Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan.

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.

Community residential facilities in mental health services: A ten-year comparison in Lombardy.

Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.

Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010-December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long-term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long-term IC.

Developing a community driven sustainable model of maternity waiting homes for rural Zambia.

BACKGROUND: maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. OBJECTIVE: the purpose of this study was to explore Zambian stakeholders' beliefs regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) to inform a model for rural Zambia. DESIGN: a qualitative design using a semi-structured interview guide for data collection was used. SETTING: two rural districts in the Eastern province of Zambia. PARTICIPANTS: individual interviews were conducted with community leaders (n=46). Focus groups were held with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia (n=500). MEASURES: latent content analysis was used to analyze the data. FINDINGS: participants were overwhelmingly in support of MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Data suggest that participants can describe features of high quality care, and the type of care they expect from a MWH. Stakeholders acknowledged the need to contribute to the maintenance of the MWH, and that community involvement was crucial to MWH sustainability. KEY CONCLUSIONS: access to facility childbirth remains particularly challenging in rural Zambia and delays in seeking care exist. Maternity waiting homes offer a feasible and acceptable intervention to reduce delays in seeking care, thereby holding the potential to improve maternal outcomes. IMPLICATIONS FOR PRACTICE: this study joins a growing literature on the acceptability, feasibility, and sustainability of MWHs. It is believed that MWHs, by addressing the distance and transportation barriers, will increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low resource areas of Zambia. We recommend that any initiative, such as MWHs, seeking to increase facility-based births with a skilled birth attendant also concurrently addresses any local deficiencies in quality of care.

An Enhanced Variable Two-Step Floating Catchment Area Method for Measuring Spatial Accessibility to Residential Care Facilities in Nanjing.

Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA) method that determines facility catchment sizes by dynamically summing the population around the facility until the facility-to-population ratio (FPR) is less than the FPR threshold (FPRT). To minimize the errors from the supply and demand catchments being mismatched, this paper proposes that the facility and population catchment areas must both contain the other location in calculating accessibility. A case study evaluating spatial accessibility to residential care facilities in Nanjing demonstrates that the proposed method is effective in accurately determining catchment sizes and identifying details in the variation of spatial accessibility. The proposed method can be easily applied to assess other public healthcare facilities, and can provide guidance to government departments on issues of spatial planning and identification of shortage and excess areas.

NHS to close residential hospitals for people with learning disabilities.

Many residential hospitals for people with learning disabilities will be shut over the next two years as part of a government pledge to move people out of these settings following the Winterbourne View abuse scandal.

Shortage of supported housing for people with mental illness: Australia as an exemplar of an international problem.

Social and economic stability promotes recovery and treatment maintenance in people with mental disorders. Research findings are strong that there is a link between economic and housing stability and relapse. To achieve social and economic stability a whole of government approach is required. Policy is not a linear process but rather is an interactive and iterative process in which administrative discretion comes to bare. Demarcations and tensions in terms of interpretation of policy among departments are international phenomena. In Australia, issues exist in the government interdepartmental interpretation of disability that discriminates against those without intellectual disability in securing supported housing. This issue is a good exemplar of the challenges of a whole of government approach to support those with psychiatric disability. The example is of particular concern in light of housing affordability in Australia. The issue is contemporary as Australia rolls out the National Disability Insurance Scheme (NDIS) and struggles to fulfil a commitment to a whole of government approach to care and support for people with a psychiatric disability. Internationally the issue is timely as more countries embrace the philosophy of a whole of government approach to mental health care.

Alternative level of care: Canada's hospital beds, the evidence and options.

Patients designated as alternative level of care (ALC) are an ongoing concern for healthcare policy makers across Canada. These patients occupy valuable hospital beds and limit access to acute care services. The objective of this paper is to present policy alternatives to address underlying factors associated with ALC bed use. Three alternatives, and their respective limitations and structural challenges, are discussed. Potential solutions may require a mix of policy options proposed here. Inadequate policy jeopardizes new acute care activity-based funding schemes in British Columbia and Ontario. Failure to address this issue could exacerbate pressures on the existing bottlenecks in the community care system in these and other provinces.

The role of community-based care capacity in shaping risk of long-term care facility placement.

