Shirley S. Travis

Positions of Influence in the Nursing Home Admission Decision

Decisions leading to nursing home admissions have substantial personal and policy consequences, but little research has focused on who is influential in the decision process. We sought to determine which of various social positions were viewed as being very influential in the decision to admit and what factors were associated with perceived level of influence of certain social positions. We examined data from telephone interviews with a sample of 145 responsible parties of first-time, recently admitted nursing home residents in Virginia. Family influence on institutional decision making appears to follow a hierarchical pattern similar to that for preadmission family caregiving. Nursing home residents were infrequently very influential parties to the decision. Health care professionals, especially physicians, were frequently described by sponsors as very influential to the decision process. There is some evidence of a cluster of influence among health professionals and clergy, with the physician occupying a central position in this cluster.

Spousal caregiving when the adult day services center is closed.

Of those spousal caregivers who identified a time when they most needed assistance, morning or afternoon time periods appeared to be most problematic. Spousal caregivers who reported receiving respite time on the weekends identified adult children as the informal support person most often available. However, more than half of the caregivers reported having no respite time during the weekend. Differences in the ways spousal caregivers spent their respite time on the weekends, if available, varied by gender, length of tenure as a caregiver, and age.

Hospitalization experiences in the long-term care trajectories of a medicaid cohort

Two groups of applicants (859 screened in the community and 607 screened in acute care) for Medicaid-reimbursed long-term care were followed for 1 year from their initial long-term care assessments. The role hospitalizations play in long-term care trajectories was explored. Results reinforce the need for active partnerships between acute care and long-term care multidisciplinary teams for ongoing management of a large number of Medicaid clients and their families.

Long-Term Care Patients in Acute Care Facilities: Determining Discharge Arrangements

This research examined 201 hospitalized patients who underwent preadmission screening for Medicaid-reimbursed long-term care. Results suggest that these patients have substantial problems in health andfunctioning and may lack needed informal supports. Availability of community living space is consistently associated with authorization decisions for institutional versus community care and skilled versus intermediate institutional care, as well as expected length of stay in an institutional setting. We discuss implications for further research, nursing practice, and discharge planning strategies for long-term care patients in acute carefacilities.

Medicaid Elders In a Rehabilitative Trajectory

&NA; This research was based on 3,611 cases from the Preadmission Screening Program of the Virginia Department of Medical Assistance Services (Medicaid). As a crude indicator of whether an individual was in a path of recovery, the study explored a rudimentary classification scheme for rehabilitative trajectory. Results indicate that 42 percent of the individuals were in rehabilitative modes of care. These individuals were more likely to be younger and situated in acute care facilities at the time of screening. Rehabilitative track elders were more likely than nonrehabilitative elders to live alone, have more dependency, more needs, more physical impairments, less serious behavior/orientation problems, and need more assistance with medication administration than nonrehabilitative elders. Rehabilitative individuals were also more likely to have one or more dressings and to be receiving a greater number of nutritional services at the time of applying for long‐term care.

Book Reviews : K. Dychtwald (Ed.), Wellness and Health Promotion for the Elderly. Rockville, MD: Aspen Systems Corporations, 1986. 420 pp.

This edited text brings together 37 contributing authors from schools of medicine, social work, public health, and nursing; institutes for gerontology and health and aging; and various research and demonstration projects from around the United States. Beginning with the foreward by Dr. Robert Butler and progressing throughout the book, it is clear that the content was designed and edited to serve as a practical resource for emerging nationwide efforts to promote the well-being of older adults.