Evaluation of care quality for disabled older patients living at home and in institutions.

AIMS AND OBJECTIVES: This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions. BACKGROUND: Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care. DESIGN: Retrospective study extracting patient data from Taiwan's National Health Insurance database. METHODS: We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed. RESULTS: The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death. CONCLUSIONS: Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations. RELEVANCE TO CLINICAL PRACTICE: Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older patients.

[Developing the core competencies of long-term care professionals].

Longer average life expectancies and an ageing society have made long-term care an urgent and important issue in Taiwan. Although the implementation of Long-Term Care Ten-year Project four years ago has begun showing success in terms of assessing Taiwan's needs in terms of long-term care services and resources, there has been little forward progress in terms of training, recruiting and maintaining more competent professionals in the long-term care sector. This paper explores the current state of long-term care competency in Taiwan and educational strategies in place to improve the competency of long-term care professionals. Results indicate that the term geriatric competency embraces sub-competencies in direct care, communication, assessment, teamwork, cultural sensitivities and career care competencies. The term long-term care competency embraces the sub-competencies of supervision, management, information technology, resource management, and organizational skill. As a main contributor to effective long-term care, the nursing profession must employ effective strategies to develop competency-based education. Also, the profession must have an adequate supply of competent manpower to effectively respond to Taiwan's aging society.

Normative physical fitness scores for community-dwelling older adults.

This study was designed to construct normative physical fitness scores for older, functionally independent adults living in the community. The Physical Activities Readiness Questionnaire and Barthel Index were initialized to screen those who have heart illness, arthritis, and functional dependence. After providing informed consent, each participant was instructed to perform seven tests in five categories, including body mass index, muscle strength/endurance (grasp test and 30-s chair stand test), balance (open-eye stand on right foot), flexibility (chair sit-and-reach test), and aerobic endurance (2- and 3-min step tests with preset cadence). Twenty-two assessors were recruited and trained by a physical fitness instructor to ensure acceptable interrater reliability. The valid sample size was 1,104. Test performances were significantly different for male and female participants for all test categories, with the exception of aerobic endurance. Mean scores of all tests correlated negatively with age. The authors constructed the percentile distributions for the seven fitness tests for both genders. Results are expected to be helpful in assessing physical fitness and evaluating physical activity in older adults.

[The education and training of manpower in elderly & long-term care].

With the rapid expansion of the aged population, elderly & long-term care has become a significant issue in Taiwan, as in many developed countries, such as Japan. Service resources in long-term care have benefitted profoundly from investment and development in the past 15 years in Taiwan, but the education and training of manpower in long-term care has only recently begun to be addressed. The purpose of this article is to describe the education and training of nursing manpower in long-term care in Taiwan and in other countries. Three recommendations are also made: (1) To integrate Gerontology Nursing & Practicum into the nursing curriculum to cultivate nursing students with competency in providing direct care and competency in accountability. (2) To prepare RN-BSN students with secondary competency in management/information & communication/activities design. (3) To incorporate faculty from across disciplines in the running of gerontology & long-term care programs in order to develop students' competency in transdisciplinary team work.

[Integrated care systems].

The development of professionalism in the health care industry has resulted in the existence of distinct lines of demarcation between disciplines. Duplication or absence of services, or lack of connection between services has made it difficult to respond to the needs of people with chronic conditions. With the rapid growth of the population with such conditions, the concept of integrated care has been proposed in order to increase accessibility, quality of care, cost sustainability and user satisfaction for such patients. The main content of this paper includes a definition of integrated care, the rationale behind it, and a model for it, as well as the advantages and disadvantages associated with it. Four integrated care systems were selected from different countries: Social HMO and PACE from USA, SIPA from Canada, Japan's community support system and Taiwan's long-term care resources management centers. Recommendations are also provided for members of the nursing profession actively participating in integrated care systems.