42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility services...

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... under section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

24 CFR 4.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... process. Assistance within the jurisdiction of the Department to any housing project is subject to Section... nonresidential facilities such as intermediate care facilities, nursing homes and hospitals. It also includes any... services, such as intermediate care facilities, nursing homes, and hospitals. (2) Residential rental...

Medicare: Comparison of Catastropic Health Insurance Proposals--an Update.

DTIC Science & Technology

1987-10-01

Accounting Office ICF intermediate care facility SNF skilled nursing facility VA Veterans Administration d4 ....... ’. - --- MEDICARE: COMPARISON OF...optional woe services, such as home and community-based services; services in an intermediate care facility (ICF); and prescribed drugs, dentures

Medicare: Comparison of Catastrophic Health Insurance Proposals.

DTIC Science & Technology

1987-06-01

GAO General Accounting Office ICF intermediate care facility SNF skilled nursing facility VA Veterans Administration -4 MEDICARE: COMPARISON OF...community-based services; services in an intermediate care facility (ICF); and prescribed drugs, dentures, and eyeglasses. In recent years, the number of

The Healthcare Administrator’s Desk Reference: A Managed Care and Health Care Contracting Dictionary for the Military Health System

DTIC Science & Technology

1998-07-01

Intermediate Care Facility ICN Internal Control Number ICU Intensive Care Unit Desk Reference 59 ID Identification IDC Independent Duty Corpsman IDFN... Intermediate Care Facility -- A less expensive healthcare setting for patients who are not in need of acute or skilled nursing care but yet need more care

Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

PubMed

Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo

2018-04-01

To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

42 CFR 456.351 - Definition.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Definition. As used in this subpart: Intermediate care facility services means those items and services furnished in an intermediate care facility as defined in §§ 440.140 and 440.150 of this subchapter, but...

42 CFR 456.351 - Definition.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Definition. As used in this subpart: Intermediate care facility services means those items and services furnished in an intermediate care facility as defined in §§ 440.140 and 440.150 of this subchapter, but...

42 CFR 456.351 - Definition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Definition. As used in this subpart: Intermediate care facility services means those items and services furnished in an intermediate care facility as defined in §§ 440.140 and 440.150 of this subchapter, but...

78 FR 50057 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... collection; Title of Information Collection: Intermediate Care Facility (ICF) for the Mentally Retarded (MR... intermediate care facility (ICF) for the mentally retarded (MR) provider and client characteristics are...

26 CFR 1.42-11 - Provision of services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... intermediate care facility for the mentally and physically handicapped. See also § 1.42-9(b). (3) Required... intermediate care facility for the mentally or physically handicapped. For a building described in section 42(i...

26 CFR 1.42-11 - Provision of services.

Code of Federal Regulations, 2013 CFR

2013-04-01

... intermediate care facility for the mentally and physically handicapped. See also § 1.42-9(b). (3) Required... intermediate care facility for the mentally or physically handicapped. For a building described in section 42(i...

42 CFR 435.622 - Individuals in institutions who are eligible under a special income level.

Code of Federal Regulations, 2010 CFR

2010-10-01

... THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA General Financial..., nursing facilities, and intermediate care facilities for the mentally retarded who would not be eligible... (hospital, nursing facility, or intermediate level care for the mentally retarded), or by other factors...

Welfare and Taxes: Extending Benefits and Taxes to Puerto Rico, Virgin Islands, Guam, and American Samoa.

DTIC Science & Technology

1987-09-01

including pre- scribed drugs, intermediate care facility services, eyeglasses, dental ser- vi-s, and inpatient psychiatric care for individuals under...does not seek federal Medicaid reim- bursement for required skilled nursing or optional intermediate care facility services. Also, we do not know... care facility services-high-cost Medicaid benefits. 5’. We do not believe assuming such persons would be in institutions in the area is reasonable

24 CFR 891.505 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... reservation. Except for intermediate care facilities for the mentally retarded and individuals with related conditions, this term does not include nursing homes, hospitals, intermediate care facilities, or... designed for the physically disabled, developmentally disabled, or chronically mentally ill depending upon...

24 CFR 891.505 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... reservation. Except for intermediate care facilities for the mentally retarded and individuals with related conditions, this term does not include nursing homes, hospitals, intermediate care facilities, or... designed for the physically disabled, developmentally disabled, or chronically mentally ill depending upon...

24 CFR 891.505 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... reservation. Except for intermediate care facilities for the mentally retarded and individuals with related conditions, this term does not include nursing homes, hospitals, intermediate care facilities, or... designed for the physically disabled, developmentally disabled, or chronically mentally ill depending upon...

24 CFR 891.505 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... reservation. Except for intermediate care facilities for the mentally retarded and individuals with related conditions, this term does not include nursing homes, hospitals, intermediate care facilities, or... designed for the physically disabled, developmentally disabled, or chronically mentally ill depending upon...

24 CFR 891.505 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... reservation. Except for intermediate care facilities for the mentally retarded and individuals with related conditions, this term does not include nursing homes, hospitals, intermediate care facilities, or... designed for the physically disabled, developmentally disabled, or chronically mentally ill depending upon...

An Analysis of Zoning and Other Problems Affecting the Establishment of Group Homes for the Mentally Disabled.

DTIC Science & Technology

1983-08-17

funds from the Medicaid- Intermediate Care Facility /Mentally Retarded Program. 20 \\PPENDIX I AJPENDIX I FACTORS OTHER THAN ZONING AND OTHER LAND-USE...In some places certain types of facilities are officially Title designated by the state as an ICF/MR (or Intermediate Care Facility for

42 CFR 456.654 - Requirements for content of showings and procedures for submittal.

Code of Federal Regulations, 2013 CFR

2013-10-01

... provider number; (7) For each on-site review in a mental hospital, intermediate care facility that... one team member who is a physician; and (8) For each on-site review in an intermediate care facility...

42 CFR 456.654 - Requirements for content of showings and procedures for submittal.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provider number; (7) For each on-site review in a mental hospital, intermediate care facility that... one team member who is a physician; and (8) For each on-site review in an intermediate care facility...

42 CFR 456.654 - Requirements for content of showings and procedures for submittal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provider number; (7) For each on-site review in a mental hospital, intermediate care facility that... one team member who is a physician; and (8) For each on-site review in an intermediate care facility...

One-year follow-up of persons discharged from a locked intermediate care facility.

PubMed

Lamb, H Richard; Weinberger, Linda E

2005-02-01

This study examined outcomes during a one-year follow-up for persons who were discharged from a locked intermediate care facility in an urban area in California. The purpose of this study was to determine the extent to which persons with severe mental illness can be successfully transferred from an intermediate care facility to lower levels of care. A total of 101 persons consecutively discharged were studied by record review and by obtaining information from facility staff members, therapists, case managers, and other community caretakers. During the follow-up period 56 percent of the patients who were discharged from the intermediate care facility were not able to demonstrate even minimal functioning in the community. These persons spent 90 or more days in locked or highly structured institutions that provided 24-hour care (including jail) or had five or more acute hospitalizations. However, 44 percent spent less than 90 days in these institutions and had fewer than five acute hospitalizations. Thirty-three percent were not known to have spent any time in an institution or hospital. The high rate of recidivism shown in this cohort suggests that the current emphasis on transferring patients from more structured, intermediate inpatient services to lower levels of care is not effective for a majority of patients. Furthermore, the poor clinical outcomes found in this cohort did not seem to be offset by any reduction in overall governmental costs because of the high use of acute and intermediate hospitalization and the costs of the criminal justice system.

42 CFR 435.114 - Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336...

Code of Federal Regulations, 2013 CFR

2013-10-01

... eligible for AFDC if he were not in a medical institution or intermediate care facility, and the Medicaid... intermediate care facility, and the current Medicaid plan covers this optional group. ...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2013 CFR

2013-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2012 CFR

2012-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2010 CFR

2010-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2011 CFR

2011-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2014 CFR

2014-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

Code of Federal Regulations, 2010 CFR

2010-10-01

... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

Code of Federal Regulations, 2012 CFR

2012-10-01

... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

Code of Federal Regulations, 2013 CFR

2013-10-01

... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

7 CFR 220.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... detention centers. A long-term care facility is a hospital, skilled nursing facility, intermediate care facility, or distinct part thereof, which is entended for the care of children confined for 30 days or more...

42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

Code of Federal Regulations, 2010 CFR

2010-10-01

... programs if he were not in a medical institution or intermediate care facility, and the Medicaid plan... institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR...

42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

Code of Federal Regulations, 2012 CFR

2012-10-01

... programs if he were not in a medical institution or intermediate care facility, and the Medicaid plan... institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR...

45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 2 2012-10-01 2012-10-01 false Assistance in the form of institutional services in intermediate care facilities. 234.130 Section 234.130 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Assessment of Needs of Adults with Developmental Disabilities in Skilled Nursing and Intermediate Care Facilities in Illinois.

ERIC Educational Resources Information Center

Uehara, Edwina S.; And Others

1991-01-01

This study evaluated 2,815 adults with developmental disabilities in 328 Illinois intermediate care and skilled nursing facilities. Only 10 percent were determined to be appropriately placed in medical settings; 27 percent were enrolled in day training programs; and many individuals recommended for alternative residential settings had medical and…

42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false State plan UR requirements and options; UR plan required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control:...

42 CFR 435.114 - Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336...

Code of Federal Regulations, 2012 CFR

2012-10-01

... in a medical institution or intermediate care facility, and the current Medicaid plan covers this...; or (3) He would have been eligible for AFDC if he were not in a medical institution or intermediate care facility, and the Medicaid plan covered this optional group. (b) The individual would currently be...

42 CFR 435.114 - Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336...

Code of Federal Regulations, 2010 CFR

2010-10-01

... in a medical institution or intermediate care facility, and the current Medicaid plan covers this...; or (3) He would have been eligible for AFDC if he were not in a medical institution or intermediate care facility, and the Medicaid plan covered this optional group. (b) The individual would currently be...

42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false State plan UR requirements and options; UR plan required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control:...

Intermediate Care Facilities for Persons with Mental Retardation (ICFs-MR): Program Utilization and Resident Characterstics. Project Report #31.

ERIC Educational Resources Information Center

Minnesota Univ., Minneapolis. Center for Residential and Community Services.

This report on the Intermediate Care Facility for the Mentally Retarded (ICF-MR) and related programs under Title XIX (Medicaid) of the Social Security Act aims to assist in consideration of improvements to Medicaid services. The report begins with a background description of the key Medicaid programs of interest, discussing: federal involvement…

42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

Code of Federal Regulations, 2013 CFR

2013-10-01

... in a medical institution or intermediate care facility, and the Medicaid plan covered this optional... (2) Would meet all current SSI requirements if he were not in a medical institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR 45204, Sept. 29, 1978...

[Study of methicillin-resistant Staphylococcus aureus colonization among intermediate-care facility patients].

PubMed

Giret, P; Roblot, F; Poupet, J Y; Thomas, P; Lussier-Bonneau, M D; Pradère, C; Becq-Giraudon, B; Fauchère, J L; Castel, O

2001-08-01

Prevalence of methicillin-resistant Staphylococcus aureus is high in the Poitiers teaching hospital, particularly in the intermediate care facilities. We performed a survey of methicillin-resistant Staphylococcus aureus colonization in the intermediate care facilities and 265 patients were included. Nasal, cutaneous and wound swab cultures were done at the time of admission and at the time of the patients' departure. A decolonization procedure of methicillin-resistant Staphylococcus aureus carriers was performed using nasal application of fusidic acid and different soaps for the skin. At entry, 17.7% of patients were methicillin-resistant Staphylococcus aureus carriers (of at least one location). At departure, 30.4% were methicillin-resistant Staphylococcus aureus carriers. Among methicillin-resistant Staphylococcus aureus non-carriers at entry, 24.3% became methicillin-resistant Staphylococcus aureus carriers. The principal risk factor of carriage was the initial presence of a wound (RR = 3.6). The incidence rate of methicillin-resistant Staphylococcus aureus infection among the 265 patients included was 3%. The systematic screening of patients at the time of admission is expensive and isolation technically hard to manage in the intermediate care facilities. The risk factor we found in this study allow us to propose a 'light' screening limited to patients with wounds.

24 CFR 232.522 - Inspection fee.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety...

24 CFR 232.560 - Interest rate.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety...

24 CFR 232.600 - Title evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety...

42 CFR 483.450 - Condition of participation: Client behavior and facility practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally... quickly as possible, and a record of these checks and usage must be kept. (5) Restraints must be designed...

42 CFR 483.450 - Condition of participation: Client behavior and facility practices.

Code of Federal Regulations, 2013 CFR

2013-10-01

... LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals... and usage must be kept. (5) Restraints must be designed and used so as not to cause physical injury to...

42 CFR 483.450 - Condition of participation: Client behavior and facility practices.

Code of Federal Regulations, 2012 CFR

2012-10-01

... LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals... and usage must be kept. (5) Restraints must be designed and used so as not to cause physical injury to...

42 CFR 483.450 - Condition of participation: Client behavior and facility practices.

Code of Federal Regulations, 2011 CFR

2011-10-01

... LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally... quickly as possible, and a record of these checks and usage must be kept. (5) Restraints must be designed...

42 CFR 483.450 - Condition of participation: Client behavior and facility practices.

Code of Federal Regulations, 2014 CFR

2014-10-01

... LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals... and usage must be kept. (5) Restraints must be designed and used so as not to cause physical injury to...

Clinical characteristics and service use of persons with mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

1999-10-01

The study examined the characteristics of residents living in a 450-bed intermediate care facility for persons with severe mental illness in Illinois and sought to determine the factors predicting their utilization of mental health services. Data on 100 randomly selected residents with a chart diagnosis of schizophrenia were collected using chart review and interviews. Data for 78 residents whose diagnosis of schizophrenia or schizoaffective disorder was confirmed using the Structured Clinical Interview for DSM-IV were included in the analyses. Fifty-three percent of the residents used facility-based specialty mental health services beyond medication management, such as group therapy or a day program. Persons with the least severe psychiatric illnesses and with higher levels of motivation for overall care used the most mental health services. Thirty-five percent of the residents had been discharged to an inpatient psychiatric unit during the previous year. Residents most likely to be discharged to those settings were young men with a history of homelessness who refused facility-based health services. Despite recent policy-driven efforts to improve care in this intermediate care facility for persons with mental illness, the facility continues to have problems addressing the mental health needs of the residents.

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

24 CFR 232.830 - Definition of default.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract of...

24 CFR 232.890 - Characteristics of debentures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract...

24 CFR 200.24 - Existing projects.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 207 of the Act, or for refinancing the existing debt of an existing nursing home, intermediate care facility, assisted living facility, or board and care home, or any combination thereof, under...

24 CFR 232.860 - Commissioner's right to require acceleration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract...

24 CFR 232.840 - Date of default.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract of Insurance § 232...

24 CFR 232.865 - Election by lender.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract of Insurance § 232...

24 CFR 232.850 - Notice of default.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Contract Rights and Obligations Rights and Duties of Lender Under the Contract of Insurance § 232...

Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule.

PubMed

2003-01-10

This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions.

Factors Associated with Expenditures for Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Services for Persons with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Lakin, K. Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger J.; Taub, Sarah; Chiri, Giuseppina

2008-01-01

This article examines expenditures for a random sample of 1,421 adult Home and Community Based Services (HCBS) and Intermediate Care Facility/Mental Retardation (ICF/MR) recipients in 4 states. The article documents variations in expenditures for individuals with different characteristics and service needs and, controlling for individual…

2014 QuickCompass of TRICARE Child Beneficiaries: Utilization of Medicaid-Waivered Services. Tabulation of Responses

DTIC Science & Technology

2014-08-30

management) Long term care (e.g., home health care, hospice, integrated personal care, intermediate care facilities for the mentally retarded, nurse ... aide training and testing, and nursing facilities) Medical equipment (e.g., medically necessary supplies, including oxygen, catheters, and reusable

Medicaid program; modification of the Medicaid upper payment limit transition period for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Final rule.

PubMed

2001-09-05

This final rule modifies the Medicaid upper payment (UPL) limit provisions by establishing a new transition period for States that submitted plan amendments before March 13, 2001 that do not comply with the new UPLs effective on that date (but do comply with the prior UPLs) and were approved on or after January 22, 2001. This new transition period applies to payments for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services.

Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

ERIC Educational Resources Information Center

Braun, Kathryn L.; Rose, Charles L.

1989-01-01

Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

Agents of Nursing Home Quality of Care: Ombudsmen and Staff Ratios Revisited.

ERIC Educational Resources Information Center

Cherry, Ralph L.

1991-01-01

Compared effects of ombudsman programs on quality of nursing home care on random sample of 134 Medicare/Medicaid-certified long-term care facilities in Missouri. Found that presence of ombudsman program was most important factor associated with quality for intermediate-care facilities, and was significantly associated with quality for skilled…

[Palliative care pathways of older patients].

PubMed

Zubieta, Lourdes; Hébert, Réjean; Raîche, Michel

To determine the palliative care pathways of older patients in Sherbrooke, Qc by examining their transfers to other facilities. This analysis was conducted by linking 3 databases: emergency department, hospitalizations and nursing homes. The study period ranged from January 2011 to December 2015. SPSS was used for statistical analysis. The study only included palliative care patients. 25% of patients waited less than 7 days for transfer, and 74% waited less than 3 weeks. 64.9% of patients were transferred to a long-term facility for dependent adults (LTF), 15.2% returned home or were transferred to private accommodation, and 15.9% were transferred to an intermediate care facility. One-half of patients subsequently changed facility, mainly those in homes or intermediate care. Palliative care patient bed occupation rates represented 1% of available bed-days and less than 2% of total beds for 86.4% of days. Only 12% of patients returned to hospital within 90 days after discharge. The number of beds occupied by palliative care patients does not seem to disrupt the hospital capacity. The majority of the palliative care patients were well managed, as reflected by the low readmission rate. Our results indicate good management of transfers and an adequate supply of long-term care facilities and home services.

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

24 CFR 232.515 - Refund of fees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety... that the installation of fire safety equipment for the project has been prevented because of...

Health care and personal care needs among residents in nursing homes, group homes, and congregate housing in Japan: why does transition occur, and where can the frail elderly establish a permanent residence?

PubMed

Nakanishi, Miharu; Hattori, Keiko; Nakashima, Taeko; Sawamura, Kanae

2014-01-01

Japan has had high rates of transition to nursing homes from other long term care facilities. It has been hypothesized that care transitions occur because a resident's condition deteriorates. The aim of the present study was to compare the health care and personal care needs of residents in nursing homes, group homes, and congregate housing in Japan. The present study was conducted using a cross-sectional study design. The present study included 70,519 elderly individuals from 5 types of residential facilities: care medical facilities (heavy medical care; n = 17,358), geriatric intermediate care facilities (rehabilitation aimed toward a discharge to home; n = 26,136), special nursing homes (permanent residence; n = 20,564), group homes (group living, n = 1454), and fee-based homes for the elderly (congregate housing; n = 5007). The managing director at each facility provided information on the residents' health care and personal care needs, including activities of daily living (ADLs), level of required care, level of cognitive impairment, current disease treatment, and medical procedures. A multinomial logistic regression analysis demonstrated a significantly lower rate of medical procedures among the residents in special nursing homes compared with those in care medical facilities, geriatric intermediate care facilities, group homes, and fee-based homes for the elderly. The residents of special nursing homes also indicated a significantly lower level of required care than those in care medical facilities. The results of our study suggest that care transitions occur because of unavailable permanent residence option for people who suffer with medical deterioration. The national government should modify residential facilities by reorganizing several types of residential facilities into nursing homes that provide a place of permanent residence. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the... psychiatric facilities, and mental hospitals; and (2) At least quarterly in ICFs; (c) Tests or observations of...

Facilitating earlier transfer of care from acute stroke services into the community.

PubMed

Robinson, Jennifer

This article outlines an initiative to reduce length of stay for stroke patients within an acute hospital and to facilitate earlier transfer of care. Existing care provision was remodelled and expanded to deliver stroke care to patients within a community bed-based intermediate care facility or intermediate care at home. This new model of care has improved the delivery of rehabilitation through alternative and innovative ways of addressing service delivery that meet the needs of the patients.

Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities. Final rule.

PubMed

2016-05-04

This final rule will amend the fire safety standards for Medicare and Medicaid participating hospitals, critical access hospitals (CAHs), long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IID), ambulatory surgery centers (ASCs), hospices which provide inpatient services, religious non-medical health care institutions (RNHCIs), and programs of all-inclusive care for the elderly (PACE) facilities. Further, this final rule will adopt the 2012 edition of the Life Safety Code (LSC) and eliminate references in our regulations to all earlier editions of the Life Safety Code. It will also adopt the 2012 edition of the Health Care Facilities Code, with some exceptions.

Medicaid: Methods for Setting Nursing Home Rates Should be Improved.

DTIC Science & Technology

1986-05-01

care facility SNF skilled nursing facility Page 7 GAO/HRJD.W626 Medicaid Nursing Home Rate Setting A,, I-?A -WI...consumer price index GNP Gross National Product HCFA Health Care Financing Administration HHS Department of Health and Human Services ICF intermediate

24 CFR 232.540 - Method of loan payment and amortization period.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety Equipment Eligible Security Instruments § 232.540 Method of loan...

42 CFR 483.405 - Relationship to other HHS regulations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded § 483.405 Relationship... participation under this Part, their violation may result in the termination or suspension of, or the refusal to...

42 CFR 483.440 - Condition of participation: Active treatment services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded... (c)(3) of this section; and (ii) Designing programs that meet the client's needs. (2) Appropriate... individual; and (v) Be assigned priorities. (5) Each written training program designed to implement the...

42 CFR 483.440 - Condition of participation: Active treatment services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded... (c)(3) of this section; and (ii) Designing programs that meet the client's needs. (2) Appropriate... individual; and (v) Be assigned priorities. (5) Each written training program designed to implement the...

The initial electrocardiogram during admission for myocardial infarction. Use as a predictor of clinical course and facility utilization.

PubMed

Stark, M E; Vacek, J L

1987-05-01

The first electrocardiogram obtained on presentation for suspected myocardial infarction was examined for its usefulness in predicting clinical course and facility use. We studied 221 patients consecutively admitted to a nonuniversity hospital coronary care unit. High-risk patients were identified if the electrocardiographic diagnoses included myocardial infarction, ischemia, left ventricular hypertrophy, left bundle-branch block, or paced rhythm. These 63 patients (29% of total) had significantly greater incidences of serious events, need for procedures, and death than low-risk patients whose initial electrocardiograms did not carry the above diagnoses. Patients with a low-risk initial electrocardiogram may not require the facilities of a coronary care unit and perhaps could be safely observed in an intermediate care area. However, many hospitals do not have an intermediate care facility available, and in those that do, daily costs may not be markedly different than for treatment in a coronary care unit. Whether these low-risk patients could be safely treated in general medicine beds, where potential cost savings would be much greater, is unknown.

Reaching out to the forgotten: providing access to medical care for the homeless in Italy

PubMed Central

De Maio, Gianfranco; Van den Bergh, Rafael; Garelli, Silvia; Maccagno, Barbara; Raddi, Freja; Stefanizzi, Alice; Regazzo, Costantina; Zachariah, Rony

2014-01-01

Background A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program. Methods A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data. Results Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care. Conclusions The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system. PMID:24505079

42 CFR 483.400 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Basis and purpose. 483.400 Section 483.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for...

42 CFR 483.400 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Basis and purpose. 483.400 Section 483.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for...

42 CFR 483.400 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Basis and purpose. 483.400 Section 483.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for...

42 CFR 483.440 - Condition of participation: Active treatment services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with... assessments required in paragraph (c)(3) of this section; and (ii) Designing programs that meet the client's... designed to implement the objectives in the individual program plan must specify: (i) The methods to be...

42 CFR 483.440 - Condition of participation: Active treatment services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with... assessments required in paragraph (c)(3) of this section; and (ii) Designing programs that meet the client's... designed to implement the objectives in the individual program plan must specify: (i) The methods to be...

