Elder care for the 1980s: health and social service in one prepaid health maintenance system

Patterns of Health and Social Services Utilization

Utilization of an array of health and social services from formal and informal sources is studied here 1) to identify profiles of services utilization and 2) to predict the location of elderly in these profiles by a set of independent variables such as the sociodemographic characteristics of the elderly, their physical and mental health status and the density of their social support network. Two samples of non-institutionalized elderly living in two middle-sized towns were drawn from the universal old-age Canadian pension scheme. Their utilization of hospital, medical and pharmaceutical services was assessed, and their use of services for help with adivities of daily living was measured by a set of six indicators. A cluster analysis was run to identify profites of services utilization, and a discriminant analysis used the profiles as the criterion to be predicted by a set of variables. Five profiles of utilization were obtained; four of them identified elderly with very few experiences of services utilization and a fifth, a low number of elderly with utilization of all of the services listed in this study. Most of the elderly were users of a small subset of medical and social services. The location of elderly in the profiles was predicted by physical health status, coresidence and income. These results show that health and social services from both formal and informal sources are utilized by elderly. It is suggested that new types of formal agencies which consider the simultaneous delivery of social and health services will succeed inasmuch as they have the ability to interact with a system of informal care.

Evaluation of the annual activity of a continuing medical and home care unit

This report presents the annual activity of a home care unit which operates as an extension of a regional hospital into the community. This 'intermediate-care' (between hospitalization and ambulatory care) was developed because of the demographic and health characteristics of the urban population served and in response to their specific health care needs (immediate availability and accessibility of care). During this period, 471 patients were under care, 85% of whom were 65 years old and over. Forty percent were referred with a diagnosis of a malignant disease, about 20% with a diagnosis of a cerebral event and 15% with cardiac and vascular problems. The average period of stay in the program was three months, with less than 10% remaining under supervision for more than a year. In about 50% of the patients involved the care goals were attained and in an additional 25% (terminal cases) the patients were cared for at home until death. The service was found to be an important factor in the interim phase between acute hospitalization and the continuation of care provided by the family physician. The multidisciplinary team care approach was found to be effective in providing services to that group of patients characterized by old age, multiple medical problems and being homebound. The concerned service is continuously developing in compliance with the changing and growing needs of particular groups of patients such as advanced malignant disease, complex cardiovascular problems and multiple (simultaneous) diseases.

The rationale for siting advanced health technologies at home

In the United States, there is growing determination among health care institutions to slow down cost increases, particularly in acute hospital situations.

One major strategy is to finance and deliver more health care in the home, which is seen as less expensive than institutional alternatives, of equal quality, often more humane, and preferred by many patients. As a result, this practice will most likely become more prevalent as long as quality of care is sustained, even if the costs are comparable to hospital care.