OBJECTIVES: Across the developed world, wait lists for facility-based long-term care (LTC) beds continue to grow. Wait lists are primarily driven by the needs of aging populations (demand-side factors). Less attention has been given to system capacity to provide community alternatives to LTC (supply-side factors). We examine the role of both demand- and supply-side factors by comparing the characteristics of individuals who have been assessed and deemed eligible for LTC in urban and rural/underserviced parts of northwestern Ontario, Canada. METHODS: Home care assessment data were analyzed for all individuals waiting for LTC in northwestern Ontario as of March 2008 (n=858). For the analysis, the sample was separated into urban and rural groups to account for geographical differences in wait list location. Characteristics between these two groups were compared. RESULTS: Individuals on LTC wait lists in the rural areas were significantly less impaired in activities of daily living and cognition than their counterparts in the urban area. However, in both areas, impairments in lighter-care activities appeared to be a key wait list driver, and few people had an informal caregiver living in the home. CONCLUSIONS: Our data suggest that LTC wait lists reflect, at least to some extent, insufficient community capacity, not just need for LTC.

The BMC ACCESS project: the development of a medically enhanced safe haven shelter.

This paper describes the development and implementation of the Boston Medical Center (BMC) Advanced Clinical Capacity for Engagement, Safety, and Services Project. In October 2002, the BMC Division of Psychiatry became the first such entity to open a Safe Haven shelter for people who are chronically homeless, struggling with severe mental illness, and actively substance abusing. The low-demand Safe Haven model targets the most difficult to reach population and serves as a "portal of entry" to the mental health and addiction service systems. In this paper, the process by which this blended funded, multi-level collaboration, consisting of a medical center, state, city, local, and community-based consumer organizations, was created and is maintained, as well as the clinical model of care is described. Lessons learned from creating the Safe Haven Shelter and the development and implementation of the consumer-informed evaluation are discussed as well as implications for future work with this population.

Assessment of mental health services in Slovenia with The European Service Mapping Schedule.

The aim of our study was to examine availability and utilization of mental health services in the 12 Slovenian statistical regions by using the The European Service Mapping Schedule (ESMS) methodology. 251 mental health services were mapped according to their type as presented in schema of ESMS service tree. Marked differences between regions were noticed in patterns of service provision and utilization. In contrast with the scarcity of mental health services in the Zasavska and Notranjsko-kraska region, the Central-Slovenian region offered the most diverse and abundant choice of services of all statistical regions. We lack day and structured activity services offering work or work-related activities. Out-patient and community services are mainly medium intensity non-mobile services that offer continuing care.

Assisted living and residential care in Oregon: two decades of state policy, supply, and Medicaid participation trends.

PURPOSE: The study describes Oregon state policy and supply developments for licensed long-term-care settings, particularly apartment-style assisted living facilities and more traditional residential care facilities. DESIGN AND METHODS: Data came from a variety of sources, including state agency administrative records, other secondary data sources, and key informant interviews. Descriptive statistics examined public financing, Medicaid reimbursement, and licensed bed supply trends from 1986 to 2004, as well as Medicaid resident use between 1990 and 2004. RESULTS: Residential care expansion, combined with nursing facility contraction, has transformed Oregon's supply of licensed long-term-care settings in favor of less institutional options. State financing, reimbursement, and licensing policies varied across provider type, with greater public resources supporting growth of assisted living facilities. By 2004, such settings were more likely to be Medicaid providers than residential care facilities and had a higher proportion of Medicaid residents relative to available bed supply. IMPLICATIONS: State financing and reimbursement policies may play a role in stimulating the supply of apartment-style assisted living available to low-income and/or rural service users. Less favorable policy conditions may have unintended consequences for the supply and use of other residential care settings.

People with learning disabilities in 'out-of-area' residential placements: 1. Policy context.

BACKGROUND: A growing shortage of residential care for people with learning disabilities leads to placement funded by one authority in another authority's area. Such out-of-area placements are governed by guidance from different government departments in respect of different funding streams. METHOD: This paper presents an analysis of this guidance and shows that it is inconsistent and incomplete. RESULTS AND CONCLUSION: The guidance creates a framework of incentives for health and social services authorities that could lead to people being placed out-of-area against their own best interests, with negative consequences for them and for the 'receiving' authorities. A companion paper uses interview data to examine the reasons for and effects of out-of-area placement.

People with learning disabilities in 'out-of-area' residential placements: 2. Reasons for and effects of placement.