42 CFR 483.440 - Condition of participation: Active treatment services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with... assessments required in paragraph (c)(3) of this section; and (ii) Designing programs that meet the client's... designed to implement the objectives in the individual program plan must specify: (i) The methods to be...

42 CFR 483.480 - Condition of participation: Dietetic services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with Intellectual..., including clients in wheelchairs; (3) Equip areas with tables, chairs, eating utensils, and dishes designed...

42 CFR 483.480 - Condition of participation: Dietetic services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with Intellectual..., including clients in wheelchairs; (3) Equip areas with tables, chairs, eating utensils, and dishes designed...

42 CFR 483.480 - Condition of participation: Dietetic services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FACILITIES Conditions of Participation for Intermediate Care Facilities for Individuals with Intellectual..., including clients in wheelchairs; (3) Equip areas with tables, chairs, eating utensils, and dishes designed...

24 CFR 232.625 - Discrimination prohibited.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Special Requirements § 232.625 Discrimination prohibited. Any contract or...

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Sunlight and health: attitudes of older people living in intermediate care facilities in southern Australia.

PubMed

Durvasula, Seeta; Kok, Cindy; Sambrook, Philip N; Cumming, Robert G; Lord, Stephen R; March, Lynette M; Mason, Rebecca S; Seibel, Markus J; Simpson, Judy M; Cameron, Ian D

2010-01-01

Older people have a high prevalence of falls and fractures, partly due to vitamin D deficiency. Sunlight is a major source of vitamin D, but many older people living in intermediate care facilities have inadequate sunlight exposure. The aim of this study was to determine the sun exposure practices and attitudes to sunlight in this population. Fifty-seven older residents of intermediate care facilities in Sydney, Australia were interviewed to determine their sun exposure practices, their views on sunlight and health and whether these have changed over their lives, factors affecting sunlight exposure and their knowledge of vitamin D. Sixty percent of the participants preferred to be outdoors, despite more than 92% believing that sunlight was healthy. In their youth however, almost 90% had preferred to be outdoors. Poor health, physical constraints and a sense of lack of ownership of outdoor spaces were barriers to sunlight exposure. Improved physical access, more outdoor leisure activities and promotion of greater autonomy may improve safe and appropriate sunlight exposure in this population. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

42 CFR 441.11 - Continuation of FFP for institutional services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... individuals under age 21. (6) Nursing facility services for individuals under 21. (7) Intermediate care facility services for individuals with intellectual disabilities. [59 FR 56234, Nov. 10, 1994] ...

42 CFR 441.11 - Continuation of FFP for institutional services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... individuals under age 21. (6) Nursing facility services for individuals under 21. (7) Intermediate care facility services for individuals with intellectual disabilities. [59 FR 56234, Nov. 10, 1994] ...

42 CFR 483.480 - Condition of participation: Dietetic services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded § 483.480... wheelchairs; (3) Equip areas with tables, chairs, eating utensils, and dishes designed to meet the...

42 CFR 483.480 - Condition of participation: Dietetic services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FACILITIES Conditions of Participation for Intermediate Care Facilities for the Mentally Retarded § 483.480... wheelchairs; (3) Equip areas with tables, chairs, eating utensils, and dishes designed to meet the...

24 CFR 232.902 - Eligible project.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... sufficient to pay operating expenses, annual debt service and reserve fund for replacement requirements) as...

42 CFR 483.400 - Basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Basis and purpose. 483.400 Section 483.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for th...

42 CFR 483.400 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Basis and purpose. 483.400 Section 483.400 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate Care Facilities for th...

76 FR 71442 - Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-17

... DEPARTMENT OF VETERANS AFFAIRS Enhanced-Use Lease (EUL) of Department of Veterans Affairs (VA) Real Property for the Development of a Skilled and Intermediate Nursing Home Care Facility in Mather... construct, renovate, operate, and maintain a permanent long-term care facility (skilled nursing home and...

Outcomes of Tracheostomized Subjects Undergoing Prolonged Mechanical Ventilation in an Intermediate-Care Facility.

PubMed

Herer, Bertrand

2018-03-01

The incidence of chronically ill subjects with prolonged mechanical ventilation (PMV) has significantly increased over the last decade because of improvements in acute critical care. The aim of this study was to describe the outcomes and care pathways of subjects receiving PMV through a tracheostomy tube in an intermediate-care facility. Sixty-six subjects with chronic respiratory failure who experienced 109 hospitalizations between December 2010 and December 2012 in a 34-bed post-care unit were retrospectively included and followed for at least 1 y. The median (interquartile range [IQR]) length of stay (LOS) was 42 (26-77) d. Subjects were admitted from home (40.4%), our hospital ICU (40.4%; median [IQR] LOS = 17 [7-38] d), or another hospital (19.2%; median [IQR] LOS = 60 [8-71] d, P = .001 vs LOS in ICU). Thirty-five percent of subjects were readmitted at least once during the follow-up period. Sixteen subjects died in the intermediate-care facility. Discharge destinations of alive subjects were home ( n = 78), another hospital ( n = 6), a skilled-nursing facility ( n = 5), or an ICU ( n = 4). A complete or partial weaning was obtained in 30.3% of subjects. One year after the first day of hospitalization, 57% of subjects were alive. Despite the chance of survival at 1 y and/or weaning from ventilation, the resources needed by subjects with PMV are high, as shown by the number of readmissions and long LOS in our unit and in other hospital units before transfer. Copyright © 2018 by Daedalus Enterprises.

A facility-wide approach to recreation programming for adults who are severely and profoundly retarded.

PubMed

Burch, M R; Reiss, M; Bailey, J S

1985-01-01

A facility-wide recreation program was designed and implemented in order to increase staff and client participation in daily leisure activities at an intermediate care facility for severely and profoundly mentally retarded adults. The baseline phase of the study consisted of having recreational materials available during scheduled recreation periods. The treatment was a package program consisting of (1) providing the staff with preplanned materials and activities, (2) assigning staff to specific roles, and (3) monitoring staff and providing feedback by supervisors. The treatment was implemented on the two living units of the Liberty Intermediate Care Facility. Treatment effects were similar on both units. Client participation increased from a baseline average of less than 10% to nearly 50% and staff participation increased from less than 10% to an average of 60% during program implementation.

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

24 CFR 232.535 - Loan multiples-minimum principal.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.535 Loan multiples—minimum principal...

24 CFR 232.610 - Certification of cost requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Cost Certification Requirements § 232.610 Certification of cost requirements...

24 CFR 232.545 - Covenant against liens.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Eligible Security Instruments § 232.545 Covenant against liens. (a) The security...

Serum procalcitonin is a marker for prediction of readmission from an intermediate care to an acute care hospital in neurosurgical patients.

PubMed

Lim, Jia Xu; King, Nicolas; Low, Sharon; Ng, Wai Hoe

2015-01-01

Readmission of patients to acute hospitals contributes significantly toward inefficient utilization of healthcare resources, with studies quoting up to 90% being preventable. We aim to report and analyze the factors involved in the readmission of neurosurgical patients who had been previously transferred to an intermediate step-down care facility, and explore possible predictive markers for such readmissions. We conducted a retrospective analysis of all 129 neurosurgical patients who were transferred from out acute tertiary hospital to an intermediate care facility. The cases were segregated into those who were readmitted and those who were not readmitted back to our acute center. The demographic data, clinical features, diagnoses, treatment modalities, pretransfer laboratory findings, and inpatient complications were compared with readmission rate. There were 23 patients (17.8%) who were readmitted to our acute hospital. The most common causes of readmission was infection (n = 12, 52.2%). We found a statistically significant correlation between the higher pretransfer procalcitonin levels with the readmission of our patients (P = 0.037). There was also a significant difference noted between ethnic groups (P = 0.026) and having no complications of disease or treatment (P = 0.008), with readmission. Procalcitonin is a pro-hormone known to correlate with infection and poor neurological status. We have found that its serum values correlate significantly with the readmission rates of neurosurgical patients in our study. We postulate that by ensuring normality in procalcitonin levels prior to transfer to an intermediate care facility, potentially half of neurosurgical readmissions can be prevented.

Serum procalcitonin is a marker for prediction of readmission from an intermediate care to an acute care hospital in neurosurgical patients

PubMed Central

Lim, Jia Xu; King, Nicolas; Low, Sharon; Ng, Wai Hoe

2015-01-01

Background: Readmission of patients to acute hospitals contributes significantly toward inefficient utilization of healthcare resources, with studies quoting up to 90% being preventable. We aim to report and analyze the factors involved in the readmission of neurosurgical patients who had been previously transferred to an intermediate step-down care facility, and explore possible predictive markers for such readmissions. Methods: We conducted a retrospective analysis of all 129 neurosurgical patients who were transferred from out acute tertiary hospital to an intermediate care facility. The cases were segregated into those who were readmitted and those who were not readmitted back to our acute center. The demographic data, clinical features, diagnoses, treatment modalities, pretransfer laboratory findings, and inpatient complications were compared with readmission rate. Results: There were 23 patients (17.8%) who were readmitted to our acute hospital. The most common causes of readmission was infection (n = 12, 52.2%). We found a statistically significant correlation between the higher pretransfer procalcitonin levels with the readmission of our patients (P = 0.037). There was also a significant difference noted between ethnic groups (P = 0.026) and having no complications of disease or treatment (P = 0.008), with readmission. Conclusion: Procalcitonin is a pro-hormone known to correlate with infection and poor neurological status. We have found that its serum values correlate significantly with the readmission rates of neurosurgical patients in our study. We postulate that by ensuring normality in procalcitonin levels prior to transfer to an intermediate care facility, potentially half of neurosurgical readmissions can be prevented. PMID:26430533

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

24 CFR 232.591 - Smoke detectors.

Code of Federal Regulations, 2013 CFR

2013-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... room is occupied by hearing-impaired persons, the smoke detector must have an alarm system designed for...

24 CFR 232.591 - Smoke detectors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... room is occupied by hearing-impaired persons, the smoke detector must have an alarm system designed for...

24 CFR 232.591 - Smoke detectors.

Code of Federal Regulations, 2012 CFR

2012-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... room is occupied by hearing-impaired persons, the smoke detector must have an alarm system designed for...

24 CFR 232.591 - Smoke detectors.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... room is occupied by hearing-impaired persons, the smoke detector must have an alarm system designed for...

24 CFR 232.591 - Smoke detectors.

Code of Federal Regulations, 2014 CFR

2014-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... room is occupied by hearing-impaired persons, the smoke detector must have an alarm system designed for...

24 CFR 232.893 - Cash adjustment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING... the lender and the total amount of the lender's claim, as approved by the Commissioner, may be...

24 CFR 232.590 - Eligibility of property.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Property Requirements § 232.590 Eligibility of property. (a) A loan to be...

24 CFR 232.530 - Disbursement of proceeds.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Eligible Security Instruments § 232.530 Disbursement of proceeds. At the time of...

24 CFR 232.585 - Prepayment privilege and prepayment charge.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.585 Prepayment privilege and prepayment...

24 CFR 232.586 - Minimum principal loan amount.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.586 Minimum principal loan amount. A...

24 CFR 232.550 - Accumulation of next premium.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.550 Accumulation of next premium. The...

24 CFR 232.555 - Security instrument and lien.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.555 Security instrument and lien. The...

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

PubMed

Suzuki, Mizue; Hattori, Hideyuki; Fukuda, Koji; Ooshiro, Hajime; Saruhara, Takayuki; Furuta, Yoshie; Abe, Kunihiko; Kanamori, Masao

2017-01-01

The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...

26 CFR 1.42-9 - For use by the general public.

Code of Federal Regulations, 2010 CFR

2010-04-01

... part of a hospital, nursing home, sanitarium, lifecare facility, trailer park, or intermediate care facility for the mentally and physically handicapped is not for use by the general public and is not...

26 CFR 1.42-9 - For use by the general public.

Code of Federal Regulations, 2013 CFR

2013-04-01

... part of a hospital, nursing home, sanitarium, lifecare facility, trailer park, or intermediate care facility for the mentally and physically handicapped is not for use by the general public and is not...

Nonprofit ownership and quality in Medicaid's longterm care program for persons with developmental disabilities.

PubMed

Brown, Samuel L

2002-01-01

To assess ownership-related differences in the Intermediate Care Facility Program for persons with Mental Retardation (ICF/MR) Industry, this article analyzes a nationally representative sample of data on Medicaid certified facilities from the Health Care Financing Administration On-line Survey and Certification Reporting System. This study found that nonprofit providers provided a higher level of quality than for-profit facilities when organizational size and facility-mix were controlled. The size and case-mix composition of these facilities were also influenced by nonprofit ownership type. Nonprofit providers offered smaller facilities, on average, and were more likely to enroll heavy case-mix residents than their for-profit counterparts.

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

24 CFR 232.525 - Note and security form.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Eligible Security Instruments § 232.525 Note and security form. The lender shall...

Living in interesting times: applying creative strategic planning.

PubMed

Jessome, P

1995-01-01

Rapidly changing expectations and environments have put health care facilities under increasing pressure. Using traditional strategic planning to deal with these challenges has often produced disappointing results. This article outlines a different approach, based on Robert Fritz's model of the creative process, and discusses its application in Kiwanis Lodge in West Vancouver, an intermediate care facility.

75 FR 4963 - Federal Housing Administration (FHA): Hospital Mortgage Insurance Program-Refinancing Hospital Loans

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... impact on hospitals across the Nation. At a time when the demand for health care services is on the rise... capital to help hospitals refinance debt was sufficiently available, and that the demand for this type of... nursing home, existing assisted living facility, existing intermediate care facility, existing board and...

78 FR 34387 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... Facility Survey CMS-3070--Intermediate Care Facility (ICF) for the Mentally Retarded (MR) or Persons with Related Conditions Survey Report Form CMS-10336--Medicare and Medicaid Programs: Electronic Health Record... Renal Disease (ESRD) Medical Information Facility Survey; Use: The End Stage Renal Disease (ESRD...

Reaching out to the forgotten: providing access to medical care for the homeless in Italy.

PubMed

De Maio, Gianfranco; Van den Bergh, Rafael; Garelli, Silvia; Maccagno, Barbara; Raddi, Freja; Stefanizzi, Alice; Regazzo, Costantina; Zachariah, Rony

2014-06-01

A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program. A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data. Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care. The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Risk of fractures in an intermediate care facility for persons with mental retardation.

PubMed

Tannenbaum, T N; Lipworth, L; Baker, S

1989-01-01

The epidemiology of fractures among 553 residents of an intermediate care facility for persons with mental retardation was examined. In a 10-month period, 61 fractures occurred among 55 residents; application of fracture rates in the United States revealed an expected number of 15 fractures among the 553 residents, p less than .001. Although 52% of fractures involved small bones of the hands and feet, elderly residents were more likely to fracture major bones and to suffer their fractures from a fall than were younger residents. The relationship between potential risk factors and fracture risk were examined and implications for preventive and rehabilitative measures discussed.

24 CFR 232.595 - Eligibility of title.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Title § 232.595 Eligibility of title. In order for the property which is to be...

Foundation Care: A Treatment Model for Nonambulatory Profoundly Mentally Retarded Persons.

ERIC Educational Resources Information Center

LaMendola, Walter F.; And Others

1987-01-01

Two institutional treatment models--Intermediate Care Facilities and Foundation Care--were compared with 30 profoundly mentally retarded adults. The Foundation Care model (which emphasized habilitation through health, nurturance, stimulation, and play) demonstrated more resident-oriented management practices and used more tactile modalities and…

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...

Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care.

PubMed

Soley-Bori, Marina; Benzer, Justin K; Burgess, James F

2018-04-01

To assess the influence of relational climate on quality of diabetes care. The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets. Multilevel panel data (2008-2012) with patients nested into clinics. Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure). The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes. Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care. © Health Research and Educational Trust.

42 CFR 442.117 - Termination of certification for ICFs/MR whose deficiencies pose immediate jeopardy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED Certification of... provider agreement, follow the appeals process specified in part 431, subpart D of this chapter. [51 FR...

42 CFR 456.608 - Personal contact with and observation of recipients and review of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608 Personal...

24 CFR 232.520 - Maximum fees and charges by lender.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Fees and Charges § 232.520 Maximum fees and charges by lender. The lender...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

A Comprehensive Staff Approach to Problem Wandering.

ERIC Educational Resources Information Center

Rader, Joanne

1987-01-01

Describes specific comprehensive program implemented in intermediate care facility/skilled nursing facility that reduced problematic wandering by patients, increased patient freedom and safety, and increased staff skill and comfort in handling wandering behaviors. Describes program components, problem identification, prevention programs,…

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

PubMed

2001-01-12

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

Perceived Needs of Developmentally Disabled Skilled Care Facility and Intermediate Care Facility Residents as Compared to Their Non-institutionalized Peers.

ERIC Educational Resources Information Center

Loughman, Sharon

The Center for Independent Living of Greater Bridgeport and its operating agencies conducted a survey of 32 people, the majority of whom were developmentally disabled and residents of institutional or community settings, in both rural and urban areas. The aim of the survey was to determine the perceived needs and levels of independence experienced…

Elements of progressive patient care in the Yale Health Plan HMO.

PubMed

Pearson, D A; Rowe, D S; Goldberg, B; Seigel, E

1975-01-01

The results of a study of the use of intermediate care beds in the intermediate care facility (ICF) of the Yale Health Plan, a prepaid group practice plan for students and an enrolled non-student population, indicate that the ICF may be a possible model for other health maintenance organizations. The ICF, with 30 beds in active use, is located in the Yale health center. Approximately one-third of the ICF patients would have been admitted to the affiliated short-term general hospital if the ICF did not exist. The plan's medical staff also has the option of transferring patients between the affiliated hospital and the ICF, depending on which institution is most appropriate for the patient's needs. A comparison of the levels of care provided in the ICF with those presented in selected articles from the progressive patient care literature revealed that the ICF is not only providing intermediate care but several other classic elements of progressive patient care -self care, continuing care, minimal care, and partial care.

Elements of progressive patient care in the Yale Health Plan HMO.

PubMed Central

Pearson, D A; Rowe, D S; Goldberg, B; Seigel, E

1975-01-01

The results of a study of the use of intermediate care beds in the intermediate care facility (ICF) of the Yale Health Plan, a prepaid group practice plan for students and an enrolled non-student population, indicate that the ICF may be a possible model for other health maintenance organizations. The ICF, with 30 beds in active use, is located in the Yale health center. Approximately one-third of the ICF patients would have been admitted to the affiliated short-term general hospital if the ICF did not exist. The plan's medical staff also has the option of transferring patients between the affiliated hospital and the ICF, depending on which institution is most appropriate for the patient's needs. A comparison of the levels of care provided in the ICF with those presented in selected articles from the progressive patient care literature revealed that the ICF is not only providing intermediate care but several other classic elements of progressive patient care -self care, continuing care, minimal care, and partial care. PMID:805444

42 CFR 456.604 - Physician team member inspecting care of recipients.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he is...

42 CFR 456.604 - Physician team member inspecting care of recipients.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Physician team member inspecting care of recipients... Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of recipients. No physician member of a team may inspect the care of a recipient for whom he is...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.

PubMed

Durvasula, Seeta; Sambrook, Philip N; Cameron, Ian D

2012-01-01

The purpose of this study was to investigate the factors influencing low adherence with therapeutic sunlight exposure in a randomized controlled trial conducted with older people living in intermediate care facilities. The study involved participants in the FREEDOM (Falls Risk Epidemiology: Effect of vitamin D on skeletal Outcomes and other Measures) study, a randomized controlled trial of therapeutic sun exposure to reduce falls in older people in intermediate care facilities. Semi-structured interviews were conducted with thirty participants in the FREEDOM trial, and with ten sunlight officers who were employed to facilitate the sun exposure. Two focus groups involving 10 participants in the FREEDOM trial were also held at the end of the intervention period. Common themes were derived from the interview and focus group transcripts. The study showed that the perceived health benefits did not influence adherence with the sun exposure. Factors such as socializing with others and being outdoors were more important in encouraging attendance. The main barriers to adherence included the perceived inflexibility and regimentation of daily attendance, clash with other activities, unsuitable timing and heat discomfort. This study showed that providing greater flexibility and autonomy to older people in how and when they receive sun exposure is likely to improve adherence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department.

PubMed

Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia

2017-06-02

To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

A Competency-Based "Hands-On" Training Package for Direct-Care Staff.

ERIC Educational Resources Information Center

Burch, Mary R.; And Others

1987-01-01

Evaluation of a combined "hands-on" and videotape training package used to teach direct care staff in an Intermediate Care Facility to conduct daily activities for profoundly mentally retarded persons indicated staff performance improved after the training and was maintained at three-week follow-up. (Author/DB)

Determining the Prevalence of Human Immunodeficiency Virus (HIV) within a Residential Facility for Persons with Mental Retardation.

ERIC Educational Resources Information Center

Pledgie, Thomas K.; Schumacher, Steven H.

1993-01-01

Administrators of residential facilities for persons with mental retardation are urged to take a proactive stance in determining the prevalence of Human Immunodeficiency Virus (HIV). Administrators of one 345-bed intermediate care facility used a double blind seroprevalence study. No HIV infection was found in this group. (DB)

Medicare and Medicaid: long-term care survey--HCFA. Final rule.

PubMed

1988-06-17

This final rule amends the Medicare and Medicaid regulations to require that the State survey agencies use the survey methods and procedures prescribed by HCFA and forms contained in regulations. The regulations define the principles on which Medicare and Medicaid survey methodologies are based and the required elements of a skilled nursing facility (SNF) or intermediate care facility (ICF) survey. This rule is in response to a court order.

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

[Impact of nasal colonization by methicillin-resistant Staphylococcus aureus among geriatric intermediate care facility patients].

PubMed

Giraud, Karine; Chatap, Guy; Bastuji-Garin, Sylvie; Vincent, Jean-Pierre

2004-12-04

To evaluate the impact of nasal carriage of Methicillin Resistant Staphylococcus aureus (MRSA) on antibiotic cost, infection morbidity, mortality and length of stay in a geriatric population. 341 consecutive elderly patients (mean age 83.4 +/- 8.7 years) admitted to an intermediate care facility were prospectively include between November 1998 and October 1999. Nasal swab cultures were taken on admission. In sixty patients (17.6%) no nasal swab was taken. Among the 281 patients screened, 52 were identified as MRSA carriers. The principle predictive factors were: diabetes (p=0,046), sores (p=0,03), malnutrition (p=0,02), polypathology (p=0,02) and prolongation of previous hospitalisation (p=0,09). Nasal carriage of MRSA on admission to the facility was not a deleterious prognostic factor regarding duration of stay, infectious morbidity and antibiotic cost, but was associated with higher mortality risk.

42 CFR 442.2 - Terms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Terms. 442.2 Section 442.2 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES General...

42 CFR 442.2 - Terms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Terms. 442.2 Section 442.2 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES General...

Drug use and accidental falls in an intermediate care facility.

PubMed

Sobel, K G; McCart, G M

1983-01-01

The relationship between nonenvironment-caused falls and drug use was evaluated in an intermediate care facility over a 14-month period. The medical problems and selected drug use of 45 patients who had fallen were retrospectively compared with those of a matched control population of 30 patients who had not fallen during this same period. Antihypertensives, diuretics, tranquilizers, sedative/hypnotics, antidepressants, and antianginal agents were reviewed for all patients. The use of diuretics, specifically furosemide, and sedative/hypnotics was significantly greater in the population who had fallen. Observations of dizziness, confusion, insomnia, and ataxia were recorded more frequently in that group, as well. Closer monitoring of medications, especially in specific drug classes, may help prevent accidental falls in this type of institution.

Impact of facility size and profit status on intermediate outcomes in chronic dialysis patients.

