Health care reform and older adults: notes from the Polish experience

Poland enacted in 1997 legislation that founded a health care system in which health insurance societies contract with providers to deliver health services to the insured population. Through a review of the new statutes, interviews with key informants, analysis of public opinion polls and surveys of insurance administrators and health care workers, we examined the impact of reform on Poland's older citizens. The findings indicate that older adults are likely to be adversely affected by the inadequacies of insurance premiums as a source of finance, the lack of emergent private medical enterprise, and the failure to eradicate private health in its earlier, black market incarnation.     

Nursing in tele-mental health

This article discusses a cooperative project involving an academic health sciences center, a state university, a women's shelter, and a community mental health center in East Texas, a medically underserved, rural region of Texas. The U.S. Department of Commerce provided grant funding to develop a telehealth network to provide an evaluation, referral, and treatment program for victims of domestic violence. Nurses were involved in all phases of the project, from initial conception through development, implementation, and evaluation. The authors concluded that all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery.     

Barriers to Implementing a Mentoring Program for Youth in Foster Care: Implications for Practice and Policy Innovation

The aim of this article is to report on the findings of an evaluation of a youth in foster care mentoring pilot program and the difficulty that arises when a program is not well implemented. The pilot program and evaluation of its effectiveness were mandated by the Texas 80th Legislature through the passing of HB 3008. Big Brothers Big Sisters of North Texas implemented the pilot to match youth in foster care age 14 years and older, who participate on a voluntary basis and who have been screened for participation by the Texas Department of Family and Protective Services (DFPS) with an adult mentor. As part of the pilot, youth were to receive 8 h of face-to-face time, and at least 1 h of phone, email, or text contact with their mentor. Though there were problems with implementation of the mentoring pilot, responses on the confidential youth survey suggest that those who did participate had positive experiences. Based on responses on the survey from the youth and based on the existing empirical literature on the benefits of mentoring programs for trouble youth and following the recommendations presented in this article the mentoring programs should be encouraged for youth aging out of foster care.     

Denied Citizens of Turkey: Experiences of Discrimination Among LGBT Individuals in Employment,Housing and Health Care

The purpose of this article is to explore experiences of discrimination against lesbian, gay, bisexual and trans (LGBT) individuals in three domains of social policies: employment, housing and health care — domains in which LGBT individuals are not openly recognized as equal citizens and anti‐discrimination legislation is absent in Turkey. Drawing on qualitative content analysis of the data collected from 14 focus group interviews with 139 LGBT individuals conducted in ten provinces of Turkey in the first half of 2014, this article sheds light on diverse forms of discrimination facing LGBT individuals in employment, housing and health care in a largely under‐researched country. The article concludes that the contemporary understanding of Turkish citizenship and its practice are rooted in heterosexist universalism that does not recognize LGBTs as equal citizens, which, in turn, leads to systematic breaches of LGBTs' social rights in employment, housing and health care. The article shows that even strong and universalistic social policies fail to serve LGBTs on an equal footing with other citizens unless equal citizenship rights of LGBTs and anti‐discrimination principles are recognized and realized.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

A Model for Change: Legislative Advocacy to Improving Access for the Uninsured and Underinsured in New York State 1

Advocates can successfully improve access to health care for people without health insurance. This article demonstrates the success of what began as a local advocacy effort to improve access to health care on Long Island, which later grew to become a major statewide advocacy movement. It explores the process taken by local coalition members to successfully fight for monumental public health legislation—first locally then statewide—to improve access to hospital care for the medically indigent. Using New York State as a model, it includes several approaches that could facilitate the enactment of legislation in other states. The experiences of New York advocates suggest that with focused collaborative efforts it is feasible to promote significant changes to public health laws to benefit the uninsured and underinsured.     

The characteristics and extent of child abuse: findings from a study of the Swedish Social Services child protection

This paper addresses child abuse and the Social Services protection and builds upon a study of verdicts concerning § 2 Care of Young Persons Act (CYPA). The aim was to explore the extent of, and what characterised, the violence the children were being subjected to. A central finding was that of all the applications of § 2 CYPA during one year concerning 196 children, 13–18 years, 70% concerned children reported as subjected to violence. The violence was in most cases described as severe and systematically exerted over many years with intimidating tactics of power and control. More girls than boys were in question for care because of violence. Girls were also to a greater extent reported as having been subjected to sexual abuse or coercive control of their sexuality in relation to standards regarding honour and virginity. In an international perspective the findings can be said to confirm the need to analyse such factors as gender, power and control when research and interventions concerns children abused by their parents. In a Swedish context the findings can be said to suggest that the § 2 CYPA is a crucial intervention to protect children from violence.     

