The British Columbia Continuing Care system: service delivery and resource planning.

The Ministry of Health and Ministry Responsible for Seniors in British Columbia, Canada, has developed a comprehensive and integrated service delivery system for the care of the elderly and the disabled. This system has a single point of entry, and contains all of the major components of Long-Term Care and Home Care services under one administrative umbrella, the Continuing Care Division. This paper presents on overview of the Division's service delivery system and its planning framework. The latter provides a vehicle for decision makers to pro-actively re-allocate resources from residential services to community and home-based services within Continuing Care.

Adult Day Care centres in British Columbia: models, characteristics and services.

Adult Day Care (ADC) is increasingly being recognized as an important sub-system of the continuing care system. This paper reviews models developed in the United States and Britain and compares them, and the services they offer, with centres in British Columbia, Canada. Data on British Columbia are from a study in which all 49 centres in the province provided detailed information about their staffing, operating characteristics, activities and services. The study found B.C. compared favourably in providing services needed by ADC clients. Key differences between the B.C. centres and those in the U.S. and U.K. were: a larger proportion of B.C. centres were not affiliated with any other organization; B.C. centres admitted a range of clients and were less likely to cater exclusively to special needs groups; and, B.C. centres were more likely than centres in the U.S. to provide a number of services such as: dental care, transportation, bathing and physiotherapy.

Adult day care centres in British Columbia: client characteristics, reasons for referral and reasons for non-attendance.

This paper discusses a 1989 study of new admissions to 22 adult day care centres in British Columbia and compares it to similar studies in the U.S. The B.C. study investigated clients' characteristics, reasons for referral to the centres, and why some referrals did not attend. Of the new admissions, 63% were female and 30% lived alone. Compared to those in American studies, B.C. clients were older and more likely to live with a spouse. The primary medical conditions of B.C. clients were related to diseases of the circulatory system. As for daily activities, 58% could not bathe without supervision and 43% required assistance with dressing. Some 37% were unable to prepare their own meals; 31% needed help with housekeeping and 62% with shopping. The proportion of clients with mental diseases (38%) was similar to that in American adult day care centres. The three most common reasons for referring clients to adult day care centres were: to assist those who were socially isolated; to give family caregivers some respite; and to give clients emotional help. Perceptions varied as to why referred clients did not attend: for continuing care staff there were psychosocial factors; for adult day care staff it was related to characteristics of the service delivery system; and clients themselves cited functional, physical and operational factors (e.g., problems related to hearing and vision, transportation or physical barriers).

Seniors' perceptions of and attitudes toward the British Columbia continuing care system.

This paper presents the findings of a study of 300 British Columbia seniors living independently in the community, in regard to their knowledge of and attitudes toward the continuing care service delivery system. The study also examined their preferences regarding the type of care they would like to receive if they were to become sick or disabled for an extended period. Seniors living in the community were relatively unaware of the range of formal care services available and how to access them. They were interested in potential new services such as "handyman" services and a medical alert system, and were relatively willing to pay fees for most continuing care services. However, the more "medically" oriented the service (e.g., home nursing care), the less willing they were to pay for it. With regard to care preferences if they were to become sick or disabled, the most popular alternative among those interviewed was to stay at home and receive care from local community agencies.

Conceptual models of the professions and their implications for the professionalization of health administration.

The extent to which health administration can be considered a profession is examined in the context of the five major models of the professions in the literature (historical, trait, functional, economic and power). A synthesis of the various models into a proposed integrative model, or typology of occupations, is also presented. Control over entry and control over conduct are identified as the two major dimensions by which the professional status of various occupations is measured. Health administration is seen as a profession in this context, and the prospects for further professionalization are discussed.

Effect of various routine cytopreparatory techniques on normal urothelial cells and their nuclei.

Nuclear and cytoplasmic sizes of cells in permanent, stained smear preparations differ from those in unfixed unstained cells. In air-dried MGG-stained smears the area of the nucleus is 50% larger and that of the cytoplasm 30% larger. In wet-fixed Papanicolaou-stained smears the nucleus is 10--30% and the cytoplasm is 15--55% smaller. The shrinkage in the wet fixation method is dependent on the concentration of the ethyl alcohol applied. The staining method has relatively little influence on nuclear and cytoplasmic size. The three-dimensional appearance of the smeared, stained cells is also dependent on the cytopreparatory technique applied:in the methods with air-drying the nuclei and cells are flat and in the wet fixation method more spherical. In the methods with air-drying the nuclear:cytoplasmic ratio is larger than that seen with the wet fixation methods.

Cell yield obtained with various cytopreparatory techniques for urinary cytology.

Information concerning the main pitfalls of cytopreparatory techniques, e.g., cell loss, is of paramount importance for general acceptance of the routine use of urinary cytology. Therefore, we studied the cell yield obtained with five Papanicolaou and two May-Grünwald-Giemsa (MGG) smear techniques commonly used in diagnostic cytology laboratories, and compared the results with those obtained with the Millipore filter technique. All smear methods using wet fixation gave very low cell harvests (2-26%), and all methods using air drying gave high cell yield (55-95%), the spray fixation method giving intermediate results (about 40%). Since the morphometric studies showed that there was no preferential cell loss, the cells remaining on the slides can be considered representative of the original cell population. However, if the cell concentration of the urinary sample is extremely low, the Millipore filter and the albumin MGG methods, in both of which cell loss is minimal, are recommended. The results obtained with the spray fixation Papanicolaou method are quantitatively acceptable and qualitatively excellent.