PubMed

Frankenfield, D L; Sugarman, J R; Presley, R J; Helgerson, S D; Rocco, M V

2000-08-01

Little information is available regarding the influence of dialysis facility size or profit status on intermediate outcomes in chronic dialysis patients. We have combined data from the Health Care Financing Administration (HCFA) Core Indicators Project; the end-stage renal disease (ESRD) facility survey; and the HCFA On-Line Survey, Certification, and Reporting System to analyze trends in this area. For hemodialysis patients, larger facilities were more likely than smaller facilities to perform dialysis on patients who were younger than 65 years of age, black, or undergoing dialysis 2 years or more (P < 0.001). Nonprofit facilities were more likely to perform dialysis on patients with diabetes mellitus as a cause of ESRD and less likely to perform dialysis on patients with hypertension as a cause of ESRD compared with for-profit units (P < 0.05). By multivariate analysis, larger facility size was modestly associated with a greater Kt/V value and urea reduction ratio, but not with hematocrit or serum albumin values. Facility profit status was not associated with these intermediate outcomes. For peritoneal dialysis patients, there were no significant differences in patient demographics based on facility size. More patients in nonprofit units had been undergoing dialysis 2 or more years than patients in for-profit units (P < 0.05). By univariate analysis, patients in larger facilities were more likely to have an adequacy measure performed than patients from smaller facilities (P < 0.05). There were few substantial differences in intermediate outcomes in chronic dialysis patients based on facility size or profit status.

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2011 CFR

2011-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2013 CFR

2013-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2014 CFR

2014-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2012 CFR

2012-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

Personal Characteristics Associated with Episodes of Injury in a Residential Facility.

ERIC Educational Resources Information Center

Konarski, Edward A., Jr.; Sutton, Kelly; Huffman, Alice

1997-01-01

Investigation of episodes of injury and personal characteristics among 412 individuals with mental retardation living in Intermediate Care Facilities found that 16% of the group experienced 67% of injuries. Individuals taking antipsychotics, having higher maladaptive behavior scores, and having relatively higher levels of adaptive behavior were…

State Medicaid Reimbursement for ICF-MR Facilities in the 1978-86 Period.

ERIC Educational Resources Information Center

Swan, James H.; And Others

1989-01-01

The survey of state Medicaid programs concerning reimbursement policies and per diem rates for private Intermediate Care Facilities for the Mentally Retarded for 1978-86 focused on: reimbursement methods; trends in reimbursement rates; and factors affecting reimbursement, including economic factors, reimbursement policies, eligibility policy, bed…

42 CFR 442.1 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Basis and purpose. 442.1 Section 442.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES...

42 CFR 442.1 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Basis and purpose. 442.1 Section 442.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES...

24 CFR 232.605 - Contract requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Form of Contract § 232.605 Contract requirements. (a) The contract between the... contract. Either form of contract shall include the cost of fire safety equipment, its installation, and...

24 CFR 232.570 - Endorsement of credit instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Eligible Security Instruments § 232.570 Endorsement of credit instrument.... (c) Statement by the Secretary of Health and Human Services that the fire safety equipment noted in...

FRED: an innovative approach to nursing home level-of-care assignments.

PubMed

Morris, J N; Sherwood, S; May, M I; Bernstein, E

1987-04-01

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED.

FRED: an innovative approach to nursing home level-of-care assignments.

PubMed Central

Morris, J N; Sherwood, S; May, M I; Bernstein, E

1987-01-01

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED. PMID:3570811

24 CFR 252.1 - Termination of program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... COINSURANCE OF MORTGAGES COVERING NURSING HOMES, INTERMEDIATE CARE FACILITIES, AND BOARD AND CARE HOMES § 252... preliminary as well as full approval to process coinsurance applications and without regard to whether the... subject to the precommitment review process described in paragraph (b) of this section. (d) Reopened...

24 CFR 232.565 - Maximum loan amount.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Eligible Security Instruments § 232.565 Maximum loan amount. The principal amount of the loan shall not exceed the lower of the Commissioner's estimate of the cost of the fire safety...

24 CFR 232.620 - Determination of compliance by HHS.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Special Requirements § 232.620 Determination of compliance by HHS. An... the fire safety equipment has been installed, will be in compliance with the HHS requirements for fire...

24 CFR 232.630 - Assurance of completion.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND ASSISTED... Fire Safety Equipment Special Requirements § 232.630 Assurance of completion. If the property upon which the fire safety equipment is to be installed is subject to a mortgage insured or held by the...

Effectiveness of a Caregiver Education Program on Providing Oral Care to Individuals with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Fickert, Nancy A.; Ross, Diana

2012-01-01

Caregivers who work in community living arrangements or intermediate care facilities are responsible for the oral hygiene of individuals with intellectual and developmental disabilities. Oral hygiene training programs do not exist in many organizations, despite concerns about the oral care of this population. The purpose of this study was to…

45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to receive care, except that in the case of services being provided in a Christian Science Sanatorium, certification by a qualified Christian Science practitioner that the individual meets the requirements specified... that, in the case of recipients who have elected care in a Christian Science sanatorium, review by a...

45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... to receive care, except that in the case of services being provided in a Christian Science Sanatorium, certification by a qualified Christian Science practitioner that the individual meets the requirements specified... that, in the case of recipients who have elected care in a Christian Science sanatorium, review by a...

45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... to receive care, except that in the case of services being provided in a Christian Science Sanatorium, certification by a qualified Christian Science practitioner that the individual meets the requirements specified... that, in the case of recipients who have elected care in a Christian Science sanatorium, review by a...

24 CFR 55.12 - Inapplicability of 24 CFR part 55 to certain categories of proposed actions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... communities that are in the Regular Program of the National Flood Insurance Program (NFIP) and in good... facilities, and intermediate care facilities) in communities that are in good standing under the NFIP. (3) HUD mortgage insurance actions for the repair, rehabilitation, modernization or improvement of...

42 CFR 442.1 - Basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Basis and purpose. 442.1 Section 442.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED General Provisions §...

Psychotropic Drug Patterns in a Large ICF/MR Facility: A Ten-Year Experience.

ERIC Educational Resources Information Center

Poindexter, Ann R.

1989-01-01

Psychotropic drug-prescribing patterns for 474 adults with mental retardation residing at an intermediate-care facility were examined for a 10-year period. Results indicated a progressive, marked decrease in total psychotropic drug usage and changes in the type of drugs prescribed with overall decline in drug usage. (Author/DB)

A Survey of Reading Programs for the Institutionalized Elderly.

ERIC Educational Resources Information Center

Bond, Carole L.; Miller, Marilyn J.

Noting that very few reading programs exist in nursing homes, a study surveyed the need for and content of reading services for residents of skilled and intermediate care facilities. The facilities responding to the survey represented 1,800 residents and provided information on their reading activities, available resources, special equipment,…

42 CFR 442.1 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Basis and purpose. 442.1 Section 442.1 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED General Provisions §...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies. (e) The failure to meet one or more of the applicable conditions of participation is cause for...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...; (2) In an ICF that cares primarily for mental patients, at least one individual knowledgeable in the...

Factors Associated with Living in Developmental Centers in California

ERIC Educational Resources Information Center

Harrington, Charlene; Kang, Taewoon; Chang, Jamie

2009-01-01

This study examined need, predisposing, market, and regional factors that predicted the likelihood of individuals with developmental disabilities living in state developmental centers (DCs) compared with living at home, in community care, or in intermediate care (ICFs) and other facilities. Secondary data analysis using logistic regression models…

Symposium: Compliance and Quality in Residential Life. Foreword.

ERIC Educational Resources Information Center

Kennedy, Edward M.

1992-01-01

The senator from Massachusetts introduces this special issue by reviewing his family's interest in persons with mental retardation, the potential of the Americans with Disabilities Act, the Intermediate Care Facilities for the Mentally Retarded (ICF/MR) program, and the importance of improving care for residents of ICFs. (DB)

Rule-Making and Justice: A Cautionary Tale.

ERIC Educational Resources Information Center

Brown, George W.

1990-01-01

This parable is presented in the form of news items and excerpts from jury testimonies in three fictional malpractice suits against physicians and adult care workers in group homes. Key issues at stake are the roles of Interdisciplinary Treatment Teams and Intermediate Care Facility for the Mentally Retarded regulations. (PB)

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Definitions. 456.601 Section 456.601 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.601...

Acceptability of Behavioral Treatments: Influence of Knowledge of Behavioral Principles.

ERIC Educational Resources Information Center

Rasnake, L. Kaye; And Others

1993-01-01

Fifty-seven direct care staff members from an intermediate care facility for adults with mental retardation rated the acceptability of interventions used for self-injurious behavior and completed a measure of knowledge about behavioral principles. Results indicated that staff age and educational attainment were related to knowledge scores, but…

Symposium Overview: Are We Making the Same Mistake Twice?

ERIC Educational Resources Information Center

Holburn, C. Steve

1992-01-01

This symposium overview briefly summarizes following articles which identify problems in the quality of care provided by Intermediate Care Facilities for the Mentally Retarded (ICF/MR), provide reactions, and identify positive trends. An emphasis on regulations and compliance is thought to be a major obstacle to quality services. (DB)

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Definitions. 456.601 Section 456.601 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.601...

42 CFR 456.608 - Personal contact with and observation of recipients and review of records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and review of records. 456.608 Section 456.608 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608 Personal...

24 CFR 232.510 - Commitment and commitment fee.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE FACILITIES, BOARD AND CARE HOMES, AND... of Fire Safety Equipment Fees and Charges § 232.510 Commitment and commitment fee. (a) Issuance of... setting forth the terms and conditions upon which the fire safety loan will be insured. (b) Type of...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... specified in § 442.105. (e) The failure to meet one or more of the applicable conditions of participation is...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies, subject to other limitations specified in § 442.105. (e) The failure to meet one or more of the...

42 CFR 442.101 - Obtaining certification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... deficiencies, subject to other limitations specified in § 442.105. (e) The failure to meet one or more of the...

Health Care Financing Administration--Medicare and Medicaid programs; protection of patients' funds. Final regulation.

PubMed

1980-07-24

This rule sets forth expanded standards for protection of personal funds of patients in skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) that participate in the Medicare or Medicaid programs. The changes are required for SNFs by Section 21(a) of Pub. L. 95-142, the Medicare-Medcaid Anti-Fraud and Abuse Amendments of 1977, and for ICFs by Section 8(c) of Pub. L. 95-292, the End-Stage Renal Disease Amendments of 1978. The intent is to safeguard patient funds from misuse by facilities, and to assure that personal funds held by the the facilities are fully accounted for and made available to patients when they need or want them.

Improving certified nurse aide retention. A long-term care management challenge.

PubMed

Mesirow, K M; Klopp, A; Olson, L L

1998-03-01

In the long-term care industry, the turnover rate among nurse aides is extremely high. This adversely affects resident satisfaction, resident care, morale, and finances. It presents a challenge to long-term care administration. Refusing to accept high turnover as an impossible situation allows changes to be made. The authors describe how the staff at one intermediate care facility identified its problems, assessed the causes, and implemented corrective action.

Evaluation of Supported Placements in Integrated Community Environments Project (SPICE). Executive Summary of the Final Report.

ERIC Educational Resources Information Center

Wilson, Leslie; And Others

This executive summary presents highlights of a study which sought to determine whether participants in the Supported Placements in Integrated Community Environments project were better off after moving to community homes from intermediate care facilities and skilled nursing facilities, and to determine the variables that contribute to quality…

Evaluation of Supported Placements in Integrated Community Environments Project (SPICE). Final Report.

ERIC Educational Resources Information Center

Wilson, Leslie; And Others

This evaluation project was designed to assess 37 persons (ages 21-72) who had moved from intermediate care facilities or skilled nursing facilities into innovative one-person or two-person community integrated living arrangements as a result of the Supported Placements in Integrated Community Environments project. The 37 persons had severe or…

24 CFR 891.105 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., subpart F of subtitle A of this title. In the case of an individual residing in an intermediate care facility for the developmentally disabled that is assisted under title XIX of the Social Security Act and...

Costs of Epilepsy in an Intermediate Care Facility for Persons with Mental Retardation.

ERIC Educational Resources Information Center

Burke, Thomas A.; McKee, Jerry R.; Pathak, Dev S.; Donahue, Rafe M. J.; Parasuraman, T. V.; Batenhorst, Alice S.

1999-01-01

A study compared the cost of caring for 50 institutionalized persons with developmental disabilities and epilepsy with 50 individuals with developmental disabilities. Costs attributable to epilepsy were found to be approximately $825.00 and $918.00 per person over a six-month period. Personnel, drugs, hospitalization, and laboratories/procures…

Evaluation of Components of Residential Treatment by Medicaid ICF-MR Surveys: A Validity Assessment.

ERIC Educational Resources Information Center

Reid, Dennis H.; And Others

1991-01-01

Four studies found serious problems with components of the federal Medicaid program's survey process for evaluating intermediate care facilities for the mentally retarded--surveys did not discriminate between certified and noncertified units, direct-care staff behavior was very reactive to the survey's presence, and service providers had divergent…

Dimensions of care for dementia sufferers in long-term care institutions: are they related to outcomes?

PubMed

Chappell, N L; Reid, R C

2000-07-01

This study empirically examined whether dimensions of care cluster in special care units (SCUs) compared with non-SCUs. The relationship between SCU status plus separate measures of the dimensions of care and outcomes for dementia sufferers was then investigated. Data were drawn from the Intermediate Care Facility Project. The sample (N = 510) included residents with dementia, aged 65 and older, in intermediate care facilities throughout the province of British Columbia. Canada. Longitudinal data included 6 outcomes: cognitive function, behavioral problems of agitation and social skills, physical functioning, and quality of life measured through affect and expressive language skills. Separate multiple linear regression equations were estimated, relating each of these outcomes to 5 dimensions of care: preadmission and admission procedures. staff training and education, nonuse of physical and chemical restraints, flexible care routines and resident-relevant activities, and the environment. The results showed there is virtually no clustering of dimensions along SCU/non-SCU lines. Neither SCU status nor the individual dimensions were highly predictive of outcomes. Residents' affect at t1 emerged as a characteristic that was significantly correlated with other outcomes. This Canadian research can be added to the few but growing number of rigorous studies that suggest SCUs are not homogeneous and do not necessarily provide better care than non-SCUs. Moreover, it raises questions about the benefits of "best practice" dimensions of care, regardless of SCU status.

24 CFR 55.12 - Inapplicability of 24 CFR part 55 to certain categories of proposed actions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... communities that are in the Regular Program of the National Flood Insurance Program (NFIP) and in good... facilities, and intermediate care facilities) in communities that are in good standing under the NFIP. (3... Program of the NFIP and are in good standing, provided that the number of units is not increased more than...

24 CFR 55.12 - Inapplicability of 24 CFR part 55 to certain categories of proposed actions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... communities that are in the Regular Program of the National Flood Insurance Program (NFIP) and in good... facilities, and intermediate care facilities) in communities that are in good standing under the NFIP. (3... Program of the NFIP and are in good standing, provided that the number of units is not increased more than...

Changes in Psychotropic Drug Use in Long-Term Residents of an ICF/MR Facility.

ERIC Educational Resources Information Center

Hancock, Robert D.; And Others

1991-01-01

Psychotropic drug use was monitored for 139 persons residing continuously over a 10-year period in an Intermediate Care Facility for mentally retarded persons. Results indicated an ongoing decrease in psychotropic drug use, with usage decreasing from 30-12 percent. Antipsychotic medication was discontinued for 73 percent of the clients over the 10…

Medicaid program; correction and reduction plans for intermediate care facilities for the mentally retarded--HCFA. Final rule.

PubMed

1991-07-05

This final rule amends the portions of the Medicaid regulations under which an intermediate care facility for the mentally retarded (ICF/MR) with substantial deficiencies that did not pose an immediate jeopardy to the health and safety of clients could continue participation in the Medicaid program. These regulations gave State Medicaid agencies the option of submitting written plans to either correct deficiencies or permanently reduce the number of beds in the certified portion of the facility. This rule removes all requirements for submitting, approving, and monitoring correction plans for ICFs/MR. The requirements for submitting and approving correction plans are being removed because the time limit for submission of these plans has passed. The provisions for monitoring correction plans are being removed because there are no remaining facilities for which these provisions apply. This final rule also removes requirements for submitting and approving reduction plans for ICFs/MR because the time limit for submitting these plans has passed. It retains and updates the requirements for monitoring and compliance that apply to those ICFs/MR for which reduction plans were approved by January 1, 1990.

24 CFR 582.310 - Resident rent.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (42 U.S.C. 1437a(a)(1)), except that in determining the rent of a person occupying an intermediate care facility assisted under title XIX of the Social Security Act, the gross income of this person is...

24 CFR 582.310 - Resident rent.

Code of Federal Regulations, 2012 CFR

2012-04-01

... (42 U.S.C. 1437a(a)(1)), except that in determining the rent of a person occupying an intermediate care facility assisted under title XIX of the Social Security Act, the gross income of this person is...

42 CFR 456.608 - Personal contact with and observation of beneficiaries and review of records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608... 42 Public Health 4 2013-10-01 2013-10-01 false Personal contact with and observation of beneficiaries and review of records. 456.608 Section 456.608 Public Health CENTERS FOR MEDICARE & MEDICAID...

42 CFR 456.608 - Personal contact with and observation of beneficiaries and review of records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608... 42 Public Health 4 2012-10-01 2012-10-01 false Personal contact with and observation of beneficiaries and review of records. 456.608 Section 456.608 Public Health CENTERS FOR MEDICARE & MEDICAID...

42 CFR 456.608 - Personal contact with and observation of beneficiaries and review of records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608... 42 Public Health 4 2014-10-01 2014-10-01 false Personal contact with and observation of beneficiaries and review of records. 456.608 Section 456.608 Public Health CENTERS FOR MEDICARE & MEDICAID...

State Medicaid reimbursement for nursing homes, 1978-86

PubMed Central

Swan, James H.; Harrington, Charlene; Grant, Leslie A.

1988-01-01

State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84. PMID:10312516

Medicaid program; appeals from cancellation of approval of Medicaid long-term care facilities--HCFA. Final rule.

PubMed

1988-08-18

This rule corrects an oversight by setting forth time limits for new issues that may be considered by an Administrative Law Judge (ALJ) during a hearing afforded a Medicaid skilled nursing facility (SNF) or intermediate care facility (ICF) because the Secretary proposes to cancel its approval under section 1910(c)(1) of the Social Security Act (the Act). This amendment is necessary because current rules do not take account of the fact that hearings under section 1910(c) of the Act (unlike Medicare hearings) may take place before the cancellation is put into effect. The purpose is to establish time limits appropriate to section 1910(c) situations.

Medicare and Medicaid programs; revaluation of assets; correction--HCFA. Correcting amendments.

PubMed

1993-04-05

This document contains corrections to final regulations (BPD-311-F) that were published September 23, 1992 (F.R. Doc. 92-22582) (57 FR 43906). The regulations describe new limitations on the valuations of assets acquired as the result of changes in ownership occurring on or after July 18, 1984. These changes affect hospitals and skilled nursing facilities under the Medicare program, and hospitals, nursing facilities, and intermediate care facilities for the mentally retarded under the Medicaid program.

Medicaid Long-Term Care Recipients Grew by 37%, Costs by 25% in 3 Years. Trends and Milestones.

ERIC Educational Resources Information Center

Anderson, Lynda; And Others

1997-01-01

This brief article presents data on trends in costs and numbers of recipients of Medicaid served by the Intermediate Care Facility/Mental Retardation program and the Medicaid Home and Community Based Services program. A table presents the data by state and a graph shows the increasing numbers of recipients and costs. (DB)

The effect of group-based exercise on cognitive performance and mood in seniors residing in intermediate care and self-care retirement facilities: a randomised controlled trial.

PubMed

Brown, A K; Liu-Ambrose, T; Tate, R; Lord, S R

2009-08-01

To determine the effect of a general group-based exercise programme on cognitive performance and mood among seniors without dementia living in retirement villages. Randomised controlled trial. Four intermediate care and four self-care retirement village sites in Sydney, Australia. 154 seniors (19 men, 135 women; age range 62 to 95 years), who were residents of intermediate care and self-care retirement facilities. Participants were randomised to one of three experimental groups: (1) a general group-based exercise (GE) programme composed of resistance training and balance training exercises; (2) a flexibility exercise and relaxation technique (FR) programme; or (3) no-exercise control (NEC). The intervention groups (GE and FR) participated in 1-hour exercise classes twice a week for a total period of 6 months. Using standard neuropsychological tests, we assessed cognitive performance at baseline and at 6-month re-test in three domains: (1) fluid intelligence; (2) visual, verbal and working memory; and (3) executive functioning. We also assessed mood using the Geriatric Depression Scale (GDS) and the Positive and Negative Affect Schedule (PANAS). The GE programme significantly improved cognitive performance of fluid intelligence compared with FR or NEC. There were also significant improvements in the positive PANAS scale within both the GE and FR groups and an indication that the two exercise programmes reduced depression in those with initially high GDS scores. Our GE programme significantly improved cognitive performance of fluid intelligence in seniors residing in retirement villages compared with our FR programme and the NEC group. Furthermore, both group-based exercise programmes were beneficial for certain aspects of mood within the 6-month intervention period.

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study

PubMed Central

Koulidiati, Jean-Louis; Nesbitt, Robin C; Ouedraogo, Nobila; Hien, Hervé; Robyn, Paul Jacob; Compaoré, Philippe; Souares, Aurélia; Brenner, Stephan

2018-01-01

Objective To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. Methods We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities’ catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. Results Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. Conclusion Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage. PMID:29858415

42 CFR 456.436 - Continued stay review process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities... mentally retarded, the recipient's qualified mental retardation professional, within 1 working day of its... final decision on the need for the continued stay; (g) If the attending physician or qualified mental...

Seeking Success amid Today's Chaotic Demands.

ERIC Educational Resources Information Center

Dillon, Michael R.

1992-01-01

This paper reacts to previous symposium papers (EC 604 155-161) concerning regulations and quality assurance in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) and stresses the central mission of helping people and the need to achieve quality and not just compliance. (DB)

A Comparative Analysis of the Functional Disability Levels of Adult Day Care, Adult Day Health and ICF-Level Nursing Home Elderly in Hawaii.

ERIC Educational Resources Information Center

Hayashida, Cullen T.

This study compared the functional disability levels of participants in adult day centers with patients in intermediate care facilities (ICFs). A three-page questionnaire measuring demographics, social resources, physical health, mental health, and activities of daily living as assessed by the Activities of Daily Living scale and the Instrumental…

77 FR 55120 - Federal Housing Administration (FHA): Section 232 Healthcare Facility Insurance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

...In 2010 through 2011, HUD commenced and completed the process of revising regulations applicable to, and closing documents used in, FHA insurance of multifamily rental projects, to reflect current policy and practices in the multifamily mortgage market. This final rule results from a similar process that was initiated in 2011 for revising and updating the regulations governing, and the transactional documents used in, the program for insurance of healthcare facilities under section 232 of the National Housing Act (Section 232 program). HUD's Section 232 program insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. This rule revises the Section 232 program regulations to reflect current policy and practices, and improve accountability and strengthen risk management in the Section 232 program.

Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment.

PubMed

Berlowitz, D R; Ash, A S; Brandeis, G H; Brand, H K; Halpern, J L; Moskowitz, M A

1996-03-15

To determine the importance of case-mix adjustment in interpreting differences in rates of pressure ulcer development in Department of Veterans Affairs long- term care facilities. A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of pressure ulcer development; the resulting model was validated in a separate sample. Facility-level rates of pressure ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Department of Veterans Affairs long-term care facilities. The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of pressure ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Development of a stage 2 or greater pressure ulcer. 11 factors predicted pressure ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of pressure ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.

42 CFR 442.14 - Effect of change of ownership.

Code of Federal Regulations, 2010 CFR

2010-10-01

....14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE... agreement is subject to all applicable statutes and regulations and to the terms and conditions under which...

Getting into the Jet Stream.

ERIC Educational Resources Information Center

Boggs, Elizabeth M.

1992-01-01

This paper reacts to previous symposium papers (EC 604 155-161) concerning regulations and quality assurance in Intermediate Care Facilities for the Mentally Retarded (ICF/MR). Contributions of the Home and Community Based Services program model, which is seen as a partial solution to overregulation, are highlighted. (DB)

The Paradox of Regulations: A Commentary.