Medicaid Managed Care Programs for High-Risk Older People in Massachusetts

The Commonwealth of Massachusetts has undertaken a major initiative in the development of comprehensive managed health care programs for two sets of high-risk older people: those who are frail and homebound and those who reside in nursing homes. This effort has been coordinated by the state's Department of Public Welfare (DPW; Medical Assistance [Medicaid] Program) and Executive Office of Elder Affairs, and expedited ba a set of Health Care Financy Administration (HCFA) waivers and by the state's revised Nurse Practice Act (MGS Chapter 56). Than act allows nurse-practioners and physician assistants expanded roles as primary providers in home care and nursing home settings. The managed care initiatives have supplemented other efforts (1) to coordinate health and social services for older people, (2) to provide as broad a range as possible of community-based services for older people, and (3) to enroll as many older adults as possible in Health Maintenance Organization (HMO) "Senior Plans" and other similar "Competive Medical Plans."

Though there is still no evidence of the managed care programs' effects, this article summarizes some of the possible risks and benefits of managed care programs for those kinds of populations and presents an agenda of questions that evaluations of managed care programs must address.     

TigerPlace, A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

Primary Care Providers’ Perspectives on Screening Older Adult Patients for Food Insecurity

Food insecurity has been associated with poor health and health outcomes among older adults, yet food assistance resources are available and underutilized. Routine screening and referral for food insecurity in primary care is one avenue to connect food-insecure older adults with available resources. This qualitative study aims to better understand the beliefs of primary care providers (PCPs) about food security screening and referrals in a primary care setting and perceived barriers to implementation. PCPs (n = 16) who have older adult patients but do not routinely screen for food insecurity were interviewed by phone. PCPs recognize the importance of food security for older patients and discuss nutrition and food access with patients under certain circumstances. Concerns emerged with regard to implementing a systematic screening and referral process: limited time to meet with patients, a lack of resources for addressing food insecurity, and prioritizing food insecurity at both the health system and the patient levels. Despite perceived challenges, PCPs are receptive to the idea of systematically screening and referring patients to external resources for food assistance and support. Barriers could be addressed by health systems prioritizing food insecurity as a health concern and public and private payers providing reimbursement for screening.     

Gambling,Drinking and Quality of Life: Evidence from Macao and Australia

The investigation of the interface between psychological constructs, compulsive consumption of alcohol and pathological gambling is an important avenue for development of future initiatives in social marketing or prevention programs. This cross-cultural study attempts to bridge the gap in literature by providing an evaluation of the predictive ability of psychological variables such as gambling urge, gambling-related erroneous cognitions and comorbid alcohol consumption on pathological gambling behaviour and its impact on overall quality of life indicators. Participants consist of 445 Macao and Australian young adults (Mean age = 23 years). Results indicate that probable pathological gamblers as compared with non-gamblers reported significantly lower quality of life in all domains—physical health, psychological well-being, social relationships and environment. Adults who drank more alcohol and have stronger erroneous cognitions evidenced higher pathological gambling behavior. Our research model fits both cohorts and interestingly, erroneous gambling-related cognitions serve as a full mediator for the predictive relationship between gambling urge and pathological gambling in the Macao sample, but serve as a partial mediator in the Australian sample. Targeting erroneous cognitions in future social marketing or preventive campaigns should demonstrate to be an important strategy in reducing the effects of urge to gamble among at-risk individuals. Further implications for the industry, marketing and governmental strategies are discussed.     

Community,Family, and Race/Ethnic Differences in Health Status in Rural Areas1

Abstract Many race-specific differences in health outcomes that have been observed in previous research have been attributed to class and racebased group differences which either facilitate or constrain health opportunities and behaviors. These include such variables as different rates of poverty, health insurance coverage, and access to medical care. However, these relationships have been inadequately examined in rural communities where minority status may be even more detrimental to health than in urban areas, due to various constraints on access to health care. We present an analysis that assesses the effects of community, family structure, sociodemographic, and medical care variables on self-reported health status among Hispanics, Mrican Americans, and non-Hispanic whites in six rural communities in Florida. Community structural characteristics had a significant effect on self-reported health, as did some of the measures of how respondents “experience” community. These relationships held even when other sets of variables were added to the models. Family/household characteristics and sociodemographic and medical care variables were less important in explaining self-reported health status. These findings suggest that community continues to be important in explaining differences in health status in rural areas.     

Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.     

Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.