Hospitals for the excluded or convalescent homes?: workhouses, medicalization and the poor law in long eighteenth-century London and Pre-Confederation Toronto.

Workhouses proliferated throughout England and the British Empire in the eighteenth and nineteenth centuries. Their role in increasingly institutionalized welfare systems has been well studied. Less attention has come to focus on their considerable medical services. Large infirmaries within English workhouses can be found by the early eighteenth century, providing crucial medical care to the very poor. However, levels of workhouse medicalization varied greatly throughout the Atlantic world. This article compares the medical services of workhouses in London with the one established in Pre-Confederation Toronto to assess how and why their medical histories diverge so greatly.

Medicare program; prospective payment system for long-term care hospitals: annual payment rate updates and policy changes. Final rule.

This final rule establishes the annual update of the payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). It also changes the annual period for which the rates are effective. The rates will be effective from July 1 to June 30 instead of from October 1 through September 30, establishing a "long-term care hospital rate year" (LTCH PPS rate year). We also change the publication schedule for these updates to allow for an effective date of July 1. The payment amounts and factors used to determine the updated Federal rates that are described in this final rule have been determined based on this revised LTCH PPS rate year. The annual update of the long-term care diagnosis-related groups (LTC-DRG) classifications and relative weights remains linked to the annual adjustments of the acute care hospital inpatient diagnosis-related group system, and will continue to be effective each October 1. The outlier threshold for July 1, 2003, through June 30, 2004, is also derived from the LTCH PPS rate year calculations. In addition, we are making an adjustment to the short-stay outlier policy for certain LTCHs and a policy change eliminating bed-number restrictions for pre-1997 LTCHs that have established satellite facilities and elect to be paid 100 percent of the Federal rate or when the LTCH is fully phased-in to 100 percent of the Federal prospective rate after the transition period.

Drug prescribing for the elderly outpatient and for those confined to convalescent hospitals. How the new OBRA laws will change some established habits.

Families as well as state and federal inspectors have long complained of unnecessary drugs prescribed by physicians, especially antipsychotic drugs, used as chemical restraints in skilled nursing facilities. The US Congress passed the Omnibus Budget Reconciliation Act of 1987 (OBRA), also commonly referred to as the Nursing Home Reform Act, to prevent inappropriate prescribing of medications in long-term care facilities that receive funds from Medicare and Medicaid. The regulations became effective October 1, 1990 and were enforced starting in 1991. Future regulations regarding drug labeling of all prescriptions, including biologics, are being proposed by the Food and Drug Administration for the protection of the elderly from adverse drug reactions in the community. A survey was performed in a 132-bed convalescent hospital in Los Angeles to assess the most frequent types of drugs ordered and the most frequent diseases found in this facility. The study revealed the most frequent diagnosis and drugs ordered on admission to the facility from acute facilities, home, and board and care facilities. The diagnosis differed, and the drugs the patients were taking differed markedly at the time of admission. Attending physicians in the convalescent hospital changed many of the drugs to meet the needs of the convalescent hospitals as well as the new OBRA regulations. Future prescribing habits of physicians will be modified in convalescent hospitals, and the results will need further studies to assess its effect on patient care.