ERIC Educational Resources Information Center

Taylor, Steven J.

1992-01-01

This response to previous symposium papers (EC 604 155-161) concerning regulations and quality assurance in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) sees regulations as the bureaucratization of values, identifies paradoxes implicit in regulatory controls, and urges reform of the current developmental disability service…

24 CFR 891.655 - Definitions applicable to 202/162 projects.

Code of Federal Regulations, 2012 CFR

2012-04-01

... residing in an intermediate care facility for the mentally retarded that is assisted under Title XIX of the... family residential structure designed or adapted for occupancy by nonelderly handicapped individuals... that are primarily nonelderly handicapped families. Independent living complex means a project designed...

42 CFR 442.10 - State plan requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false State plan requirement. 442.10 Section 442.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE...

Factors associated with expenditures for medicaid home and community based services (HCBS) and intermediate care facilities for persons with mental retardation (ICF/MR) services for persons with intellectual and developmental disabilities.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger J; Taub, Sarah; Chiri, Giuseppina

2008-06-01

This article examines expenditures for a random sample of 1,421 adult Home and Community Based Services (HCBS) and Intermediate Care Facility/Mental Retardation (ICF/MR) recipients in 4 states. The article documents variations in expenditures for individuals with different characteristics and service needs and, controlling for individual characteristics, by residential setting type, Medicaid program (ICF/MR or HCBS), and state. Annual average per-person Medicaid expenditures for HCBS recipients were less than those of ICF/MR residents ($61,770 and $128,275, respectively). HCBS recipients had less severe disability (intellectual, physical, health service needs) than ICF/MR residents. Controlling these differences, and for congregate settings, HCBS were less costly than ICFs/MR, but this distinction accounted for only 3.3% of variation in expenditures. Persons living with families receiving HCBS ($25,072) and in host families (including foster, companion, or shared living arrangements; $44,112) had the lowest Medicaid expenditures.

Application of federal indicators in nursing-home drug-regimen review.

PubMed

Shannon, R C; De Muth, J E

1984-05-01

Numbers of medications per patient and rate of drug administration errors were compared in Wisconsin long-term care facilities that used federal indicators in conducting drug-regimen review versus facilities that did not use the indicators. Data were collected from 1132 charts in 24 facilities randomly selected from a state survey schedule for June-October 1982. Both prescription and nonprescription drugs that patients received during the 30-day period preceding the survey were counted. Medication use was compared by facility type--skilled-nursing facility (SNF), intermediate-care facility (ICF), or ICF for the mentally retarded. The federal indicators were used in 10 facilities. Mean number of medications used per patient where indicators were applied (5.4 versus 6.6 for SNFs and 3.4 versus 5.8 for ICFs ) was not significantly different. In SNFs using the indicators, patients received 5.6 medications where the consultant pharmacist was also the provider and 5.2 where the consultant was not the provider. Medication use was not significantly different by facility type. The number of drug administration irregularities per 100 residents was significantly greater where indicators were not applied. Further study is needed to determine whether use of federal indicators encourages more efficient and appropriate drug therapy for patients in long-term care facilities.

Clinical pharmacy services in an intermediate care facility for the mentally retarded.

PubMed

McKee, J R

1994-03-01

The impact of a focused drug regimen review process based on clear objectives and of interdisciplinary team cooperation is described. By shifting from a pharmacy departmental focus, which was primarily on drug distribution activities, to a broader agenda that promotes pharmacists as clinicians, inroads were made in reducing medication doses per resident, decreasing nursing time spent in medication administration, and decreasing pharmacy expenses in this residential facility for the developmentally disabled.

42 CFR 456.370 - Medical, psychological, and social evaluations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medical, psychological, and social evaluations. 456...: Intermediate Care Facilities Medical, Psychological, and Social Evaluations and Admission Review § 456.370 Medical, psychological, and social evaluations. (a) Before admission to an ICF or before authorization for...

42 CFR 456.350 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Scope. 456.350 Section 456.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.350 Scope. This subpart prescribes requirements for...

42 CFR 456.350 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Scope. 456.350 Section 456.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.350 Scope. This subpart prescribes requirements for...

Use of Psychotropic Medication in Oklahoma: A Statewide Survey.

ERIC Educational Resources Information Center

Spreat, Scott; Conroy, James W.; Jones, Jennifer C.

1997-01-01

Analysis of statewide (Oklahoma) survey data revealed that 22.5% of individuals with mental retardation who were served by the Oklahoma mental retardation system were receiving antipsychotic medication. Higher levels of medication use were found in institutional settings and Intermediate Care Facility settings. (Author/DB)

Our Residential Rules--Have We Gone Too Far? Symposium Overview.

ERIC Educational Resources Information Center

Holburn, C. Steve

1990-01-01

This symposium overview examines the outcomes of standards established in Intermediate Care Facilities for the Mentally Retarded to receive Medicaid funding. The argument is made that, although regulations have provided cleaner environments and better documented procedures, they lack in provisions promoting personal, moral, and educational…

42 CFR 456.350 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Scope. 456.350 Section 456.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.350 Scope. This subpart prescribes requirements for...

42 CFR 456.350 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Scope. 456.350 Section 456.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.350 Scope. This subpart prescribes requirements for...

42 CFR 456.350 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Scope. 456.350 Section 456.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.350 Scope. This subpart prescribes requirements for...

42 CFR 456.370 - Medical, psychological, and social evaluations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychological, and social evaluations. 456...: Intermediate Care Facilities Medical, Psychological, and Social Evaluations and Admission Review § 456.370 Medical, psychological, and social evaluations. (a) Before admission to an ICF or before authorization for...

Exploring the negative social evaluation of patients by specialist physiotherapists working in residential intermediate care.

PubMed

Thomson, Di; Love, Helen

2013-03-01

Residential intermediate care represents an innovative model of care that facilitates early hospital discharge and avoids unnecessary hospital admission. It also represents an environment where patients may demonstrate emotional vulnerability following a period of acute illness or injury, and this may impact on the quality of the patient/physiotherapist relationship. To gain an understanding of the negative social evaluation of patients by specialist physiotherapists, and to explore possible coping strategies in order to engage patients in appropriately designed rehabilitation programmes. Using a grounded theory approach, physiotherapists working in an intermediate care facility in a senior role were invited to participate in a focus group. Following the focus group analysis, a further four physiotherapists, with similar levels of experience to those in the focus group, were recruited to participate in semi-structured interviews to explore the emerging categories in greater depth. The findings revealed some categories that the therapists believed resided with the patients (alcohol dependency, failing to adapt/accept their condition and patients whose families hindered the process of rehabilitation) and some that appeared to reside within the context of intermediate rehabilitation (labelling, the 6-week model of intermediate care and the process of transition into the service). Coping strategies cited were workforce planning, goal setting and reflective practice. While supportive strategies have been developed locally to assist staff in managing their anxiety related to therapeutic interactions with 'difficult patients', it is also recognised that they have the potential for demotivation and are a possible precursor for stress. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

PubMed

Kanoh, Asako; Kizawa, Yoshiyuki; Tsuneto, Satoru; Yokoya, Shoji

2018-01-01

Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

"It's very complicated": a qualitative study of medicines management in intermediate care facilities in Northern Ireland.

PubMed

Millar, Anna N; Hughes, Carmel M; Ryan, Cristín

2015-06-02

Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

The influence of financial incentives and racial status on the use of post-hospital care.

PubMed

Robertson, Madeline J; Broyles, Robert W; Khaliq, Amir

2004-01-01

This study examines the influence of financial incentives and the racial status of the patient on the use of extended care following an episode of hospitalization. Post-hospital care (PHC) is defined as the services provided by a skilled nursing facility (SNF) or intermediate care facility (ICF) following discharge. The focus of the analysis is on the use or nonuse of PHC, the presence or absence of a delay in transfer to an ICF or SNF and, limited to those who experienced a postponement, the length of the delayed discharge. After controlling for multiple factors, the results indicate that Medicare beneficiaries were more likely to use PHC, less likely to experience a delay in discharge, and used fewer days of prolonged care. Medicaid recipients and uninsured patients experienced reduced access to PHC. The results also indicated that the access of Native Americans and Americans to PHC was impeded.

42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...

42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...

42 CFR 456.372 - Medicaid agency review of need for admission.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456.372 Section 456.372 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...: Intermediate Care Facilities Medical, Psychological, and Social Evaluations and Admission Review § 456.372...

42 CFR 456.351 - Definition.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Definition. 456.351 Section 456.351 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.351 Definition. As used in this subpart: Intermediat...

Regulating Professional Services in ICFs/MR: Remembering the Past and Looking to the Future.

ERIC Educational Resources Information Center

Sparr, Margaret P.; Smith, Wayne

1990-01-01

This article reviews regulations governing Intermediate Care Facilities for the Mentally Retarded (ICF/MR), including 1971 ICF/MR Medicaid funding legislation, standards development by professional consensus, development of federal regulations, intergovernmental roles, and possible directions for the future. A need is seen for professionals to…

Regulations: Can They Control Staff Compliance in Human Services Systems?

ERIC Educational Resources Information Center

Jacobson, John W.

1990-01-01

This article discusses results of regulations for Intermediate Care Facilities for the Mentally Retarded, arguing that, by establishing minimum standards for funding, these policies promote mediocrity. Strategies for promoting compliance behaviors are offered, as are observations on regulatory reform and the process of regulatory impact. (PB)

How a Regression Artifact Makes ICFs/MR Look Ineffective.

ERIC Educational Resources Information Center

Crinella, Francis M.; McCleary, Richard; Swanson, James M.

1998-01-01

Criticizes the research design in "The Small ICF/MR program: Dimensions of Quality and Cost" (Conroy), that found small Intermediate Care Facilities (ICF) for individuals with mental retardation are inferior to other community programs. Discusses the problem in selecting a control group on the basis of pretest matching. (CR)

42 CFR 456.351 - Definition.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Definition. 456.351 Section 456.351 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities § 456.351 Definition. As used in this subpart: Intermediat...

76 FR 21311 - Medicaid Program; Home and Community-Based Services (HCBS) Waivers

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... planned on the grounds of existing Intermediate Care Facilities for Individuals with Mental Retardation... than diagnosis. These changes will enable States to realize administrative and program design... for States that wish to design a waiver that meets the needs of more than one target population. This...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2014 CFR

2014-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2013 CFR

2013-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 442.14 - Effect of change of ownership.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Effect of change of ownership. 442.14 Section 442.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE...

24 CFR 290.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... section 202 of the Housing Act of 1959, or a hospital, intermediate care facility, nursing home, group... anticipated demand (e.g., the housing market is balanced), as well as those in which there is an excess supply... turnover of rental housing, and, usually, by high levels of rent inflation. HUD will make the determination...

24 CFR 290.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 202 of the Housing Act of 1959, or a hospital, intermediate care facility, nursing home, group... anticipated demand (e.g., the housing market is balanced), as well as those in which there is an excess supply... turnover of rental housing, and, usually, by high levels of rent inflation. HUD will make the determination...

24 CFR 290.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... section 202 of the Housing Act of 1959, or a hospital, intermediate care facility, nursing home, group... anticipated demand (e.g., the housing market is balanced), as well as those in which there is an excess supply... turnover of rental housing, and, usually, by high levels of rent inflation. HUD will make the determination...

24 CFR 290.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... section 202 of the Housing Act of 1959, or a hospital, intermediate care facility, nursing home, group... anticipated demand (e.g., the housing market is balanced), as well as those in which there is an excess supply... turnover of rental housing, and, usually, by high levels of rent inflation. HUD will make the determination...

24 CFR 290.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section 202 of the Housing Act of 1959, or a hospital, intermediate care facility, nursing home, group... anticipated demand (e.g., the housing market is balanced), as well as those in which there is an excess supply... turnover of rental housing, and, usually, by high levels of rent inflation. HUD will make the determination...

[Follow-up study of the elderly users of a geriatric intermediate care facility after discharge].

PubMed

Wada, J

1993-03-01

Geriatric intermediate care facilities (GICF) were started by subsidies from the Ministry of Health and Welfare in 1987 to promote the return of elderly from hospitals to their homes or nursing homes and to give support to the cared elderly and their families. This paper describes about the function of a GICF established in a rural community in Oita, Kyushu. One hundred seventy four elderly users (66 males, 108 females: mean age; 81 years old) who were discharged from the GIFC between July 1990 and June 1991 were studied. The main results were as follows: 1. The reason for admission to the GIFC of 174 elderly users were cerebrovascular disease in 50 cases, bone and/or joint diseases in 63, senile dementia in 25 and other diseases in 36.2. Eighty three persons (48%) needed continuous care. 3. The activities of daily living of approximately 37% of those who needed continuous care improved to some degree. 4. Ninety six users were discharged and went home, 43 were readmitted to a hospital, 32 were admitted to a nursing home, and 3 died at the GIFC. 5. The situation as of September 1991 was 70 persons (40%) at home, 12 persons in hospital, 33 persons in the GICF, 35 persons in nursing homes and 24 deaths. 6. Fifty two persons (37%) used the GICF more than twice. These findings suggested that the GICF enabled care for weak elderly persons at home.

42 CFR 483.405 - Relationship to other HHS regulations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Relationship to other HHS regulations. 483.405 Section 483.405 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Conditions of Participation for Intermediate...

One Last Pleasure? Alcohol Use among Elderly People in Nursing Homes.

ERIC Educational Resources Information Center

Klein, Waldo C.; Jess, Carol

2002-01-01

Describes the alcohol-related policies, practices, and problems experienced by a sample of intermediate care facilities and homes for elderly people. Despite the problems reported, screening for alcohol problems among residents, treatment of identified problems, and training of staff were not found to be widespread. Challenges to social workers…

Changing Medicaid and Intermediate Care Facilities for the Mentally Retarded (ICF/MR): Evaluation of Alternatives.

ERIC Educational Resources Information Center

Fernald, Charles Denton

1986-01-01

Some alternatives for changing IFC are evaluated, and a model that can be used for considering other alternatives is presented. Proposals include a system of treatment protocols for diagnosis-related groups and a revision of S.873, The Community and Family Living Amendments of 1985. (Author/CL)

Young Women and the City: Adolescent Deviance and the Transformation of Educational Policy, 1870-1960.

ERIC Educational Resources Information Center

Sedlak, Michael W.

1983-01-01

Evangelical residential homes and intermediate care facilities in urban centers, professional clinical programs, and financial assistance from the federal government characterize three periods in the history of institutional response to pregnant and delinquent young women. Each period is analyzed in terms of funding sources, clientele, and…

From Standards to Compliance, to Good Services, to Quality Lives: Is This How It Works?

ERIC Educational Resources Information Center

Shea, John R.

1992-01-01

Licensing and certification regulations for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) can adversely affect individuals, distort the allocation of scarce resources, and encourage community residences to become small institutions. A case study of one home in northern California illustrates poor program evaluation and the need…

Financing Community Services in the United States: Results of a Nationwide Study.

ERIC Educational Resources Information Center

Braddock, David; And Others

1987-01-01

Results of an analysis of state-federal expenditures for community services between Fiscal Years 1977 and 1984 are summarized. Important trends identified include rapid real economic growth in total nationwide community spending, in federal Intermediate Care Facility for the Mentally Retarded reimbursements, and in funds derived from state-source…

Differences between Workers on Different Shifts in Rating of Client Skills.

ERIC Educational Resources Information Center

Gampel, Ezra S.

The study sought to determine if there are differences between shifts of workers in Intermediate Care Facilities in their ratings of the daily living skills of mentally retarded residents, and whether these differences reflect actual differences in performance by the residents. Staff were interviewed concerning the level of prompt required to…

Rhetoric and Realities in Today's ICF/MR: Control out of Control.

ERIC Educational Resources Information Center

Holburn, C. Steve

1992-01-01

This paper contrasts the rhetoric of quality assurance with the realities of poor quality in today's Intermediate Care Facilities for the Mentally Retarded (ICF/MR). The ICF/MR operational model is described as paper oriented, failure based, and insensitive to the effects of its own practices. Recommendations include the establishment of local…

Farm-Life Skills Training of Autistic Adults at Bittersweet Farms.

ERIC Educational Resources Information Center

Giddan, Jane J.

A farmstead community in Northwest Ohio, called Bittersweet Farms, serves as a habilitation program for autistic adults, involving 20 residents ranging from profoundly retarded to high functioning and 15 developmentally delayed adults who are part of an agricultural day program. The community is designated as an Intermediate Care Facility for the…

State Medicaid ICF-MR Utilization and Expenditures in the 1980-1984 Period.

ERIC Educational Resources Information Center

Harrington, Charlene; Swan, James H.

1990-01-01

State Medicaid expenditures for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) increased sharply between 1980 and 1984. The ICF-MR bed capacity declined relative to the total state population, while numbers of ICF-MR Medicaid recipients increased. Trends among states are examined, emphasizing changes in demographic factors,…

Choice-Making among Medicaid HCBS and ICF/MR Recipients in Six States

ERIC Educational Resources Information Center

Lakin, K. Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-01-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in nonfamily settings in six states. Everyday choice in daily life and in…

Promoting Community-Based Services: Implications for Program Design, Implementation, and Public Policy.

ERIC Educational Resources Information Center

Powers, Michael D.

1986-01-01

Program design, implementation, and public policy issues are discussed for five urban community-based programs for the developmentally disabled: (1) direct services in intermediate care facilities; (2) a High Risk Infant project; (3) group home consultative services; (4) training for support services to adoptive families; (5) a national…

Social Behavior of Mentally Handicapped Clients in Different Community Settings.

ERIC Educational Resources Information Center

Romer, Daniel; Berkson, Gershon

To study the influence that community settings have upon peer relationships and social behavior, 81 mentally disabled (retarded and emotionally disturbed retarded) adults were observed in their intermediate care residential facility and in one of four workshop programs. In summary, Ss tended to have more extensive affiliation and to aggregate more…

Resident aggression toward staff at a center for the developmentally disabled.

PubMed

West, Christine A; Galloway, Ellen; Niemeier, Maureen T

2014-01-01

Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICP/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury.

Nursing Home Levels of Care: Reimbursement of Resident Specific Costs

PubMed Central

Willemain, Thomas R.

1980-01-01

The companion paper on nursing home levels of care (Bishop, Plough and Willemain, 1980) recommended a “split-rate” approach to nursing home reimbursement that would distinguish between fixed and variable costs. This paper examines three alternative treatments of the variable cost component of the rate: a two-level system similar to the distinction between skilled and intermediate care facilities, an individualized (“patient-centered”) system, and a system that assigns a single facility-specific rate that depends on the facility's case-mix (“case-mix reimbursement”). The aim is to better understand the theoretical strengths and weaknesses of these three approaches. The comparison of reimbursement alternatives is framed in terms of minimizing reimbursement error, meaning overpayment and underpayment. We develop a conceptual model of reimbursement error that stresses that the features of the reimbursement scheme are only some of the factors contributing to over- and underpayment. The conceptual model is translated into a computer program for quantitative comparison of the alternatives. PMID:10309330

Medicare and Medicaid programs; rural hospitals: provision of long-term care services (swing-bed provision); flexibility in application of standards--Health Care Financing Administration. Interim final rule with comment period.

PubMed

1982-07-20

These regulations implement sections 904 and 949 of Pub. L. 96-499, the Omnibus Reconciliation Act of 1980. Under section 904 (the swing-bed provision), certain small, rural hospitals may use their inpatient facilities to furnish skilled nursing facility (SNF) services to Medicare and Medicaid beneficiaries, and intermediate care facility (ICF) services to Medicaid beneficiaries. These hospitals will be reimbursed at rates appropriate for those services, which are generally lower than hospital rates. This statutory provision is intended to encourage the most efficient and effective use of inpatient hospital beds for delivery of either hospital or SNF and ICF services. Under section 949, rural hospitals of 50 or fewer beds may be exempted from certain personnel standards in the conditions of participation for hospitals. This exemption applies only to the extent that it does not jeopardize or adversely affect the health and safety of patients.

Nursing home levels of care: reimbursement of resident specific costs.

PubMed

Willemain, T R

1980-01-01

The companion paper on nursing home levels of care (Bishop, Plough and Willemain, 1980) recommended a "split-rate" approach to nursing home reimbursement that would distinguish between fixed and variable costs. This paper examines three alternative treatments of the variable cost component of the rate: a two-level system similar to the distinction between skilled and intermediate care facilities, an individualized ("patient-centered") system, and a system that assigns a single facility-specific rate that depends on the facility's case-mix ("case-mix reimbursement"). The aim is to better understand the theoretical strengths and weaknesses of these three approaches. The comparison of reimbursement alternatives is framed in terms of minimizing reimbursement error, meaning overpayment and underpayment. We develop a conceptual model of reimbursement error that stresses that the features of the reimbursement scheme are only some of the factors contributing to over- and underpayment. The conceptual model is translated into a computer program for quantitative comparison of the alternatives.

MRSA Transmission Dynamics Among Interconnected Acute, Intermediate-Term, and Long-Term Healthcare Facilities in Singapore.

PubMed

Chow, Angela; Lim, Vanessa W; Khan, Ateeb; Pettigrew, Kerry; Lye, David C B; Kanagasabai, Kala; Phua, Kelvin; Krishnan, Prabha; Ang, Brenda; Marimuthu, Kalisvar; Hon, Pei-Yun; Koh, Jocelyn; Leong, Ian; Parkhill, Julian; Hsu, Li-Yang; Holden, Matthew T G

2017-05-15

Methicillin-resistant Staphylococcus aureus (MRSA) is the most common healthcare-associated multidrug-resistant organism. Despite the interconnectedness between acute care hospitals (ACHs) and intermediate- and long-term care facilities (ILTCFs), the transmission dynamics of MRSA between healthcare settings is not well understood. We conducted a cross-sectional study in a network comprising an ACH and 5 closely affiliated ILTCFs in Singapore. A total of 1700 inpatients were screened for MRSA over a 6-week period in 2014. MRSA isolates underwent whole-genome sequencing, with a pairwise single-nucleotide polymorphism (Hamming distance) cutoff of 60 core genome single-nucleotide polymorphisms used to define recent transmission clusters (clades) for the 3 major clones. MRSA prevalence was significantly higher in intermediate-term (29.9%) and long-term (20.4%) care facilities than in the ACH (11.8%) (P < .001). The predominant clones were sequence type [ST] 22 (n = 183; 47.8%), ST45 (n = 129; 33.7%), and ST239 (n = 26; 6.8%), with greater diversity of STs in ILTCFs relative to the ACH. A large proportion of the clades in ST22 (14 of 21 clades; 67%) and ST45 (7 of 13; 54%) included inpatients from the ACH and ILTCFs. The most frequent source of the interfacility transmissions was the ACH (n = 28 transmission events; 36.4%). MRSA transmission dynamics between the ACH and ILTCFs were complex. The greater diversity of STs in ILTCFs suggests that the ecosystem in such settings might be more conducive for intrafacility transmission events. ST22 and ST45 have successfully established themselves in ILTCFs. The importance of interconnected infection prevention and control measures and strategies cannot be overemphasized. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Discharge disposition of adolescents admitted to medical hospitals after attempting suicide.

PubMed

Levine, Leonard J; Schwarz, Donald F; Argon, Jesse; Mandell, David S; Feudtner, Chris

2005-09-01

To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region. Retrospective cohort analysis. The nationally representative Kids' Inpatient Database for 2000. Patients aged 10 to 19 years with a diagnosis of suicide attempt or self-inflicted injury.Main Outcome Measure Likelihood of transfer to another facility vs discharge to home. Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children's units in general hospitals (10%), and children's hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children's units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, 0.65-0.97; Midwest: OR, 0.63; 95% CI, 0.49-0.80; West: OR, 0.29; 95% CI, 0.22-0.38). Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.