BACKGROUND: Official guidance on out-of-area placements creates incentives that could lead to people being placed against their own best interests, with negative consequences for them and for the 'receiving' authorities. METHOD: Information was collected for 30 people through interviews with them, their families, home managers and care managers. Interviews concerned resident needs, reasons for placement, the homes, care management arrangements, resident quality of life and social inclusion. Information on care standards was abstracted from official records. RESULTS: The main reasons for out-of-area placement were insufficient local services of acceptable quality, financial incentives and loss of family contact through prior institutionalization. The effects varied, with the most disabled people experiencing worst outcomes. Some aspects were worse than comparison studies (choice, community involvement, number of homes meeting all the national minimum standards), some were the same (participation, family visiting and other contact), and one was better (visits to families). Variation was also evident in the involvement of social services staff from the placing authority and in ease of access to local healthcare resources. CONCLUSIONS: Social services and health authorities should develop services locally that can support people with the full range of individual needs. Perverse incentives should be removed, perhaps by increasing the application of direct payments and personalized budgets.

The Olmstead decision: landmark opportunity or platform for rhetoric? Our collective responsibility for full community participation.

Occupational therapy's core values and founding beliefs reflect a commitment to the attainment of a self-directed life that enables full community participation. The reality that this desired outcome remains unattainable for millions of persons with disabilities due to the institutional bias of current public policies cannot be ignored. The Supreme Court's landmark Olmstead decision provides a judicial mechanism to right this fundamental injustice. The executive branch's response to the Olmstead decision, the New Freedom Initiative (NFI), offers the potential to finally end the societal segregation of persons with disabilities. Occupational therapy practitioners share a moral collective responsibility to advocate for the major systemic changes that will be needed to fully implement the NFI and achieve the promise of the Olmstead decision. By joining with the disability rights movement, occupational therapy practitioners can become effective activists to help persons with disabilities attain full participation in life.

[The impact of social welfare policies on the deinstitutionalisation of the mentally ill in Germany]. / Der Einfluss der Ausführungspraxis des Bundessozialhilfegesetzes auf die Deinstitutionalisierung psychisch Kranker.

OBJECTIVE: In Germany the competent institution for supported housing for mentally ill and handicapped persons is traditionally the regional welfare authority, while welfare authorities on state (Lander) level hold the competencies for accommodation in hostels and homes: Assessment of the impact of policies that try to overcome this separation of competencies. METHOD: 1. Analysis of the practise of distributing the competencies for accommodation for mental ill and handicapped persons in the 16 German Lander. 2. Assessment of the supply with accommodation for mental ill and handicapped persons in the Lander. 3. Investigation of a possible relationship between distribution of competencies for accommodation and number of accommodation in supported housing and hostels/homes. RESULTS: Data about available accommodation in supported housing and hostels are inconsistently limited and available. As far as this data can be interpreted, Lander that have the administrative and particularly financial competency for accommodation uniquely organised, generally offer more supported housing. At the same time they provide relatively less accommodation in hostels and homes. Despite having the competencies for accommodation uniquely organised, some Lander continue to provide accommodation for mentally ill persons predominantly in hostels and homes. CONCLUSION: A comprehensive and between the Lander comparable system of documentation of accommodation for mentally ill and handicapped persons is highly needed. Unique organisation of competencies for accommodation of mental ill and handicapped persons is a necessary - however not commensurate precondition for the increase of the supply in supported housing. Beyond that, other factors seem to be influential, such as political will, attitudes towards the mentally ill, interests of hostel providers, pre-existing hostel infrastructure. In respect of these factors more research is needed.

Impact of service supply, need, and municipal factors on the use of residential services for people with intellectual disabilities.

We examined the use of residential services for people with intellectual disabilities in Finland from a regional perspective. Our aims were to investigate how service supply and need, as well as municipal factors, impact the use of residential services and to analyze whether the available information in registers and databases can be effectively utilized in studies of this kind. According to the model based on the register data, after age adjustment the most important factors determining service use were service supply, the prevalence of intellectual disabilities, the municipality's level of urbanization, the number of persons granted long-term care as a percentage of all care recipients, and the percentage of middle-class and managerial households in a given municipality.

Length of stay for psychiatric inpatient services: a comparison of admissions of people with and without developmental disabilities.

This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n = 294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n = 287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalysis in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder.