ABSTRACT
Just as the voices of people with Alzheimer's disease are driving changes, the voices of caregivers can also facilitate change, which is vital now and for the future. Caregivers play an important role in the educational process.
Subject(s)
Adaptation, Psychological , Alzheimer Disease/prevention & control , Attitude to Health , Caregivers/psychology , Cost of Illness , Family/psychology , Activities of Daily Living/psychology , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Caregivers/education , Female , Humans , Institutionalization , Life Change Events , Male , Middle Aged , Quality of Life , Role , Safety Management , Social Behavior , Social SupportABSTRACT
Hospice care has ancient origins, but its modern history has included a resurgence since the 1960s. Coverage of hospice care by Medicare and other insurers has helped it develop into an important part of today's health care system. Nevertheless, substantial barriers to its ideal use remain. This article discusses those barriers, with an emphasis on organizational and policy considerations. Hospice providers have an opportunity to educate physicians, patients, and families and thus help them to make full use of hospice care's potential.
Subject(s)
Health Care Sector/organization & administration , Hospice Care/organization & administration , Hospices/organization & administration , Cost Savings , Forecasting , Health Policy , Health Services Accessibility/organization & administration , Health Services Needs and Demand , Home Care Services/organization & administration , Hospice Care/psychology , Humans , Insurance Coverage/organization & administration , Medicare/organization & administration , Referral and Consultation/organization & administration , Reimbursement Mechanisms/organization & administration , Skilled Nursing Facilities/organization & administration , United StatesABSTRACT
The national healthcare agenda to improve efficiencies, reduce costs, provide high quality evidence and performance based care while simultaneously meeting stricter legal and regulatory requirements, has forced home care and hospice staff to change the way they work. These pressures require a reliance on new technologies to meet these goals. Through the agency-wide introduction and implementation of a variety of technological systems; electronic medical record/ point of care devises, telehealth, telephony and e-learning the Norwell VNA and Hospice has been able to improve efficiencies for employees allowing the focus of services to remain solely on patients and patient care. The technology has enhanced the agency's performance standards, communication and ultimate outcomes.
Subject(s)
Health Services for the Aged/organization & administration , Home Care Agencies/organization & administration , Home Care Services/organization & administration , Internet/organization & administration , Medical Records Systems, Computerized/organization & administration , Telemedicine/organization & administration , Aged , Community Health Nursing/organization & administration , Computer-Assisted Instruction , Education, Nursing, Continuing , Efficiency, Organizational , Health Care Reform/organization & administration , Home Health Aides/organization & administration , Hospice Care/organization & administration , Humans , Massachusetts , Organizational Innovation , Patient-Centered Care/organization & administration , Point-of-Care Systems/organization & administration , Technology Assessment, Biomedical , TelephoneABSTRACT
OBJECTIVE: The researchers sought to determine what factors might affect the outcomes of remediation, including the likelihood of recidivism, among nurses who had been the subject of disciplinary action and had been put on probation by a state board of nursing. METHODS: Boards of nursing in six states, Arizona, Maryland, Massachusetts, Minnesota, Nebraska, and North Carolina, chose to participate in this exploratory study. A 29-item questionnaire was used to investigate the records of 207 RNs, LPNs, and advanced practice RNs (APRNs) who were disciplined and put on probation by a state nursing board in 2001, as well as to collect data on their employment settings, the boards' actions, and remediation outcomes (the presence or absence of recidivism); 491 nurses who had not been disciplined served as controls. RESULTS: Among the disciplined nurses studied, 57% were RNs, 36% were LPNs, 3% held both RN and LPN licenses, and 3% were APRNs. Of the disciplined group, 39% recidivated between 2001 and 2005. Three factors were shown to influence the recidivism rate: having a history of criminal conviction, having committed more than one violation before the 2001 probation, and changing employers during the probationary period.Data on history of criminal conviction prior to state board disciplinary action were available for 112 (54%) of the 207 nurses. Among those 112, 35% (n = 39) had a history of criminal conviction, whereas only 3% of the control group reported one. The recidivism rate among those with a history of criminal conviction (56%; 22 of 39 nurses) was nearly twice as high as the rate among those without such a history (33%; 24 of 73). Also, 33% of the disciplined nurses changed employers during their probation; the recidivism rate among them was more than twice the rate among the disciplined nurses who stayed with the same employer. The recidivism rate of the 45 disciplined nurses who committed more than one practice-related violation from 1996 through 2001 was twice as high as the rate of those who committed only a single violation.The proportion of men who had been disciplined was more than twice the proportion of men in the national nursing workforce. Younger nurses (both men and women) were more likely to recidivate. CONCLUSIONS: All health care regulators and nursing employers should be aware of the association between a history of criminal conviction and the likelihood of committing a violation that requires state nursing board disciplinary action.
