivery system for long-term care should also be carefully considered and maximized. This study explores major empirical suggestions for Taiwan's long-term care insurance scheme from a primarily theoretical point of view. The three relevant issues deliberated in this paper include risk sharing and financial equity in long-term care insurance and long-term care system delivery efficiency. Content focuses on concepts that may be easily misunderstood or misinterpreted by medical professionals.