An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa

PubMed Central

A. Mabunda, Sikhumbuzo; London, Leslie; Pienaar, David

2018-01-01

Background: A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care. Methods: A multi-method design was used. Sixty-eight patients were recruited over one month in mid-2011 in a prospective cohort. Patient data were collected from clinical record review and an interviewer-administered questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution, knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A telephonic questionnaire at 9-weeks post-discharge recorded their vital status, use of HBC post-discharge and their satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics and skills. Cox regression was used to identify predictors of survival. Results: Of the 68 participants, 38% and 24% were referred from a secondary and tertiary hospital, respectively. Stroke (35%) was the most common single reason for admission. The three most common reasons reported why care was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most patients reported admission to another health facility in the preceding year, only 13 patients (21%) had ever accessed HBC and only 25% (n=15) of discharged patients used HBC post-discharge. Of the 57 patients traced on follow-up, 21(37%) had died. The presence of a Care-plan was significantly associated with a 62% lower risk of death (hazard ratio: 0.38; CI 0.15–0.97). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. Conclusion: Clients understood this service as a caring environment primarily responsible for rehabilitation services. A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation with HBC services. IC services should be recognised as an integral part of the health system and should be accessible. PMID:29524940

Effects of Switching from Depakene to Generic Valproic Acid on Individuals with Mental Retardation.

ERIC Educational Resources Information Center

Vadney, Victor J.; Kraushaar, Kevin W.

1997-01-01

Comparison of brand-name Depakene with generic valproic acid medication to control seizures in 64 subjects with mental retardation living in an intermediate care facility found no statistically significant differences in seizures or blood levels. Results suggest use of the generic medication can result in substantial cost savings. (Author/DB)

Use of psychotropic medication in Oklahoma: a statewide survey.

PubMed

Spreat, S; Conroy, J W; Jones, J C

1997-07-01

Analysis of statewide survey data revealed that 22.5% of individuals with mental retardation who were served by the Oklahoma mental retardation system were receiving antipsychotic medication. Anxiolytic medications were prescribed for 9.3%, and antidepressants were prescribed for 5.9%. Higher levels of medication use were found in institutional settings and Intermediate Care Facility settings.

Fiscal Year 2001 Medicaid Home and Community-Based Services Expenditures Exceed Those of ICFs/MR.

ERIC Educational Resources Information Center

Lakin, K. Charlie; Prouty, Robert; Smith, Jerra; Polister, Barb; Smith, Gary

2002-01-01

This article reports that in 2001, for the first time since its creation 20 years earlier, Medicaid Home and Community-Based Services (HCBS) Waiver programs for persons with intellectual and developmental disabilities had Federal and state expenditures that exceeded those for Medicaid Intermediate Care Facilities for Persons with Mental…

Living Independently in a Home and Community of Choice: How?

ERIC Educational Resources Information Center

Braswell, Gail; Ritter, Linda; Sufficool, Mary Jane

2009-01-01

Residents in a group home, supported apartment, or intermediate care facility for the mentally retarded (ICF/MR) are not guaranteed a place for life. Neither are they guaranteed they won't have to move if their provider needs to "rearrange" clients. Separating residence from support gives an individual control over the most basic decisions…

Total and High-Density Lipoprotein Cholesterol in Adults with Mental Retardation.

ERIC Educational Resources Information Center

Rimmer, James H.; Kelly, Luke E.

1990-01-01

The study evaluated the total cholesterol and high density lipoprotein cholesterol of 40 adults (mean age 37.5 years) with mental retardation residing at an intermediate care facility. Results indicated that 59 percent of the males and 68 percent of the females were at moderate to high risk for coronary heart disease. (DB)

The relationship between organizational climate and quality of chronic disease management.

PubMed

Benzer, Justin K; Young, Gary; Stolzmann, Kelly; Osatuke, Katerine; Meterko, Mark; Caso, Allison; White, Bert; Mohr, David C

2011-06-01

To test the utility of a two-dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross-sectional study. All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient-level data. Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate. © Health Research and Educational Trust.

Medicaid program; home and community-based services. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

PubMed

2000-10-10

This final rule with comment period expands State flexibility in providing prevocational, educational, and supported employment services under the Medicaid home and community-based services waiver provisions currently found in section 1915(c) of the Social Security Act (the Act); and incorporates the self-implementing provisions of section 4743 of the Balanced Budget Act of 1997 that amends section 1915(c)(5) of the Act to delete the requirements that an individual have prior institutionalization in a nursing facility or intermediate care facility for the mentally retarded before becoming eligible for the expanded habilitation services. In addition, we are making a number of technical changes to update or correct the regulations.

Medicaid-financed residential care for persons with mental retardation.

PubMed

Lakin, K C; Hall, M J

1990-12-01

Two sources of Medicaid support for persons with mental retardation and related conditions (MR/RC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States.

Medicaid-financed residential care for persons with mental retardation

PubMed Central

Lakin, K. Charlie; Hall, Margaret Jean

1990-01-01

Two sources of Medicaid support for persons with mental retardation and related conditions (MRIRC) are examined, the intermediate care facility for the mentally retarded (ICF/MR) program and the home and community-based services (HCBS) waiver. Results indicate that Medicaid support through the ICF/MR program has shown little recent growth in terms of number of persons served, although expenditures continue to increase. Medicaid's HCBS waiver is being used increasingly by States to support residential placement because of its greater flexibility and more individualized approach relative to ICF/MR care. Use of Medicaid to finance care for persons with MR/RC varies considerably across States. PMID:10113489

High dependency units in the UK: variable size, variable character, few in number.

PubMed Central

Thompson, F. J.; Singer, M.

1995-01-01

An exploratory descriptive survey was conducted to determine the size and character of high dependency units (HDUs) in the UK. A telephone survey and subsequent postal questionnaire was sent to the 39 general HDUs in the UK determined by a recent survey from the Royal College of Anaesthetists; replies were received from 28. Most HDUs (82%, n = 23) were geographically distinct from the intensive care unit and varied in size from three to 13 beds, although only 64% (n = 18) reported that all beds were currently open. Nurse: patient ratios were at least 1:3. Fifty per cent of units had one or more designated consultants in charge, although only 11% (n = 3) had specifically designated consultant sessions. Junior medical cover was provided mainly by the on-call speciality term. Twenty units acted as a step-down facility for discharged intensive care unit patients and 21 offered a step-up facility for patients from general wards. Provision of facilities and levels of monitoring varied between these units. Few HDUs exist in the UK and they are variable in size and in the facilities and monitoring procedures which they provide. Future studies are urgently required to determine cost-effectiveness and outcome benefit of this intermediate care facility. Images p221-a PMID:7784281

High dependency units in the UK: variable size, variable character, few in number.

PubMed

Thompson, F J; Singer, M

1995-04-01

An exploratory descriptive survey was conducted to determine the size and character of high dependency units (HDUs) in the UK. A telephone survey and subsequent postal questionnaire was sent to the 39 general HDUs in the UK determined by a recent survey from the Royal College of Anaesthetists; replies were received from 28. Most HDUs (82%, n = 23) were geographically distinct from the intensive care unit and varied in size from three to 13 beds, although only 64% (n = 18) reported that all beds were currently open. Nurse: patient ratios were at least 1:3. Fifty per cent of units had one or more designated consultants in charge, although only 11% (n = 3) had specifically designated consultant sessions. Junior medical cover was provided mainly by the on-call speciality term. Twenty units acted as a step-down facility for discharged intensive care unit patients and 21 offered a step-up facility for patients from general wards. Provision of facilities and levels of monitoring varied between these units. Few HDUs exist in the UK and they are variable in size and in the facilities and monitoring procedures which they provide. Future studies are urgently required to determine cost-effectiveness and outcome benefit of this intermediate care facility.

Comparing clinical automated, medical record, and hybrid data sources for diabetes quality measures.

PubMed

Kerr, Eve A; Smith, Dylan M; Hogan, Mary M; Krein, Sarah L; Pogach, Leonard; Hofer, Timothy P; Hayward, Rodney A

2002-10-01

Little is known about the relative reliability of medical record and clinical automated data, sources commonly used to assess diabetes quality of care. The agreement between diabetes quality measures constructed from clinical automated versus medical record data sources was compared, and the performance of hybrid measures derived from a combination of the two data sources was examined. Medical records were abstracted for 1,032 patients with diabetes who received care from 21 facilities in 4 Veterans Integrated Service Networks. Automated data were obtained from a central Veterans Health Administration diabetes registry containing information on laboratory tests and medication use. Success rates were higher for process measures derived from medical record data than from automated data, but no substantial differences among data sources were found for the intermediate outcome measures. Agreement for measures derived from the medical record compared with automated data was moderate for process measures but high for intermediate outcome measures. Hybrid measures yielded success rates similar to those of medical record-based measures but would have required about 50% fewer chart reviews. Agreement between medical record and automated data was generally high. Yet even in an integrated health care system with sophisticated information technology, automated data tended to underestimate the success rate in technical process measures for diabetes care and yielded different quartile performance rankings for facilities. Applying hybrid methodology yielded results consistent with the medical record but required less data to come from medical record reviews.

Reverse transport of children from a tertiary pediatric hospital.

PubMed

McPherson, Mona L; Jefferson, Larry S; Smith, E O'Brian; Sitler, Garry C; Graf, Jeanine M

2007-01-01

The purpose of this study was to determine the epidemiology and resources used and to study the potential savings of pediatric reverse transport patients. A case control study was performed with patients undergoing a reverse or outbound transport from a large, pediatric hospital. Twenty-five children undergoing reverse transport were compared with matched controls. Lengths of stay and costs were compared between the reverse transport and matched control patients. Fifty-two percent of the reverse transport patients returned home, whereas 32% went home for end-of-life care and 16% went to other facilities. The average reverse transport was more than 400 miles and cost $6,064. The reverse transport of these patients did not save pediatric intensive care unit (PICU) days but did result in a shorter hospital stay compared with the matched controls (10 vs. 19 days, P = .03). Decreased utilization of bed days came from less use of intermediate care unit resources. Pediatric patients undergo reverse transports for a variety of reasons, often for end-of-life care. The ability to reverse transport pediatric patients may not save PICU bed days but may offer pediatric tertiary care hospitals a means to provide more intermediate care bed availability.

Research and Implementation Issues in Developing a Reimbursement System for ICFs/MR Program Costs Based on Client Resource Use.

ERIC Educational Resources Information Center

Chapin, Rosemary; Rotegard, Lisa

Under the current Medicaid reimbursement system in Minnesota for intermediate care facilities for the mentally retarded (ICFs/MR), payments are not targeted properly because there is no uniform assessment and resource use information to determine those clients for whom services are most costly to provide. A project was mandated by the state…

Satisfaction and Sense of Well Being among Medicaid ICF/MR and HCBS Recipients in Six States

ERIC Educational Resources Information Center

Stancliffe, Roger J.; Lakin, K. Charlie; Taub, Sarah; Chiri, Giuseppina; Byun, Soo-yong

2009-01-01

Self-reported satisfaction and sense of well-being were assessed in a sample of 1,885 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services in 6 states. Questions dealt with such topics as loneliness, feeling afraid at home and in one's…

Break the Data-Bank with Monte Carlo? Statistical Problems in the Dispute between Conroy (1996) and Crinella, McCleary, and Swanson (1998).

ERIC Educational Resources Information Center

Heifetz, Louis J.

1998-01-01

Comments on "The Small ICF/MR Program: Dimensions of Quality and Cost" (Conroy), that found small Intermediate Care Facilities (ICF) for individuals with mental retardation are inferior to other community programs. Acknowledges that while some research problems exist, no important evidence against the findings has been provided. (CR)

Assessing Risk of Injury in People with Mental Retardation Living in an Intermediate Care Facility

ERIC Educational Resources Information Center

Konarski, Edward A.; Tasse, Marc

2005-01-01

A brief instrument to assess risk of injury was applied retrospectively for 2 years and prospectively for 1 year to all people living in a large ICF/MR. Results suggest that the percentage of people who experienced an injury significantly increased across the levels of increasing risk indicated by the assessment. Furthermore, people who…

Abusing the Unprotected: A Study of the Misuse of Aversive Behavior Modification Techniques and Weaknesses in the Regulatory Structure.

ERIC Educational Resources Information Center

New York State Commission on Quality of Care for the Mentally Disabled, Albany.

This report examines issues concerned with the use of aversive behavior modification techniques in actual treatment practices at one intermediate care facility for the mentally retarded. The review of these practices reveals how, once the philosophy of using aversives takes hold at a program (to deal with seemingly intractable behaviors), its…

River Gardens Intermediate-Care Facility water-to-air heating and air-conditioning demonstration project. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, R.C.

An integrated system of heat pumps is used to reject heat into or extract heat from circulating water from a shallow well adjacent to the river to demonstrate the efficiency and fuel cost savings of water-to-air heat pumps, without the expense of drilling a deep well. Water is returned unpolluted to the Guadalupe River and is circulated through a five-building complex at River Gardens Intermediate Care Facility for the Mentally Retarded in New Braunfels, Texas. The water is used as a heat source or sink for 122 heat pumps providing space heating and cooling, and for refrigeration and freezer units.more » The system was not installed as designed, which resulted in water pumping loads being higher than the original design. Electrical consumption for pumping water represented 36 to 37% of system electrical consumption. Without the water pumping load, the water-to-air system was an average of 25% more efficient in heating than a comparable air-to-air unit with resistance heating. With water pumping load included, the installed system averaged 17% less efficient in cooling and 19% more efficient in heating than the comparable unit.« less

[Factors influencing users' destination upon discharge from a geriatric intermediate care facility in an urban area].

PubMed

Ishizaki, T; Kai, I; Hirayama, T

1995-02-01

Geriatric Intermediate Care Facilities (GICF) have been established to help the hospitalized elderly return home. Users of the GICF are elderly persons who do not need hospitalization, but are mentally or physically impaired. To determine what factors influence users' destinations upon discharge from GICF, we analyzed various characteristics such as age, sex, place of residence before admission, length of stay, intellectual impairment, ability to perform activities of daily living (ADL) among users (N = 389) in a GICF in Chiba City. Multiple logistic regression analyses revealed that, compared with the users who were hospitalized, users who were male, admitted for home, stayed for long periods, and had a high ability to perform ADL were more likely to return home. The analyses also revealed that, compared with the users who were institutionalized, users who came from home, stayed for short periods, and had a high ability to perform ADL were more likely to return home. Evaluating a user's physical, mental, and socioeconomical conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended period.

Medicaid program; correction and reduction plans for intermediate care facilities for the mentally retarded--HCFA. Final rule.

PubMed

1988-01-25

These final regulations provide States options under which an intermediate care facility for the mentally retarded (ICF/MR) found to have substantial deficiencies only in physical plant and staffing (or physical plant, staffing, and other minor deficiencies) that do not pose an immediate threat to the clients' health and safety may remedy those deficiencies. The regulations provide the State Medicaid agency with options to submit written plans either to correct the necessary staff and physical plant deficiencies, and all other minor deficiencies, within 6 months of the approval date of the plan, or to reduce permanently the number of beds in certified units within 36 months of the approval date of the plan. These regulations implement section 9516 of the Consolidated Omnibus Budget Reconciliation Act of 1985 and section 4217 of the Omnibus Budget Reconciliation Act of 1987. The purpose of the correction plan provision is to promote correction of deficiencies without having to exclude ICFs/MR from the Medicaid program. The reduction plan provision is intended to move Medicaid clients out of deficient ICFs/MR into licensed or certified (as applicable) community settings while maintaining the clients' quality of life and retaining their Medicaid eligibility.

Resident Aggression Toward Staff at a Center for the Developmentally Disabled

PubMed Central

West, Christine A.; Galloway, Ellen; Niemeier, Maureen T.

2015-01-01

Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICF/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies for a safe workplace. The authors recommended review and maintenance of workplace violence prevention policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury. PMID:24571051

An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa.

PubMed

A Mabunda, Sikhumbuzo; London, Leslie; Pienaar, David

2017-05-14

A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care. A multi-method design was used. Sixty-eight patients were recruited over one month in mid-2011 in a prospective cohort. Patient data were collected from clinical record review and an interviewer-administered questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution, knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A telephonic questionnaire at 9-weeks post-discharge recorded their vital status, use of HBC post-discharge and their satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics and skills. Cox regression was used to identify predictors of survival. Of the 68 participants, 38% and 24% were referred from a secondary and tertiary hospital, respectively. Stroke (35%) was the most common single reason for admission. The three most common reasons reported why care was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most patients reported admission to another health facility in the preceding year, only 13 patients (21%) had ever accessed HBC and only 25% (n=15) of discharged patients used HBC post-discharge. Of the 57 patients traced on follow-up, 21(37%) had died. The presence of a Care-plan was significantly associated with a 62% lower risk of death (hazard ratio: 0.38; CI 0.15-0.97). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. Clients understood this service as a caring environment primarily responsible for rehabilitation services. A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation with HBC services. IC services should be recognised as an integral part of the health system and should be accessible. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Research without billing data. Econometric estimation of patient-specific costs.

PubMed

Barnett, P G

1997-06-01

This article describes a method for computing the cost of care provided to individual patients in health care systems that do not routinely generate billing data, but gather information on patient utilization and total facility costs. Aggregate data on cost and utilization were used to estimate how costs vary with characteristics of patients and facilities of the US Department of Veterans Affairs. A set of cost functions was estimated, taking advantage of the department-level organization of the data. Casemix measures were used to determine the costs of acute hospital and long-term care. Hospitalization for medical conditions cost an average of $5,642 per US Health Care Financing Administration diagnosis-related group weight; surgical hospitalizations cost $11,836. Nursing home care cost $197.33 per day, intermediate care cost $280.66 per day, psychiatric care cost $307.33 per day, and domiciliary care cost $111.84 per day. Outpatient visits cost an average of $90.36. These estimates include the cost of physician services. The econometric method presented here accounts for variation in resource use caused by casemix that is not reflected in length of stay and for the effects of medical education, research, facility size, and wage rates. Data on non-Veteran's Affairs hospital stays suggest that the method accounts for 40% of the variation in acute hospital care costs and is superior to cost estimates based on length of stay or diagnosis-related group weight alone.

[Cross sectional study of structural quality of German intensive care units. A reevaluation of the DIVI register].

PubMed

Fölsch, C; Kofahl, N; Waydhas, C; Stiletto, R

2013-09-01

Effectiveness of intensive care treatment is essential to cope with increasing costs. The German national register of intensive care established by the German Interdisciplinary Association for Intensive Care Medicine (DIVI) contains basic data on the structure of intensive care units in Germany. A repeat analysis of data of the DIVI register within 8 years provides information for the development of intensive care units under different economic circumstances. The recent data on the structure of intensive care units were obtained in 2008 and compared with the primary multicenter study from 2000. The hospitals selected were a representative sample for the whole of Germany. Data on the status of the hospital, staff and technical facilities, foundation of the hospital and the statistics of mechanically ventilated patients were analyzed. The technical facilities and the number of staff have improved from 2000 to 2008. A smaller availability of diagnostic procedures and staff remain in hospitals for basic treatment outside normal working hours. The average utilization of intensive care unit beds was not altered. The existence of intermediate care units did not significantly change the proportion of patients with artificial ventilation or ventilation times. The number of beds in intensive care units was unchanged as was the average number of beds in units and the number of patients treated. A relevant number of beds of intensive care units shifted towards hospitals with private foundation without changes in the overall numbers. The structure of the hospitals was comparable at both time points. The introduction of intermediate care units did not alter ventilation parameters of patients in 2008 compared with 2000. There is no obvious medical reason for the shift of intensive care beds towards private hospitals. The number of staff and patients varied considerably between the intensive care units. The average number of patients treated per bed was not different between the periods or between hospitals with different structures. Overall availability of medical staff and diagnostic procedures increased during the study period. An increase of availability of fully trained medical staff in intensive care medicine is desirable to increase the quality of treatment.

Intensive rehabilitation for dementia improved cognitive function and reduced behavioral disturbance in geriatric health service facilities in Japan.

PubMed

Toba, Kenji; Nakamura, Yu; Endo, Hidetoshi; Okochi, Jiro; Tanaka, Yukiko; Inaniwa, Chiyako; Takahashi, Akira; Tsunoda, Naoko; Higashi, Kentaro; Hirai, Motoharu; Hirakawa, Hiroyuki; Yamada, Shizuru; Maki, Yohko; Yamaguchi, Tomoharu; Yamaguchi, Haruyasu

2014-01-01

To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community-based care at home and dehospitalization. Participants were older adults with dementia newly admitted to intermediate facilities. A total of 158 in the intervention group who claimed Long-Term Care Insurance for three consecutive months, and 54 in the control group were included in the analysis. The interventions were carried out in a tailor-made manner to meet individual needs. The personal sessions were carried out three times a week for 3 months after admission by physical, occupational or speech therapists. Outcome measures were cognitive tests (Hasegawa Dementia Scale revised [HDS-R] and Mini-Mental State Examination), and observational assessments of dementia severity, activities of daily living (ADL), social activities, behavioral and psychological symptoms of dementia (BPSD) using a short version of the Dementia Disturbance Scale (DBD13), depressive mood, and vitality. Significant improvement in the intervention group was shown in cognitive function measured by HDS-R (interaction F[1, 196] = 5.190, P = 0.024), observational evaluation of dementia severity (F[1,198] = 9.550, P = 0.002) and BPSD (DBD13; F[1,197] = 4.506, P = 0.035). Vitality, social activities, depressive mood and ADL were significantly improved only in the intervention group, although interaction was not significant. Significant improvement by intervention was shown in multiple domains including cognitive function and BPSD. Cognitive decline and worsening of BPSD are predictors of care burden and hospitalization, thus intensive rehabilitation for dementia was beneficial for both individuals with dementia and their caregivers. © 2013 Japan Geriatrics Society.

The Relationship between Organizational Climate and Quality of Chronic Disease Management

PubMed Central

Benzer, Justin K; Young, Gary; Stolzmann, Kelly; Osatuke, Katerine; Meterko, Mark; Caso, Allison; White, Bert; Mohr, David C

2011-01-01

Objective To test the utility of a two-dimensional model of organizational climate for explaining variation in diabetes care between primary care clinics. Data Sources/Study Setting Secondary data were obtained from 223 primary care clinics in the Department of Veterans Affairs health care system. Study Design Organizational climate was defined using the dimensions of task and relational climate. The association between primary care organizational climate and diabetes processes and intermediate outcomes were estimated for 4,539 patients in a cross-sectional study. Data Collection/Extraction Methods All data were collected from administrative datasets. The climate data were drawn from the 2007 VA All Employee Survey, and the outcomes data were collected as part of the VA External Peer Review Program. Climate data were aggregated to the facility level of analysis and merged with patient-level data. Principal Findings Relational climate was related to an increased likelihood of diabetes care process adherence, with significant but small effects for adherence to intermediate outcomes. Task climate was generally not shown to be related to adherence. Conclusions The role of relational climate in predicting the quality of chronic care was supported. Future research should examine the mediators and moderators of relational climate and further investigate task climate. PMID:21210799

Surveying Unstructured Time of Adults with Mental Retardation Living in Two Community Settings: A Search for Normalization.

ERIC Educational Resources Information Center

Pierce, Thomas B., Jr.; And Others

1990-01-01

A survey assessed time spent in the community and/or on unstructured activities by randomly selected individuals in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) (N=20) or minigroup home settings (N=20). Individuals in ICF/MR homes spent more time in the community with staff and made fewer choices of unstructured activities.…

Benchmark dataset for undirected and Mixed Capacitated Arc Routing Problems under Time restrictions with Intermediate Facilities.

PubMed

Willemse, Elias J; Joubert, Johan W

2016-09-01

In this article we present benchmark datasets for the Mixed Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities (MCARPTIF). The problem is a generalisation of the Capacitated Arc Routing Problem (CARP), and closely represents waste collection routing. Four different test sets are presented, each consisting of multiple instance files, and which can be used to benchmark different solution approaches for the MCARPTIF. An in-depth description of the datasets can be found in "Constructive heuristics for the Mixed Capacity Arc Routing Problem under Time Restrictions with Intermediate Facilities" (Willemseand Joubert, 2016) [2] and "Splitting procedures for the Mixed Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities" (Willemseand Joubert, in press) [4]. The datasets are publicly available from "Library of benchmark test sets for variants of the Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities" (Willemse and Joubert, 2016) [3].

