As the basis for describing the background of the problem this paper uses the work “Knowing the Resident with Dementia: Perspectives of Assisted Living Facility Caregivers” by Joyce Rasin and Donald D. Kautz published in the Journal of Gerontological Nursing. This research reveals the attitudes of two different groups of caregivers: those relying on behavior-centered knowledge and person-centered knowledge. This work also sheds light on the diverse constituencies involved in direct provision, funding, and evaluation of health care delivery to older Americans. The combination of practical research and policy expertise illustrates a rich diversity of perspectives for the modern assisted living facility caregivers. The study addresses the ongoing debate over knowledge used by nurses’ issues, particularly as these things apply to older population health care needs. Several common themes emerge in the study and are highlighted here to present an overview of salient issues related to the role of the gerontological nurses, choice and delivery of retiree health services.
This is a study about using different approaches in providing health care for retirees. One objective of this research is to evaluate several explanations for differing attitudes in health insurance services for people with dementia in assisted living facilities. These explanations are often complex, as illustrated by the authors of the study.
The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.
You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs.
Some of you may ask here: But can people afford health care on their own?
Fourth, we need a reimbursement system that aligns everyone's interests around improving value for patients. Reimbursement must move to single bundled payments covering the entire cycle of care for a medical condition, including all providers and services. Bundled payments will shift the focus to restoring and maintaining health, providing a mix of services that optimizes outcomes, and reorganizing care into integrated practice structures. For chronic conditions, bundled payments should cover extended periods of care and include responsibility for evaluating and addressing complications.
Steward’s aggressive growth has made local doctors like me nervous. But many health systems, for-profit and not-for-profit, share its goal: large-scale, production-line medicine. The way medical care is organized is changing—because the way we pay for it is changing.
Comprehensive reform will require simultaneous progress in all these areas because they are mutually reinforcing. For example, outcome measurement not only will improve insurance-market competition but also will drive the restructuring of care delivery. Delivery restructuring will be accelerated by bundled reimbursement. Electronic medical records will facilitate both delivery restructuring and outcome measurement.
Health-care reforms—public and private—have sought to reshape that system. This year, my employer’s new contracts with Medicare, BlueCross BlueShield, and others link financial reward to clinical performance. The more the hospital exceeds its cost-reduction and quality-improvement targets, the more money it can keep. If it misses the targets, it will lose tens of millions of dollars. This is a radical shift. Until now, hospitals and medical groups have mainly had a landlord-tenant relationship with doctors. They offered us space and facilities, but what we tenants did behind closed doors was our business. Now it’s their business, too.
Emergency Departments face challenges with managing the congestion of patients presented daily, with contributing factors including individual socioeconomic status, the availability of primary health care, insurance rebate policies and the ever growing and aging population.
The big question is whether we can move beyond a reactive and piecemeal approach to a true national health care strategy centered on value. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what's right for patients.
Finally, consumers must become much more involved in their health and health care. Unless patients comply with care and take responsibility for their health, even the best doctor or team will fail. Simply forcing consumers to pay more for their care is not the answer. New integrated care delivery structures, together with bundled reimbursement for full care cycles, will enable vast improvements in patient engagement, as will the availability of good outcome data.
Dr. Porter reports receiving lecture fees from the American Surgical Association, the American Medical Group Association, the World Health Care Congress, Hoag Hospital, and the Children's Hospital of Philadelphia, receiving director's fees from Thermo Fisher Scientific, and having an equity interest in Thermo Fisher Scientific, Genzyme, Zoll Medical, Merck, and Pfizer. No other potential conflict of interest relevant to this article was reported.
Advances in medical science and the underlying demographics of the American society portend that, in the future, the elderly will need even more health services than now. The general level of resources that will be available to provide medical services to the elderly and the allocation of those resources cannot be ignored. Before investigating why Americans feel that all medical services should be available to everyone and before investigating whether this philosophy should be curtailed, it is important to assess the nature of the resource limitations giving rise to the debate over health care rationing.
This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.