Nursing home cost and ownership type: evidence of interaction effects.

PubMed

Arling, G; Nordquist, R H; Capitman, J A

1987-06-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed.

Nursing home cost and ownership type: evidence of interaction effects.

PubMed Central

Arling, G; Nordquist, R H; Capitman, J A

1987-01-01

Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed. PMID:3301746

Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility.

PubMed

Clark, L P; Dion, D M; Barker, W H

1990-09-01

The objective of this study was to determine the incidence and selected clinical outcomes of taking to bed among a population of independently ambulating older individuals. It was designed as a retrospective case series and was conducted in the intermediate-care facility of a not-for-profit, teaching nursing home. Our study group was composed of individuals over 65 years of age who became bed bound. Thirty-six taking-to-bed episodes occurred in 36 individuals during one calendar year, giving an incidence of 13 per 1,000 resident-months (95% CI, 4 to 23 per 1,000). Twelve of the 36 died within 3 months, and 17 within 6 months, but almost all who survived regained ambulation. Survival was significantly shorter for the five without localizing symptoms (P less than .05). Orthopedic, neurologic, psychiatric, and iatrogenic conditions were most commonly identified as concurrent medical events. Almost half who took to bed had multiple concurrent medical events, and these residents were more likely to present without localizing symptoms (P less than .05). Twenty-one (58%) of the episodes occurred after a fall. The incidence of taking to bed in this population indicates that clinicians caring for older persons should be alert to its occurrence. The dramatic decline in mobility deserves careful assessment because it initiated a period of relatively rapid change in the health careers of the individuals we studied: almost half died within 6 months, but nearly all who survived regained ambulation. Those without localizing symptoms may have more complex interacting medical problems and a worse prognosis.

77 FR 72920 - Federal Housing Administration (FHA) Section 232 Healthcare Mortgage Insurance Program: Partial...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

...This rule amends the regulations governing FHA's Section 232 Healthcare Mortgage Insurance program (Section 232 program) by establishing the criteria and process by which FHA will accept and pay a partial payment of a claim under the FHA mortgage insurance contract. The Section 232 program insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. Through acceptance and payment of a partial payment of claim, FHA pays the lender a portion of the unpaid principal balance and recasts a portion of the mortgage under terms and conditions determined by FHA, as an alternative to the lender assigning the entire mortgage to HUD. Partial payment of claim also allows FHA- insured healthcare projects to continue operating and providing services.

Functional independence of residents in urban and rural long-term care facilities in Taiwan.

PubMed

Lin, Kwan-Hwa; Wu, Shiao-Chi; Hsiung, Chia-Ling; Hu, Ming-Hsia; Hsieh, Ching-Lin; Lin, Jau-Hong; Kuo, Mei-Ying

2004-02-04

To compare the score of functional independence measure (FIM) between urban and rural residents living in long-term care facilities (LTCF) in Taiwan. A total of 437 subjects in 112 licensed LTCF in Taiwan were randomly selected by stratification strategy. Physical therapists interviewed the subjects in nursing homes (NH) and intermediate care facilities (ICF) to obtain the basic data, and the FIM score. (1) There was no significant difference in basic demographic data between urban and rural LTC subjects. (2) Most of the subjects in urban and rural LTCF were males, less than 80 years old, single/widowed, having multiple diseases, using more than one assistive devices, and having social welfare financial support. (3) Motor abilities (eating, grooming, and transfer) and cognition (comprehension, social interaction and problem solving) in rural LTCF subjects were significantly (p < 0.05) higher than those in urban areas as revealed by the FIM assessment. (4) The median of FIM total score of rural LTCF subjects was 90.5, which was significantly (p < 0.05) higher than that of urban LTCF subjects (median = 76). Some of the functional performance of subjects in rural long-term care institutions is better than those in urban areas. Our results may provide guidelines for the manpower and equipment supply estimation.

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010

PubMed Central

Valley, Thomas S.; Prescott, Hallie C.; Wunsch, Hannah; Iwashyna, Theodore J.; Cooke, Colin R.

2016-01-01

Rationale: Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. Objectives: To characterize trends in intermediate care use among U.S. hospitals. Methods: We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. Measurements and Main Results: In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons). Conclusions: Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals. PMID:26372779

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010.

PubMed

Sjoding, Michael W; Valley, Thomas S; Prescott, Hallie C; Wunsch, Hannah; Iwashyna, Theodore J; Cooke, Colin R

2016-01-15

Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. To characterize trends in intermediate care use among U.S. hospitals. We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P < 0.01). Only 8.2% of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P < 0.01), whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P < 0.01 for all comparisons). Intermediate care billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.

[Factors facilitating the return of the elderly to their homes after discharge from a geriatric intermediate care facility].

PubMed

Ishizaki, T

1992-02-01

Geriatric intermediate care facilities (GICFs) were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Contrary to the initial expectation, only half of users (the elderly) have returned home. In order to examine the factors influencing destination after discharge from GICFs, characteristics of the users of a GICF and their primary caregivers were analyzed in a rural community in Nagano. The users were grouped according to their discharge destinations (i.e. 1: home, 2: hospital, 3: nursing home and other GICFs) and compared with respect to the users' and caregivers' socio-demographic characteristics, the length of stay, the users' activities of daily living (ADL) and mental status, the type of place before admission and after discharge, and the caring capacity of the family (i.e. manpower, housing conditions, household economic level and social support). A multiple logistic regression analysis revealed that the following factors were correlated to their return home: good ADL, a short admission period, good level of health of caregivers, adequate space in the residence, negative perception of the caregivers regarding the costs of GICF, and economic level of the household. Evaluation of these factors at an early stage of admission to GICFs may enable prediction of whether or not a user can be successfully discharged to return home.

Performance evaluation of the essential dimensions of the primary health care services in six localities of Bogota–Colombia: a cross-sectional study

PubMed Central

2013-01-01

Background The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. Methods The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. Results The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users. Conclusions The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required. PMID:23947574

Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium.

PubMed

Maldonado, José R

2017-07-01

Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium. Copyright © 2017 Elsevier Inc. All rights reserved.

Three statistical models for estimating length of stay.

PubMed Central

Selvin, S

1977-01-01

The probability density functions implied by three methods of collecting data on the length of stay in an institution are derived. The expected values associated with these density functions are used to calculate unbiased estimates of the expected length of stay. Two of the methods require an assumption about the form of the underlying distribution of length of stay; the third method does not. The three methods are illustrated with hypothetical data exhibiting the Poisson distribution, and the third (distribution-independent) method is used to estimate the length of stay in a skilled nursing facility and in an intermediate care facility for patients enrolled in California's MediCal program. PMID:914532

Three statistical models for estimating length of stay.

PubMed

Selvin, S

1977-01-01

The probability density functions implied by three methods of collecting data on the length of stay in an institution are derived. The expected values associated with these density functions are used to calculate unbiased estimates of the expected length of stay. Two of the methods require an assumption about the form of the underlying distribution of length of stay; the third method does not. The three methods are illustrated with hypothetical data exhibiting the Poisson distribution, and the third (distribution-independent) method is used to estimate the length of stay in a skilled nursing facility and in an intermediate care facility for patients enrolled in California's MediCal program.

An Analysis of Minnesota Property Values of Community Intermediate Care Facilities for Mentally Retarded (ICF-MRs). Issues Related to Welsch v. Noot. Policy Analysis Series No. 11.

ERIC Educational Resources Information Center

Minnesota Governor's Planning Council on Developmental Disabilities, St. Paul.

The paper analyzes one issue, property values, as an impact of Welsch v. Noot which affected zoning practices regarding group homes for mentally retarded persons. Assessed value was used to measure property vaues of 14 group home neighborhoods for the year preceding and following establishment of the home. Data were obtained from local tax…

Involving older people in intermediate care.

PubMed

Andrews, JoyAnn; Manthorpe, Jill; Watson, Roger

2004-05-01

Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.

Essential medicines for emergency care in Africa.

PubMed

Broccoli, Morgan C; Pigoga, Jennifer L; Nyirenda, Mulinda; Wallis, Lee; Calvello Hynes, Emilie J

2018-04-07

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process. The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres). The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The impact of intermediate care services on job satisfaction, skills and career development opportunities.

PubMed

Nancarrow, Susan

2007-07-01

The purpose of this study was to examine, in depth, the impact of intermediate care services on staff job satisfaction, skills development and career development opportunities. Recruitment and retention difficulties present a major barrier to the effective delivery of intermediate care services in the UK. The limited existing literature is contradictory, but points to the possibility of staff deskilling and suggests that intermediate care is poorly understood and may be seen by other practitioners as being of lower status than hospital work. These factors have the potential to reduce staff morale and limit the possibilities of recruiting staff. The research is based on interviews with 26 staff from case studies of two intermediate care services in South Yorkshire. Participants reported high levels of job satisfaction, which was because of the enabling philosophy of care, increased autonomy, the setting of care and the actual teams within which the workers were employed. For most disciplines, intermediate care facilitated the application of existing skills in a different way; enhancing some skills, while restricting the use of others. Barriers to career development opportunities were attributed to the relative recency of intermediate care services, small size of the services and lack of clear career structures. Career development opportunities in intermediate care could be improved through staff rotations through acute, community and intermediate care to increase their awareness of the roles of intermediate care staff. The non-hierarchical management structures limits management career development opportunities, instead, there is a need to enhance professional growth opportunities through the use of consultant posts and specialization within intermediate care. This study provides insight into the impact of an increasingly popular model of care on the roles and job satisfaction of workers and highlights the importance of this learning for recruitment and retention of staff.

Quality Measures for Dialysis: Time for a Balanced Scorecard

PubMed Central

2016-01-01

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. PMID:26316622

[Characteristics of the clients in a geriatric intermediate care facility located in the suburbs of an urban area and factors related to the discharge destinations desired by family caregivers].

PubMed

Watanabe, M; Kono, K; Nishiura, K; Miyata, K; Saito, M

1999-01-01

Among the clients in a geriatric intermediate care facility located in the suburbs of Osaka and their family caregivers (72 subjects), the characteristics of the clients and their caregivers, and the discharge destination desired by their family caregivers were investigated, and the associated factors were evaluated. 1. Characteristics of the clients. The clients were elderly females with a low degree of independence, and dementia was observed in about 60% of them. The clients had a relatively large number of children, but many of them lived alone before admission. The rate of admission from hospitals was high (54%), and that of discharge to hospitals was also high (50%). Sixty-seven percent of the clients stayed for a long duration of over 6 months. 2. Conditions of the family caregivers. Most of the family caregivers were daughters or daughters-in-law, and considered themselves to be healthy. Sixty-three percent of the caregivers had jobs. However, most of the caregivers did not have sub-caregiver. 3. Factors related to the discharge destination desired by family caregivers. Not many family caregivers (19.4%) wanted them to go back to their homes after discharge, but their preferred discharge destinations were home (19.4%), hospitals (55.5%), and nursing homes (25.1%). The caregivers of single household clients often desired a nursing home as the discharge destination, and those of the clients from a 2- or 3-generation household often desired a hospital. The factors related to the discharge destination desired by client's family caregivers were that the client not show dementia, the job of the caregiver was a part-time job, there was a sub-caregiver, and the client had the experience of home public health nursing visits. This study showed, the percentage of the clients discharged from the geriatric intermediate care facility to their homes was low, and that of the family caregivers who desired their home as the discharge destination was also low. However, the results suggested that leading the discharge destination to the client's home is possible if social resources are provided such as the use of public health nursing services.

Meeting the needs of people with AIDS: local initiatives and Federal support.

PubMed Central

Sundwall, D N; Bailey, D

1988-01-01

The Health Resources and Services Administration (HRSA), one of the seven agencies of the Public Health Service, is working to meet some of the resource and patient service needs engendered by the epidemic of acquired immune deficiency syndrome (AIDS). Those actions derived from, and support the continuation, expansion, and replication of, initiatives at the community and State levels. HRSA is carrying out many of the recommendations of the Intragovernmental Task Force on AIDS Health Care Delivery by enhancing the AIDS training of health care personnel in prevention, diagnosis, and care and by counseling and encouraging the expansion of facilities outside hospitals to care for AIDS patients. The agency, through its pediatric AIDS demonstration projects, is working on models for the care of children with HIV infections. The needs of AIDS patients are being addressed through a drug therapy reimbursement program; demonstration grants to 13 projects to promote coordinated, integrated systems of care in the community; and grants for the development of intermediate and long-term care facilities for patients. Ten regional education and training centers, funded in 1987 and 1988, will increase the supply of health care providers prepared to diagnose and treat persons with HIV infections. Programs will be conducted for several thousand providers over the next 3 years, using such modalities as televised programs and train-the-trainer courses. The centers will also offer support and referral services for providers. PMID:3131821

Causes of death of patients in an institution for the developmentally disabled.

PubMed

Blisard, K S; Martin, C; Brown, G W; Smialek, J E; Davis, L E; McFeeley, P J

1988-11-01

The causes of death of 53 severely to profoundly developmentally disabled patients who died in an intermediate care facility were reviewed. Respiratory disease, predominantly pneumonia and aspiration, accounted for 72% of deaths. Seven patients died of nonrespiratory causes, and in 8 patients, no cause of death could be determined, even after a complete autopsy or investigation. The median age at death was 20 years. The weights of these patients' organs at autopsy were lower than those for normal individuals of the same age. The lifespan of these severely impaired individuals continues to be significantly shortened, even with improved methods of care.

Patterns of family caregiving and support provided to older psychiatric patients in long-term care.

PubMed

Beeler, J; Rosenthal, A; Cohler, B

1999-09-01

Data on patterns of relationships and caregiving between older, institutionalized chronically mentally ill patients and their families were gathered in brief face-to-face interviews with 109 patients randomly selected from residents age 45 or older in a large intermediate care facility in Chicago. Three-fourths of the sample maintained some form of family contact. One-third had been married or had children. Siblings were the most frequently identified family contact and support. The results suggests that older, institutionalized psychiatric patients continue to have family contact and that siblings and offspring become increasingly important as patients age.

Comparability of WAIS and WAIS--R scores among mentally retarded adults.

PubMed

Raggio, D J

1989-08-01

This study compared the performance on the WAIS and WAIS--R of 21 mentally retarded adults residing in an Intermediate Care Facility. Tests were administered in one order, the WAIS initially and the WAIS--R second, with approximately two years between testings. Significant differences were found on the WAIS and WAIS--R for Verbal, Performance and Full Scale IQs. This finding contrasts with the differences between the measures as reported in the WAIS--R manual.

Implementation of a psychotropic drug review service in a mental retardation facility.

PubMed

Marcoux, A W

1985-11-01

A redesigned psychotropic drug review service was needed for our 650-bed intermediate care facility for the mentally retarded (ICF/MR). A committee consisting of a client's rights monitor, pharmacist, and psychologist prepared the necessary policy and procedure as well as data collection sheets. Meetings are now conducted in a semiformal fashion, with each discipline contributing in tis area of expertise. Since the inception of the restructured psychotropic drug review service, psychotropic medication dosages (neuroleptic agents only) have decreased at a projected annual rate of 17% and there have been no significant withdrawal reactions. This dosage decrease has saved the institution approximately $2800 to $3200 in medication costs after a 10-month period.

Brachial plexus palsy with the use of haloperidol and a geriatric chair.

PubMed

King, T; Mallet, L

1991-10-01

An 81-year-old white man was admitted to an intermediate care facility because of increased wandering and confusion secondary to dementia. On the first day after admission, the patient tried to leave the facility and was hitting and kicking the employees. Haloperidol 0.5 mg tid was prescribed to help control his behavior. He became more agitated and confused; haloperidol was then increased to 1 mg qid and the patient was confined to a geriatric chair to prevent injuries. Cogwheel movements, rigidity, and marked sedation were documented. A right brachial plexus palsy was diagnosed. This case demonstrated the hazards of two commonly used interventions in a nursing home: antipsychotic agents and the geriatric chair.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.

PubMed

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-03-01

The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. Copyright © 2014 World Health Organization. Published by Mosby, Inc. All rights reserved.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

PubMed Central

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-01-01

Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. PMID:24581011

Corrosion behaviour of steel rebars embedded in a concrete designed for the construction of an intermediate-level radioactive waste disposal facility

NASA Astrophysics Data System (ADS)

Duffó, G. S.; Arva, E. A.; Schulz, F. M.; Vazquez, D. R.

2013-07-01

The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on an instrumented reinforced concrete prototype specifically designed for this purpose, to study the behaviour of an intermediate level radioactive waste disposal facility from the rebar corrosion point of view. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

Durability of a reinforced concrete designed for the construction of an intermediate-level radioactive waste disposal facility

NASA Astrophysics Data System (ADS)

Duffó, G. S.; Arva, E. A.; Schulz, F. M.; Vazquez, D. R.

2012-01-01

The National Atomic Energy Commission of the Argentine Republic is developing a nuclear waste disposal management programme that contemplates the design and construction of a facility for the final disposal of intermediate-level radioactive wastes. The repository is based on the use of multiple, independent and redundant barriers. The major components are made in reinforced concrete so, the durability of these structures is an important aspect for the facility integrity. This work presents an investigation performed on a reinforced concrete specifically designed for this purpose, to predict the service life of the intermediate level radioactive waste disposal facility from data obtained with several techniques. Results obtained with corrosion sensors embedded in a concrete prototype are also included. The information obtained will be used for the final design of the facility in order to guarantee a service life more or equal than the foreseen durability for this type of facilities.

Using evidence-based leadership initiatives to create a healthy nursing work environment.

PubMed

Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela

2013-01-01

In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

Effects of a complete smoking ban on inpatients at an intermediate to long-term psychiatric facility.

PubMed

Smith, Philip H; Homish, Gregory G; Kozlowski, Lynn T; Spacone, Celia; Trigoboff, Eileen; Joffe, Susan

2013-04-01

The majority of research on reactions to smoking bans in psychiatric facilities focuses on staff feedback in acute inpatient settings. The purpose of this pilot study was to assess inpatient attitudes about a complete smoking ban in an intermediate to long-term psychiatric facility. One hundred inpatients were surveyed via questionnaire. Inpatients reported changes in smoking and improvements in health as a result of the ban, despite evidence of non-compliant smoking at the facility. There was evidence that inpatients perceived others' attitudes about the ban to be worse than reality. The findings from this pilot study suggest that consequences of smoking bans in psychiatric facilities are not as negative as some perceive. Smoking bans in intermediate to long-term settings may result in improvements in health among both smoking and non-smoking patients.

Factors influencing users' return home on discharge from a geriatric intermediate care facility in Japan.

PubMed

Ishizaki, T; Kai, I; Hisata, M; Kobayashi, Y; Wakatsuki, K; Ohi, G

1995-06-01

To determine the factors that influence users' destinations on discharge from Geriatric Intermediate Care Facilities (GICFs), which were established in Japan in 1987 to help hospitalized older people return home. Retrospective chart review. A 94-bed GICF attached to Saku Central Hospital in Japan. Charts of all users (N = 437) aged 65 years and older, discharged from the GICF between July 1987 and February 1991, were reviewed. The independent variables, obtained from users' admission records, were age, sex, place of residence before admission, length of stay, intellectual impairment (assessed by Karasawa's diagnostic criteria for senile dementia), ability to perform activities of daily living (ADLs), and living arrangement of users in the GICF. The dependent variable was destination after discharge from the GICF. Multiple logistic regression analyses revealed that, compared with users who were able to successfully return home, users with little ability to perform ADLs, male users, and those admitted from other institutions were more likely to be hospitalized. Such analyses also revealed that users who came from institutions, had low ability to perform ADLs, and lived alone were more likely to be institutionalized in nursing homes. Evaluating a user's physical, mental, and socioeconomic conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain in the GICF for an extended period.

Quality Measures for Dialysis: Time for a Balanced Scorecard.

PubMed

Kliger, Alan S

2016-02-05

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. Copyright © 2016 by the American Society of Nephrology.

Documentation of ethnicity.

PubMed

Brasić, James Robert

2004-12-01

The comparison of the ethnic composition of an intermediate care facility with several Hispanic residents and the general population was hindered by the absence of categorization of ethnicity according to the United States Census. If all Hispanic residents of the facility were white, then 55% of the facility population were white, a proportion comparable to the 58.2% white population of the general population. On the other hand, if all the Hispanic residents were not white, then 27.5% of the facility residents were white. In that case, the proportion of white residents of the facility is much less than in the general population. Therefore, a Demographic Coding Form was developed to capture the essential data to make direct comparisons and contrasts with the general population recorded by the United States Census. Since the United States Census records Hispanic ethnic minority status as a separate category independent from all other ethnic groups, the design of experiments to investigate the possible effects of ethnicity on populations wisely incorporates the administration of a Demographic Coding Form to capture the key ethnic data to permit direct comparison with the general population.

The costs and service implications of substituting intermediate care for acute hospital care.

PubMed

Mayhew, Leslie; Lawrence, David

2006-05-01

Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

Design and construction of a spectrometer facility and experiment for intermediate energy proton scattering on helium. [Wave functions, preliminary experimental techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rolfe, R.M.

1976-12-01

The goal of the research was to investigate proton scattering on nuclei at intermediate energies and in particular to investigate proton scattering on helium. A theoretical investigation of the helium nucleus and the nature of the intermediate energy interaction, design and optimization of an energy-loss spectrometer facility for proton-nucleus scattering, and the unique superfluid helium target and experimental design are discussed.

[Record linkage of the elderly in the national surveys on the geriatric intermediate care facility].

PubMed

Doi, T; Chen, B

1997-07-01

Geriatric intermediate care facility, GICF, have been established since 1986 in Japan. The term of 'intermediate' denotes a facility midpoint between a hospital and home, with a powerful rehabilitation function. The annual governmental survey on GICF has been applied to all GICFs in Japan since 1989. This survey is a cross-sectional-type survey. For evaluating the role of GICF, we considered a type of cohort study using these surveys for four years by means of a record linkage method. This method is possible, because subjects of a survey for any year become subjects in the survey of the following year, if they have been in a GICF for more than one year. In this paper, for the purpose of preparing for a study of the role of GICF, we report some results about a record linkage for these surveys, and two continuing rates were calculated for these cohorts. Sources were personal records in 1989 to 1992 gathered by The National Survey on GICF in Japan. The record linkage method is as follows. We divided the annual personal records into several files by both the periods of the last admission and the survey year. Three cohorts, i.e. a cohort-89, a cohort-90 and a cohort-91 for persons for whom the first survey was 1989, 1990 and 1991, respectively are thus obtained. Next, we identified individuals from the annual files in each cohort. As personal names were not available, we identified individuals by sex, birth date, date of admission and facility number by the use of a personal computer and a FORTRAN program. Results were as follows. 1. Multiple matched persons were few (0.5% or less), and identification rates were 90% or more, despite the fact that basic linking variables were used. 2. Continuing rates were about 40% and decreased with new cohorts, while those of a fixed cohort were increased as length of stay increased. These reveal that recent admissions who stay continuously at a GICF were decreasing, but the longer the period for which the elderly stays at a GICF, the less possibility that he will be discharged. 3. Between record agreement rates for individuals over two years for unchangeable characteristics such as a place before admission which are expected to be 100% were about 80%. 4. A record linkage method appears to be useful for calculating continuing rates classified by any attribute.

Choice-making among Medicaid HCBS and ICF/MR recipients in six states.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-09-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in non family settings in six states. Everyday choice in daily life and in support-related choice was considerably higher on average for HCBS than for ICF/MR recipients, but after controlling for level of intellectual disability, medical care needs, mobility, behavioral and psychiatric conditions, and self-reporting, we found that choice was more strongly associated with living in a congregate setting than whether that setting was HCBS- or ICF/MR-financed. Marked differences in choice were also evident between states.

Medicaid program; home and community-based services waivers for individuals age 65 or older--HCFA. Interim final rule with comment period.

PubMed

1992-06-30

This interim final rule amends current Medicaid regulations to permit States to offer, under a Secretarial waiver, a wide array of home and community-based services to individuals age 65 or older who are determined, but for the provision of these services, to be likely to require the level of care furnished in a skilled nursing facility (SNF) or intermediate care facility (ICF) (nursing facility (NF) effective October 1, 1990). The rule allows Federal payment for these and other long term care services, up to an amount specified in section 1915(d)(5)(B) of the Social Security Act, subject to HCFA's approval of the States' requests for waivers and certain assurances made by the States. Once granted, waivers are in effect for 3 years, unless terminated by the State with notice to the Secretary, and are renewable for periods of 5 years. Periodic evaluation, assessment, and review of the care furnished under the waivers is required. This rule implements section 4102 of the Omnibus Budget Reconciliation Act of 1987, as modified by section 411(k) of the Medicare Catastrophic Coverage Act of 1988, section 8432 of the Technical and Miscellaneous Revenue Act of 1988, and section 4741(b) of the Omnibus Budget Reconciliation Act of 1990. This rule is being issued in final and, for the most part, without a delay in the effective date for the reasons explained in section IV, "Waiver of Proposed Rulemaking and Delay in the Effective Date."

Providing effective and preferred care closer to home: a realist review of intermediate care.

PubMed

Pearson, Mark; Hunt, Harriet; Cooper, Chris; Shepperd, Sasha; Pawson, Ray; Anderson, Rob

2015-11-01

Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice. © 2015 John Wiley & Sons Ltd.

Management of haemophilia in the developing world.

PubMed

Srivastava, A; Chuansumrit, A; Chandy, M; Duraiswamy, G; Karagus, C

1998-07-01

The problems with management of haemophilia in developing countries are poor awareness, inadequate diagnostic facilities and scarce factor concentrates for therapy. The priorities in establishing services for haemophilia include training care providers, setting up care centres, initiating a registry, educating affected people and their families about the condition, providing low-cost factor concentrates, improving social awareness and developing a comprehensive care team. A coagulation laboratory capable of reliably performing clotting times with correction studies using normal pooled, FVIII and FIX deficient patient plasma and factor assay is most essential for diagnosis. More advanced centralized laboratories are also needed. Molecular biology techniques for mutation detection and gene tracking should be established in each country for accurate carrier detection and antenatal diagnosis. Different models of haemophilia care exists. In India, there is no support from the government. Services, including import of factor concentrates, are organized by the Haemophilia Federation of India, with support from other institutions. Haemophilia is managed with minimal replacement therapy (about 2000 i.u./PWH/year). In Malaysia, where the system is fully supported by the government, facilities are available at all public hospitals and moderate levels of factor concentrates are available 'on-demand' (about 11,000 i.u./PWH/year) at the hospitals. Haemophilia care in South Africa is provided through major public hospitals. Intermediate purity factor concentrates are locally produced (about 12,000 i.u./PWH/year) at low cost. The combined experience in the developing world in providing haemophilia services should be used to define standards for care and set achievable goals.

The second national audit of intermediate care.

PubMed

Young, John; Gladman, John R F; Forsyth, Duncan R; Holditch, Claire

2015-03-01

Intermediate care services have developed internationally to expedite discharge from hospital and to provide an alternative to an emergency hospital admission. Inconsistencies in the evidence base and under-developed governance structures led to concerns about the care quality, outcomes and provision of intermediate care in the NHS. The National Audit of Intermediate Care was therefore established by an interdisciplinary group. The second national audit reported in 2013 and included crisis response teams, home-based and bed-based services in approximately a half of the NHS. The main findings were evidence of weak local strategic planning, considerable under-provision, delays in accessing the services and lack of mental health involvement in care. There was a very high level of positive patient experience reported across all types of intermediate care, though reported involvement with care decisions was less satisfactory. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[OR management - Checklists for OR-design for OR-managers - results of a workshop].

PubMed

Bock, Matthias; Steinmeyer-Bauer, Klaus; Schüpfer, Guido

2014-10-01

The construction of an operating room (OR) suite represents an important intermediate- and long term investment. The planning process starts with the quantitative estimation of the procedures to be carried out which defines the operative capacity for the life time of the facility. This permits the calculation of the number of ORs and the definition of the resources for the recovery room, the intermediate care and intensive care unit.The projectors should integrate the new facility into workflow, workload and logistics of the entire hospital. The simulation flow of patients and accompanying persons and of the routes of the personnel is helpful for this purpose. Separating structures for outpatients from those for inpatients and avoiding de-centralized rooms helps designing an efficient and safe OR suite.The design of the single ORs should be flexible to permit changes or technical innovations during their use period. Mobile equipment is preferable to permanently installed devices. We consider an expanse of at least 45 m(2) for any location adequate for general ORs. The space requirements are elevated for hybrid ORs and rooms dedicated for robotic surgery.The design of the suite should separate the flow of personnel, patients and logistics. Surgical instruments and their logistics should be standardized. Dedicated locations for a simultaneous preparation of the instrumentation tables permit parallel processing. Thus an adequate capacity of preparation rooms and storage rooms is necessary. Dressing rooms, rest rooms, showers and lounges are important for the working conditions and should be planned in an adequate size and number. © Georg Thieme Verlag Stuttgart · New York.

The status of LILW disposal facility construction in Korea

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, Min-Seok; Chung, Myung-Sub; Park, Kyu-Wan

2013-07-01

In this paper, we discuss the experiences during the construction of the first LILW disposal facility in South Korea. In December 2005, the South Korean Government designated Gyeongju-city as a host city of Low- and Intermediate-Level Radioactive Waste(LILW) disposal site through local referendums held in regions whose local governments had applied to host disposal facility in accordance with the site selection procedures. The LILW disposal facility is being constructed in Bongilri, Yangbuk-myeon, Gyeongju. The official name of the disposal facility is called 'Wolsong Low and Intermediate Level Radioactive Waste Disposal Center (LILW Disposal Center)'. It can dispose of 800,000 drumsmore » of radioactive wastes in a site of 2,100,000 square meters. At the first stage, LILW repository of underground silo type with disposal capacity of 100,000 drums is under construction expected to be completed by June of 2014. The Wolsong Low and Intermediate Level Radioactive Waste Disposal Center consists of surface facilities and underground facilities. The surface facilities include a reception and inspection facility, an interim storage facility, a radioactive waste treatment building, and supporting facilities such as main control center, equipment and maintenance shop. The underground facilities consist of a construction tunnel for transport of construction equipment and materials, an operation tunnel for transport of radioactive waste, an entrance shaft for workers, and six silos for final disposal of radioactive waste. As of Dec. 2012, the overall project progress rate is 93.8%. (authors)« less

Misconceptions about case-mix payments for nursing homes.

PubMed

Grimaldi, P L

1987-04-01

Despite the increasing use of case-mix payment systems for skilled and intermediate nursing home care (at least 10 state Medicaid programs have adopted or are considering adopting such a system), misconceptions about such systems still exist. Unless these inaccurate perceptions are corrected, a state may adopt a system that fails to realize its goals. Some of these misconceptions include the beliefs that case-mix payment systems: Apply to all nursing homes costs; Will benefit hospital-based facilities; Will resolve the access problems of heavy care public patients; Will result in higher statewide payment rates because patient characteristics are factored directly into the calculations. In fact, case-mix adjustments are applied only to costs that can be traced directly to patients' impairments. Nursing services and some ancillary services are dependent on case mix, while administrative and support services are largely independent of case mix. Capital costs usually can be ignored in formulating the case-mix adjustment. Although hospital-based facilities frequently have sicker patients than freestanding facilities, studies show that only a portion of the cost differential is explained by case-mix differences. In the case of heavy-care patients, some believe that case-mix payment systems will resolve access problems by paying higher rates in response to the higher treatment costs. Access may not improve, however, if the new rates are lower than those paid by comparable private patients. Perhaps a loosening in the certificate-of-need process will also be needed to resolve the access problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Predicting Resource Utilization of Elderly Burn Patients in the Baby Boomer Era

PubMed Central

Richards, Winston A.; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W.; Ang, Darwin

2014-01-01

Background Census predictions for Florida suggest a threefold increase in the population 65 or older within 20 years. We predict resource utilization for this age group. Methods Using the Florida Agency for Healthcare Administration admission dataset we evaluated the effect of age on length of stay, hospital charges and discharge disposition while adjusting for clinical and demographic factors. Using U.S. Census Bureau data and burn incidence rates from this dataset we estimated future resource utilization. Results Elderly patients were discharged to home less often and were discharged to short term general hospitals, intermediate care facilities and skilled nursing facilities more often than the other age groups (p < 0.05). They also required home health care and IV medications significantly more often (p <0.05). Their length of stay was longer and total hospital charges were greater (p < 0.05) after adjusting for gender, race, Charleson comorbidity index, payer, TBSA burned and burn center treatment. Conclusions Our data show an age dependent increase in the utilization of post-hospitalization resources, LOS and total charges for elderly burn patients. PMID:23017253

Evaluation and treatment of urinary incontinence in long term care.

PubMed

Pannill, F C; Williams, T F; Davis, R

1988-10-01

All elderly patients with established urinary incontinence residing in an intermediate care facility during one year were evaluated for medical and urological conditions contributing to the incontinence; treatment was initiated for all diagnosed problems if possible. Unstable detrusor function (65%), sphincter weakness (13%), and overflow incontinence (10%) were all frequent urological causes, although several patients required extensive testing in addition to cystometrics to establish a complete diagnosis. Frequent nonurological causes of incontinence included behavioral problems (53%), immobility (45%), medication problems (24%), diabetes (18%), and local pathology (47%). Thirty-seven percent had three or more conditions identified. Treatment aimed at nonurological causes was more successful in ameliorating incontinence than urological medication; side effects were significant limitations to urological treatment success. Of the 22 patients who completed evaluation, treatment, and follow-up, five patients (23%) were cured, three (14%) showed at least a 65% decrease in incontinence, four (18%) showed at least a 30% decrease in incontinence, and 10 (45%) showed no change or worsened. We conclude that nonurological problems frequently contribute to urinary incontinence in long term care facilities; incontinence in some of these patients can be improved without urological therapy. Nonurological problems need careful definition and treatment; patients whose incontinence persists require comprehensive urological evaluation and therapy. A complete solution to incontinence in this setting may require safer drugs and better understanding of urinary pathophysiology.

Facile synthesis of covalent probes to capture enzymatic intermediates during E1 enzyme catalysis.

PubMed

An, Heeseon; Statsyuk, Alexander V

2016-02-11

We report a facile synthetic strategy to prepare UBL-AMP electrophilic probes that form a covalent bond with the catalytic cysteine of cognate E1s, mimicking the tetrahedral intermediate of the E1-UBL-AMP complex. These probes enable the structural and biochemical study of both canonical- and non-canonical E1s.

Facile preparation of oxazole-4-carboxylates and 4-ketones from aldehydes using 3-oxazoline-4-carboxylates as intermediates.

PubMed

Murai, Kenichi; Takahara, Yusuke; Matsushita, Tomoyo; Komatsu, Hideyuki; Fujioka, Hiromichi

2010-08-06

A novel 2-step synthesis of oxazole-4-carboxylates from aldehydes was developed, which is characterized by the utilization of 3-oxazoline-4-carboxylates as synthetic intermediates. The facile preparation of 4-keto-oxazole derivatives from 3-oxazoline-4-carboxylates based on their interesting reactivity toward Grignard reagents is also described.

Impact of a critical pathway on postoperative length of stay and outcomes after infrainguinal bypass.

PubMed

Stanley, A C; Barry, M; Scott, T E; LaMorte, W W; Woodson, J; Menzoian, J O

1998-06-01

To determine the effect of a critical pathway on postoperative length of stay and outcomes after infrainguinal bypass. A critical pathway for care of patients after infrainguinal bypass was introduced in December 1995 to coordinate postoperative care at our institution. We compared care of 67 consecutively treated patients before institution of the pathway with care of 69 consecutively treated patients with the critical pathway in place. Data collection was done by means of chart review. Univariate analyses were used to identify differences between prepathway and postpathway patients and to identify factors influencing postoperative length of stay. Multivariate analysis was used to identify factors that influenced length of stay and to examine the effect of use of the pathway after adjusting for other factors. Patients on the pathway were similar to prepathway controls with respect to comorbid illnesses, vascular risk factors, indications for surgical treatment, type of conduit, and type of operation. Factors associated with longer postoperative stays included distal anastomoses to tibial rather than popliteal vessels (p = 0.02), preexisting cardiac disease (p = 0.005), postoperative complications (p = 0.0003), lower preoperative hematocrit (p = 0.01), and elevated preoperative creatinine level (p = 0.006). Overall, pathway patients had somewhat shorter postoperative lengths of stay (median value 7 days; range 2 to 29 days) than prepathway patients (median value 6 days; range 2 to 35; p = 0.01), and the two groups had similar frequencies of postoperative complications, readmission, and 6-month mortality. However, patients on the pathway were more likely to be discharged to an intermediate-care facility rather than directly home. After 12 patients with extraordinarily prolonged postoperative stays were excluded, multivariate analysis indicated that pathway patients had significantly shorter postoperative stays (p = 0.001). However, the difference was not significant if patients with extraordinarily long postoperative stays were included in the analysis (p = 0.28). Use of a critical pathway was associated with a modest decrease in postoperative length of stay for most patients. This was accomplished without an adverse effect on readmission, complication, or mortality rates. However, the decrease in stay may have been achieved primarily by discharging more patients to intermediate-care facilities. The pathway did not appear to have any effect when the subset of patients with extraordinarily long stays because of complex medical problems was included.

Special Analysis for Disposal of High-Concentration I-129 Waste in the Intermediate-Level Vaults at the E-Area Low-Level Waste Facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Collard, L.B.

2000-09-26

This revision was prepared to address comments from DOE-SR that arose following publication of revision 0. This Special Analysis (SA) addresses disposal of wastes with high concentrations of I-129 in the Intermediate-Level (IL) Vaults at the operating, low-level radioactive waste disposal facility (the E-Area Low-Level Waste Facility or LLWF) on the Savannah River Site (SRS). This SA provides limits for disposal in the IL Vaults of high-concentration I-129 wastes, including activated carbon beds from the Effluent Treatment Facility (ETF), based on their measured, waste-specific Kds.

Applying a participatory approach to the promotion of a culture of respect during childbirth.

PubMed

Ratcliffe, Hannah L; Sando, David; Mwanyika-Sando, Mary; Chalamilla, Guerino; Langer, Ana; McDonald, Kathleen P

2016-07-18

Disrespect and abuse (D&A) during facility-based childbirth is a topic of growing concern and attention globally. Several recent studies have sought to quantify the prevalence of D&A, however little evidence exists about effective interventions to mitigate disrespect and abuse, and promote respectful maternity care. In an accompanying article, we describe the process of selecting, implementing, and evaluating a package of interventions designed to prevent and reduce disrespect and abuse in a large urban hospital in Tanzania. Though that study was not powered to detect a definitive impact on reducing D&A, the results showed important changes in intermediate outcomes associated with this goal. In this commentary, we describe the factors that enabled this effect, especially the participatory approach we adopted to engage key stakeholders throughout the planning and implementation of the program. Based on our experience and findings, we conclude that a visible, sustained, and participatory intervention process; committed facility leadership; management support; and staff engagement throughout the project contributed to a marked change in the culture of the hospital to one that values and promotes respectful maternity care. For these changes to translate into dignified care during childbirth for all women in a sustainable fashion, institutional commitment to providing the necessary resources and staff will be needed.

An analysis of ED utilization by adults with intellectual disability.

PubMed

Venkat, Arvind; Pastin, Rene B; Hegde, Gajanan G; Shea, John M; Cook, Jeffrey T; Culig, Carl

2011-05-01

We sought to identify factors increasing the odds of ED utilization among intellectually disabled (ID) adults and differentiate their discharge diagnoses from the general adult ED population. This was a retrospective, observational open cohort study of all ID adults residing at an intermediate care facility and their ED visits to a tertiary center (January 1, 2007-July 30, 2008). We abstracted from the intermediate care facility database subjects' demographic, ID, health and adaptive status variables, and their requirement of ED care/hospitalization. We obtained from the hospital database the primary International Classification of Diseases 9 ED/hospital discharge diagnoses for the study and general adult population. Using multivariate logistic regression, we computed odds ratios (OR) for ED utilization/hospitalization in the cohort. Using the conditional large-sample binomial test, we differentiated the study and general populations' discharge diagnoses. A total of 433 subjects met the inclusion criteria. Gastrostomy/jejunostomy increased the odds of ED utilization (OR, 4.16; confidence interval [CI], 1.64-10.58). Partial help to feed (OR, 2.59; CI, 1.14-5.88), gastrostomy/jejunostomy (OR, 3.26; CI, 1.30-8.18), and increasing number of prescribed medications (OR, 1.08; CI, 1.03-1.14) increased the odds of hospitalization. Auditory impairment (OR, 0.45; CI, 0.23-0.88) decreased the odds of hospitalization. For ED discharge diagnoses, ID adults were more likely (P < .05) than the general population to have diagnoses among digestive disorders and ill-defined symptoms/signs. For hospital discharge diagnoses, ID adults were more likely (P < .05) to have diagnoses among infectious/parasitic, nervous system, and respiratory disorders. Among ID adults, feeding status increased the odds of ED utilization, feeding status, and increasing number of prescribed medications of that hospitalization. Intellectually disabled adults' discharge diagnoses differed significantly from the general adult ED population. Copyright © 2011 Elsevier Inc. All rights reserved.

Training direct care staff to increase positive interactions with individuals with developmental disabilities.

PubMed

Zoder-Martell, Kimberly A; Dufrene, Brad A; Tingstrom, Daniel H; Olmi, D Joe; Jordan, Sara S; Biskie, Erika M; Sherman, Julie C

2014-09-01

This study tested the effects of direct training on direct care staff's initiation of positive interactions with individuals with developmental disabilities who resided in an intermediate care facility. Participants included four direct care staff and their residents. Direct training included real-time prompts delivered via a one-way radio, and data were collected for immediate and sustained increases in rates of direct care staff's positive interactions. Additionally, this study evaluated the link between increased rates of positive interactions and concomitant decreases in residents' challenging behaviors. A multiple baseline design across participants was used and results indicated that all direct care staff increased their rates of positive interactions during direct training. Moreover, all but one participant continued to engage residents in positive interactions at levels above the criterion during the maintenance phase and follow-up phases. The direct care staff member who did not initially meet the criterion improved to adequate levels following one brief performance feedback session. With regard to residents' challenging behaviors, across phases, residents engaged in low levels of challenging behaviors making those results difficult to evaluate. However, improvements in residents' rate of positive interactions were noted. Copyright © 2014 Elsevier Ltd. All rights reserved.

Psychoactive medication use in intermediate-care facility residents.

PubMed

Beers, M; Avorn, J; Soumerai, S B; Everitt, D E; Sherman, D S; Salem, S

1988-11-25

Despite the large number of elderly patients in nursing homes and the intensity of medication use there, few current data are available on patterns of medication use in this setting. We studied all medication use among 850 residents of 12 representative intermediate-care facilities in Massachusetts. Data on all prescriptions and patterns of actual use were recorded for all patients during one month. On average, residents were prescribed 8.1 medications during the month (interquartile range, 7.4 to 8.8) and actually received 4.7 (range, 4.2 to 5.4) medications during this period. More than half of all residents were receiving a psychoactive medication, with 26% receiving antipsychotic medication. Twenty-eight percent of patients were receiving sedative/hypnotics during the study month, primarily on a scheduled rather than an as-needed basis. Of patients receiving a sedative/hypnotic, 26% (range, 14% to 41%) were taking diphenhydramine hydrochloride, a strongly anticholinergic hypnotic. Of those receiving one of the benzodiazepines, 30% were receiving long-acting drugs, generally not recommended for elderly patients. The typical benzodiazepine dose was equivalent to 7.3 mg per patient per day of diazepam. The most commonly used antidepressant was amitriptyline hydrochloride, the most sedating and anticholinergic antidepressant in common use. These data indicate that despite growing evidence of the risks of psychoactive drug use in elderly patients, the nursing home population studied was exposed to high levels of sedative/hypnotic and antipsychotic drug use. Suboptimal choice of medication within a given class was common, and use of standing vs as-needed orders was often not in keeping with current concepts in geriatric psychopharmacology. Additional research is needed to assess the impact of such drug therapy on cognitive and physical functioning, as well as to determine how best to improve patterns of medication use in this vulnerable population.

Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay.

PubMed

Hoffman, Suma B; Terrell, Natalie; Driscoll, Colleen Hughes; Davis, Natalie L

2016-10-01

Heated humidified high-flow nasal cannula (HFNC) is thought to be comparable with nasal CPAP. The effect of multimodality mid-level respiratory support use in the neonatal ICU is unknown. The objective of this work was to evaluate the effect of introducing HFNC on length of respiratory support and stay. A chart review was conducted on subjects at 24-32 weeks gestation requiring mid-level support (HFNC/nasal CPAP) 1 y before and after HFNC implementation. The 2 groups were compared for clinical and demographic data using t test or chi-square analysis. Further, multivariate linear and logistic regression was done to determine significant risk factors for outcomes controlling for covariates. Eighty subjects were eligible in the pre-HFNC group, and 83 were eligible in the post-HFNC group. Subjects were similar in their baseline characteristics. In clinical outcomes, the post-HFNC group had higher rates of retinopathy of prematurity (P = .02) and a trend toward higher bronchopulmonary dysplasia rates (P = .063). The post-HFNC subjects had longer duration of mid-level support and were older at the time they were weaned to stable low-flow nasal cannula (P < .05). Although the length of respiratory support and stay and corrected gestational age at discharge were similar, those in the pre-HFNC period were more likely to be receiving full oral feeds and be discharged home versus being transferred to an intermediate care facility (P < .05). HFNC introduction was significantly associated with a longer duration of mid-level respiratory support, decrease in oral feeding at discharge, increased retinopathy of prematurity rates, and higher use of intermediate care facilities, leading us to examine our noninvasive ventilation and weaning strategies. Copyright © 2016 by Daedalus Enterprises.

75 FR 9442 - Lonza, Inc., Riverside Plant, Lonza Exclusive Synthesis Section, Custom Manufacturing Division...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... competitive with cGMP intermediates and Active Pharmaceutical Ingredients from the subject facility to a..., Conshohocken, Pennsylvania, who are engaged in employment related to the production of cGMP intermediates and...GMP intermediates and Active Pharmaceutical Ingredients, who became totally or partially separated...

Science Facilities for Mississippi Schools, Grades 1-12.

ERIC Educational Resources Information Center

Mississippi State Dept. of Education, Jackson. Div. of Instruction.

Prepared to assist those planning the construction of new science facilities on the elementary, intermediate, or secondary school level. Standards are outlined and specifications detailed. A statement of fifteen general pricniples for planning science facilities in secondary schools precedes a discussion of--(1) special facilities for different…

Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study.

PubMed

Diamond, Paul T; Gale, Shawn D; Evans, Brent A

2003-07-01

To examine the association between initial hematocrit level at the time of ischemic stroke, discharge destination, and resource utilization. Case series. University hospital. A total of 1012 consecutive patients with ischemic stroke admitted to a university health system between August 3, 1995, and June 24, 1999. Not applicable. Length of stay, hospital cost, and discharge disposition. Of 1012 patients presenting with ischemic stroke, 58% were discharged home, 10% were discharged home with home care services, 15% were discharged to a rehabilitation hospital, 11% were discharged to a skilled or intermediate care facility, and 6% died. After adjusting for age, sex, race, and comorbidities, a significant association (P=.009) existed between discharge outcome and initial hematocrit level. The probability of achieving an equivalent or less favorable outcome increased at both high and low hematocrit levels, with a minimum probability at a hematocrit level of approximately 45%. An association exists between hematocrit level at the time of ischemic stroke and discharge outcome. Midrange hematocrit levels appear to be associated with discharge to home rather than to an inpatient rehabilitation unit or to a nursing facility. Further study is indicated to examine the relationship among hematocrit level, stroke severity, and outcome.

Predicting resource utilization of elderly burn patients in the baby boomer era.

PubMed

Richards, Winston T; Richards, Winston A; Miggins, Makeesha; Liu, Huazhi; Mozingo, David W; Ang, Darwin N

2013-01-01

Census predictions for Florida suggest a 3-fold increase in the 65 and older population within 20 years. We predict resource utilization for burn patients in this age group. Using the Florida Agency for Healthcare Administration admission dataset, we evaluated the effect of age on length of stay, hospital charges, and discharge disposition while adjusting for clinical and demographic factors. Using US Census Bureau data and burn incidence rates from this dataset, we estimated future resource use. Elderly patients were discharged to home less often and were discharged to short-term general hospitals, intermediate-care facilities, and skilled nursing facilities more often than the other age groups (P < .05). They also required home health care and intravenous medications significantly more often (P < .05). Their length of stay was longer, and total hospital charges were greater (P < .05) after adjusting for sex, race, Charleson comorbidity index, payer, total body surface area burned, and burn center treatment. Our data show an age-dependent increase in the use of posthospitalization resources, the length of stay, and the total charges for elderly burn patients. Copyright © 2013 Elsevier Inc. All rights reserved.

Services for Mentally Retarded Persons: Joint Hearing before the Subcommittee on the Handicapped of the Committee on Labor and Human Resources and the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations. United States Senate, Ninety-Eighth Congress, Second Session on Recommendations to Improve Services for Mentally Retarded Citizens (July 31, 1984).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Appropriations.

The proceedings of this 1984 hearing presents recommendations to improve services for mentally retarded citizens. A report on conditions in intermediate care facilities for the mentally retarded is followed by statements of Senators L. Weicker, Jr., J. Randolph, and R. Stafford and by the Secretary of the U.S. Department of Health and Human…

Improving Orientation Outcomes: Implementation of Phased Orientation Process in an Intermediate Special Care Nursery.

PubMed

Rivera, Emily K; Shedenhelm, Heidi J; Gibbs, Ardyce L

2015-01-01

In response to changing needs of registered nurse orientees, the staff education committee in the Intermediate Special Care Nursery has implemented a phased orientation process. This phased process includes a mentoring experience postorientation to support a new nurse through the first year of employment. Since implementing the phased orientation process in the Intermediate Special Care Nursery, orientee satisfaction and preparation to practice have increased, and length of orientation has decreased.

Specialized Community-Based Care: An Evidence-Based Analysis

PubMed Central

2012-01-01

Background Specialized community-based care (SCBC) refers to services that manage chronic illness through formalized links between primary and specialized care. Objectives The objectives of this evidence-based analysis (EBA) were as follows: to summarize the literature on SCBC, also known as intermediate care to synthesize the evidence from previous Medical Advisory Secretariat (now Health Quality Ontario) EBAs on SCBC for heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and chronic wounds to examine the role of SCBC in family practice Results Part 1: Systematic Review of Intermediate Care Seven systematic reviews on intermediate care since 2008 were identified. The literature base is complex and difficult to define. There is evidence to suggest that intermediate care is effective in improving outcomes; however, the effective interventions are still uncertain. Part 2: Synthesis of Evidence in Intermediate Care Mortality • Heart failure Significant reduction in patients receiving SCBC • COPD Nonsignificant reduction in patients receiving SCBC Hospitalization • Heart failure Nonsignificant reduction in patients receiving SCBC • COPD Significant reduction in patients receiving SCBC Emergency Department Visits • Heart failure Nonsignificant reduction in patients receiving SCBC • COPD Significant reduction in patients receiving SCBC Disease-Specific Patient Outcomes • COPD Nonsignificant improvement in lung function in patients receiving SCBC • Diabetes Significant reduction in hemoglobin A1c (HbA1c) and systolic blood pressure in patients receiving SCBC • Chronic wounds Significant increase in the proportion of healed wounds in patients receiving SCBC Quality of Life • Heart failure Trend toward improvement in patients receiving SCBC • COPD Significant improvement in patients receiving SCBC Part 3: Intermediate Care in Family Practice—Evidence-Based Analysis Five randomized controlled trials were identified comparing SCBC to usual care in family practice. Inclusion criteria were 1) the presence of multiple chronic conditions, and 2) interventions that included 2 or more health care professions. The GRADE quality of the evidence was assessed as low for all outcomes due to the inconsistency and indirectness of the results. Limitations This review did not look at disease-specific studies on intermediate care in family practice. Conclusions Specialized community-based care effectively improves outcomes in patients with heart failure, COPD, and diabetes. The effectiveness of SCBC in family practice is unclear. PMID:23226812

Mortality among referrals to a community-based intermediate care team.

PubMed

Lakkappa, Bharath; Shah, Sanjay; Rogers, Stephen; Holman, Leanne Helen

2017-11-18

Intermediate care services have been introduced to help mitigate unnecessary hospital demand and premature placement in long-term residential care. Many patients are elderly and/or with complex comorbidities, but little consideration has been given to the palliative care needs of patients referred to intermediate care services. The objective of this study is to determine the proportion of patients referred to a community-based intermediate care team who died during care and up to 24 months after discharge and so to help inform the development of supportive and palliative care in this setting. A retrospective cohort study of all 4770 adult patients referred to Northamptonshire Intermediate Care Team (ICT) between 11 April 2010 and 10 April 2011. Of 4770 patients referred, 60% were 75 years or older and 32% were 85 years of age or older. 4.0% of patients died during their ICT stay and 11% within 30 days of discharge. At the end of 12 months, 25% of the patients had died, increasing to 32% before the end of the second year. About 34% of all deaths occurred during the ICT stay or within 30 days of discharge, and a further 46% by the end of the first year. Male gender and higher age were associated with greater likelihood of death. It is important for ICT clinicians to consider immediate and longer-term palliative care needs among patients referred to ICTs. Care models involving ICTs and palliative care teams working together could enable more people with end-stage non-cancer illnesses to die at home. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of components of residential treatment by Medicaid ICF-MR surveys: a validity assessment.

PubMed Central

Reid, D H; Parsons, M B; Green, C W; Schepis, M M

1991-01-01

We evaluated the proficiency of the federal Medicaid program's survey process for evaluating intermediate care facilities for the mentally retarded. In Study 1, an observational analysis of active treatment during leisure times in living units suggested that these surveys did not discriminate between certified and noncertified units. In Study 2, a reactivity analysis of a survey indicated that direct-care staff performed differently during the survey by increasing interactions with clients and decreasing nonwork behavior. Similarly, results of Study 3 showed increases in client access to leisure materials during a survey. In Study 4, questionnaire results indicated considerable variability among service providers' opinions on the consistency, accuracy, and objectivity with which survey teams determine agency standard compliance. Results are discussed regarding effects of the questionable proficiency of survey processes and the potential utility of behavioral assessment methodologies to improve such processes. PMID:1909696

Sources of Chemical Toxics and Their Precursors in Pharmaceutical Industry

DTIC Science & Technology

2001-09-01

includes a lot of independent units specialized in synthesis of active substances, their processing as pharmaceutical forms, control of intermediate and...materials (ingredients), synthesis intermediates, intermediate forms (solutions, powders), analytical reactives, drugs itself, residues etc. Secondary...specialist scenario The simplest idea is to orient the attack against chemical synthesis facilities friom where a lot of volatile solvents could be spread

[New integrated care model for older people admitted to Intermediate Care Units in Catalonia: A quasi-experimental study protocol].

PubMed

Santaeugènia, Sebastià J; García-Lázaro, Manuela; Alventosa, Ana María; Gutiérrez-Benito, Alícia; Monterde, Albert; Cunill, Joan

To evaluate the clinical effectiveness of an intermediate care model based on a system of care focused on integrated care pathways compared to the traditional model of geriatric care (usual care) in Catalonia. The design is a quasi-experimental pre-post non-randomised study with non-synchronous control group. The intervention consists of the development and implementation of integrated care pathways and the creation of specialised interdisciplinary teams in each of the processes. The two groups will be compared for demographic, clinical variables on admission and discharge, geriatric syndromes, and use of resources. This quasi-experimental study, aims to assess the clinical impact of the transformation of a traditional model of geriatric care to an intermediate care model in an integrated healthcare organisation. It is believed that the results of this study may be useful for future randomised controlled studies. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

9 CFR 2.102 - Holding facility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... animals remain under the total control and responsibility of the research facility or intermediate handler... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Holding facility. 2.102 Section 2.102 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL...

9 CFR 2.102 - Holding facility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... animals remain under the total control and responsibility of the research facility or intermediate handler... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Holding facility. 2.102 Section 2.102 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL...

Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature.

PubMed

Cornes, Michelle; Whiteford, Martin; Manthorpe, Jill; Neale, Joanne; Byng, Richard; Hewett, Nigel; Clark, Michael; Kilmister, Alan; Fuller, James; Aldridge, Robert; Tinelli, Michela

2018-05-01

This review presents a realist synthesis of "what works and why" in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the "Homeless Hospital Discharge Fund"). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless. The synthesis adopted the RAMESES guidelines and reporting standards. Electronic searches were carried out for peer-reviewed articles published in English from 2000 to 2016. Local evaluations and the grey literature were also included. The inclusion criteria was that articles and reports should describe "interventions" that encompassed most of the key characteristics of intermediate care as previously defined in the academic literature. Searches yielded 47 articles and reports. Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements. First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episode ends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital. © 2017 John Wiley & Sons Ltd.

A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

DTIC Science & Technology

2006-01-01

cough. Pain was assessed during incentive spirometry or coughing using a visual analogue scale (score from 1 to 10) with failure being a score...fracture multidisciplinary clinical pathway. SIMU Surgical Intermediate Care Unit; STICU Shock Trauma Intensive Care Unit; IS incentive spirometry ...monitored bed (Surgical Intermediate Care Unit or Shock Trauma Intensive Care Unit) where they received patient-controlled analgesia and incentive

Beliefs about intellectual disability among employees at a state facility and undergraduate students: An exploratory analysis.

PubMed

James, Jessica S

2018-06-27

Individuals with intellectual disability are subject to stigmatization, even among those providing services to them. Employees from an intermediate care facility (n = 97) and undergraduate students (n = 92) completed measures on their attitudes, beliefs of etiological causes and endorsement of helpful treatments and supports. Overall, participants reported few stigmatizing attitudes and high levels of support for interventions. Differences between employees and students emerged in regard to attitudes and causal beliefs, with employees reporting more support for sheltering and less endorsement of biomedical causes. Among students, those that reported knowing someone with intellectual disability reported less agreement with causal factors as well as differences in what supports were thought to be necessary or beneficial. Attitudes and beliefs are interrelated and while familiarity impacts these views, it does not necessarily lead to greater understanding or endorsement of treatments or supports. The effects of familiarity on attitudes and beliefs should continue to be explored. © 2018 John Wiley & Sons Ltd.

[Alcohol and drug misuse of the elderly in health care facilities].

PubMed

Kuhn, S; Haasen, C

2012-05-01

A nationwide representative survey was conducted in residential care facilities and facilities offering care for the elderly in their homes (home care facilities) with the aim to estimate the rate of alcohol and drug misuse among this population and to evaluate the way in which nursing staff deal with the problem. A total of 5000 randomly selected facilities were contacted with a 2-page questionnaire. Reliable data were obtained from 550 residential care facilities and from 436 home care facilities. According to the investigated facilities, the mean rate of misuse among the elderly was 14%. Nearly all facilities acknowledge the necessity to react to these facts, but only a quarter of them considered their staff to be sufficiently trained. 38.4% of the residential care facilities and 26.9% of the home care facilities have a concept on how to react to misuse problems. Addiction services are rarely contacted. The prevalence of alcohol and drug misuse among the elderly in health care facilities is high compared to the same age cohort of the total population. The lack of networking between facilities for the elderly and addiction services is remarkable. © Georg Thieme Verlag KG Stuttgart · New York.

A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa.

PubMed

Chetty, Verusia; Hanass-Hancock, Jill

2016-01-01

In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The health facility as well as outreach services such as intermediate clinics, home-based care, outreach and community-based rehabilitation was identified as important structures for potential rehabilitation interventions.

Examining Japanese women's preferences for a new style of postnatal care facility and its attributes.

PubMed

Shen, Junyi; Nakashima, Takako; Karasawa, Izumi; Furui, Tatsuro; Morishige, Kenichiro; Saijo, Tatsuyoshi

2018-05-21

Perinatal care in rural Japan is currently facing a crisis because of the lack of medical staff, especially obstetricians. In this study, a new style of postnatal care facility that combines both medical and nonmedical support is considered. Contrary to most postnatal care facilities in Japan, this new postnatal care facility accepts a puerperant from the cooperating maternity facility soon after birth (≤2 days). We conducted a hypothetical choice experiment to investigate whether this new postnatal care facility could be accepted by women in Gero City, Hida, Gifu Prefecture and how these women evaluate different kinds of postnatal care services. The results show that after a 2-day hospital stay, women from Gero City preferred to move to the new postnatal care facility over the other alternatives (continued hospitalization or discharge home). In addition, the estimated choice probabilities for selecting the postnatal care facility under different scenarios show a high level of acceptance for this new postnatal care facility. Copyright © 2018 John Wiley & Sons, Ltd.

Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys.

PubMed

Kruk, Margaret E; Leslie, Hannah H; Verguet, Stéphane; Mbaruku, Godfrey M; Adanu, Richard M K; Langer, Ana

2016-11-01

Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in health-care facilities in five sub-Saharan African countries. In this analysis, we combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survery Programme) with data for volume of deliveries and quality of delivery care from Kenya, Namibia, Rwanda, Tanzania, and Uganda. We measured the quality of basic maternal care functions in delivery facilities using an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions. We regressed the quality index on volume of births and confounders (public or privately managed, availability of antiretroviral therapy services, availability of skilled staffing, and country) stratified by facility type: primary (no caesarean capacity) or secondary (has caesarean capacity) care facilities. The Harvard University Human Research Protection Program approved this analysis as exempt from human subjects review. The national surveys were completed between April, 2006, and May, 2010. Our sample consisted of 1715 (93%) of 1842 health-care facilities that provided normal delivery service, after exclusion of facilities with missing (n=126) or invalid (n=1) data. 1511 (88%) study facilities (site of 276 965 [44%] of 622 864 facility births) did not have caesarean section capacity (primary care facilities). Quality of basic maternal care functions was substantially lower in primary (index score 0·38) than secondary care facilities (0·77). Low delivery volume was consistently associated with poor quality, with differences in quality between the lowest versus highest volume facilities of -0·22 (95% CI -0·26 to -0·19) in primary care facilities and -0·17 (-0·21 to -0·11) in secondary care facilities. More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. None. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

PubMed

Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

2015-01-01

In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001). Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.

Hospital mortality prediction for intermediate care patients: Assessing the generalizability of the Intermediate Care Unit Severity Score (IMCUSS).

PubMed

Hager, David N; Tanykonda, Varshitha; Noorain, Zeba; Sahetya, Sarina K; Simpson, Catherine E; Lucena, Juan Felipe; Needham, Dale M

2018-05-19

The Intermediate Care Unit Severity Score (IMCUSS) is an easy to calculate predictor of in-hospital death, and the only such tool developed for patients in the intermediate care setting. We sought to examine its external validity. Using data from patients admitted to the intermediate care unit (IMCU) of an urban academic medical center from July to December of 2012, model discrimination and calibration for predicting in-hospital death were assessed using the area under the receiver operating characteristic (AUROC) and the Hosmer-Lemeshow goodness-of-fit chi-squared (HL GOF X 2 ) test, respectively. The standardized mortality ratio (SMR) with 95% confidence intervals (95% CI) was also calculated. The cohort included data from 628 unique admissions to the IMCU. Overall hospital mortality was 8.3%. The median IMCUSS was 10 (Interquartile Range: 0-16), with 229 (36%) patients having a score of zero. The AUROC for the IMCUSS was 0.72 (95% CI: 0.64-0.78), the HL GOF X 2  = 30.7 (P < 0.001), and the SMR was 1.22 (95% CI: 0.91-1.60). The IMCUSS exhibited acceptable discrimination, poor calibration, and underestimated mortality. Other centers should assess the performance of the IMCUSS before adopting its use. Copyright © 2018. Published by Elsevier Inc.

Ageing management program for the Spanish low and intermediate level waste disposal and spent fuel and high-level waste centralised storage facilities

NASA Astrophysics Data System (ADS)

Zuloaga, P.; Ordoñez, M.; Andrade, C.; Castellote, M.

2011-04-01

The generic design of the centralised spent fuel storage facility was approved by the Spanish Safety Authority in 2006. The planned operational life is 60 years, while the design service life is 100 years. Durability studies and surveillance of the behaviour have been considered from the initial design steps, taking into account the accessibility limitations and temperatures involved. The paper presents an overview of the ageing management program set in support of the Performance Assessment and Safety Review of El Cabril low and intermediate level waste (LILW) disposal facility. Based on the experience gained for LILW, ENRESA has developed a preliminary definition of the Ageing Management Plan for the Centralised Interim Storage Facility of spent Fuel and High Level Waste (HLW), which addresses the behaviour of spent fuel, its retrievability, the confinement system and the reinforced concrete structure. It includes tests plans and surveillance design considerations, based on the El Cabril LILW disposal facility.

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

PubMed

Wilkinson, Krista; Gravel, Denise; Taylor, Geoffrey; McGeer, Allison; Simor, Andrew; Suh, Kathryn; Moore, Dorothy; Kelly, Sharon; Boyd, David; Mulvey, Michael; Mounchili, Aboubakar; Miller, Mark

2011-04-01

Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan.

PubMed

Nishino, Tatsuya

2017-12-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan

PubMed Central

Nishino, Tatsuya

2017-01-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly’s care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan’s Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize ‘Ageing in Place’. When considering households’ tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia. PMID:29194405

Zeitgeists and development trends in long-term care facility design.

PubMed

Wang, Chia-Hui; Kuo, Nai-Wen

2006-06-01

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.

Legionnaires' Disease: a Problem for Health Care Facilities

MedlinePlus

... Clips Legionnaires’ Disease A problem for health care facilities Language: English (US) Español (Spanish) Recommend on Facebook ... drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have ...

Barriers to providing palliative care in long-term care facilities

PubMed Central

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-01-01

OBJECTIVE To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS Medical directors in the facilities. MAIN OUTCOME MEASURES Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff’s capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care. PMID:17327890

Barriers to providing palliative care in long-term care facilities.

PubMed

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-04-01

To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. All licensed LTC facilities in Ontario with designated medical directors. Medical directors in the facilities. Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.

The Effects of Guided Careful Online Planning on Complexity, Accuracy and Fluency in Intermediate EFL Learners' Oral Production: The Case of English Articles

ERIC Educational Resources Information Center

Ahmadian, Mohammad Javad

2012-01-01

The purpose of the study reported in this article was twofold: First, to see whether guided careful online planning assists intermediate learners of English as a foreign language (EFL) in accurate oral production of English articles ("an/a" and "the"); and, second, to see whether guided careful online planning has any effects…

Assessing risk of injury in people with mental retardation living in an intermediate care facility.

PubMed

Konarski, Edward A; Tassé, Marc

2005-09-01

A brief instrument to assess risk of injury was applied retrospectively for 2 years and prospectively for 1 year to all people living in a large ICF/MR. Results suggest that the percentage of people who experienced an injury significantly increased across the levels of increasing risk indicated by the assessment. Furthermore, people who experienced an injury had significantly higher risk scores than those who did not. Using psychometric analyses, we found a mean correlation of .79 for interrater reliability and .90 for test-retest reliability on individual items and correlations of .91 and .95, respectively, on total score. We conclude that the assessment has promise as a reliable and valid method for predicting injury risk level.

Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards.

PubMed

Bakken, Marit Stordal; Ranhoff, Anette Hylen; Engeland, Anders; Ruths, Sabine

2012-09-01

To identify inappropriate prescribing among older patients on admission to and discharge from an intermediate-care nursing home unit and hospital wards, and to compare changes during stay within and between these groups. Observational study. Altogether 400 community-dwelling people aged ≥ 70 years, on consecutive emergency admittance to hospital wards of internal medicine and orthopaedic surgery, were randomized to an intermediate-care nursing home unit or hospital wards; 290 (157 at the intermediate-care nursing home unit and 133 in hospital wards) were eligible for this sub-study. Prevalence on admission and discharge of potentially inappropriate medications (Norwegian general practice [NORGEP] criteria) and drug-drug interactions; changes during stay. The mean (SD) age was 84.7 (6.2) years; 71% were women. From admission to discharge, the mean numbers of drugs prescribed per person increased from 6.0 (3.3) to 9.3 (3.8), p < 0.01. The prevalence of potentially inappropriate medications increased from 24% to 35%, p < 0.01; concomitant use of ≥ 3 psychotropic/opioid drugs and drug combinations including non-steroid anti-inflammatory drugs (NSAIDs) increased significantly. Serious drug-drug interactions were scarce both on admission and discharge (0.7%). Inappropriate prescribing was prevalent among older people acutely admitted to hospital, and the prevalence was not reduced during stay at an intermediate-care nursing home unit specially designed for these patients.

Care coordination in epilepsy: Measuring neurologists' connectivity using social network analysis.

PubMed

Altalib, Hamada Hamid; Fenton, Brenda T; Cheung, Kei-Hoi; Pugh, Mary Jo V; Bates, Jonathan; Valente, Thomas W; Kerns, Robert D; Brandt, Cynthia A

2017-08-01

The study sought to quantify coordination of epilepsy care, over time, between neurologists and other health care providers using social network analysis (SNA). The Veterans Health Administration (VA) instituted an Epilepsy Center of Excellence (ECOE) model in 2008 to enhance care coordination between neurologists and other health care providers. Provider networks in the 16 VA ECOE facilities (hub sites) were compared to a subset of 33 VA facilities formally affiliated (consortium sites) and 14 unaffiliated VA facilities. The number of connections between neurologists and each provider (node degree) was measured by shared epilepsy patients and tallied to generate estimates at the facility level separately within and across facilities. Mixed models were used to compare change of facility-level node degree over time across the three facility types, adjusted for number of providers per facility. Over the time period 2000-2013, epilepsy care coordination both within and across facilities significantly increased. These increases were seen in all three types of facilities namely hub, consortium, and unaffiliated site, relatively equally. The increase in connectivity was more dramatic with providers across facilities compared to providers within the same facilities. Establishment of the ECOE hub and spoke model contributed to an increase in epilepsy care coordination both within and across facilities from 2000 to 2013, but there was substantial variation across different facilities. SNA is a tool that may help measure coordination of specialty care. Published by Elsevier Inc.

17 CFR 37.203 - Rule enforcement program.

Code of Federal Regulations, 2014 CFR

2014-04-01

... shall establish and enforce trading, trade processing, and participation rules that will deter abuses... practices prohibited. A swap execution facility shall prohibit abusive trading practices on its markets by members and market participants. Swap execution facilities that permit intermediation shall prohibit...

Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

PubMed Central

Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

2016-01-01

Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with similar populations in the community and nursing home. These results suggest the residential care facility population could benefit greatly from models that coordinate health and long-term care. However, few providers have invested in integrated delivery models. Several challenges exist toward greater integration including the private payment of residential care facility services and the fact that residential care facilities do not share in any Medicare savings due to improved coordination of care. PMID:26438740

[Stakeholder representations of the role of the intermediate level of the DRC health system].

PubMed

Mbeva, Jean Bosco Kahindo; Karemere, Hermès; Schirvel, Carole; Porignon, Denis

2014-01-01

Intermediate health care structures in the DRC were designed during the setting-up of primary health care in a perspective of health district support. This study was designed to describe stakeholder representations of the intermediate level of the DRC health system during the first 30 years of the primary health care system. This case study was based on inductive analysis of data from 27 key informant interviews.. The intermediate level of the health system, lacking sufficient expertise and funding during the 1980s, was confined to inspection and control functions, answering to the central level of the Ministry of health and provincial authorities. Since the 1990s, faced with the pressing demand for support from health district teams, whose self-management had to deal with humanitarian emergencies, the need to integrate vertical programmes, and cope with the logistics of many different actors, the intermediate heath system developed methods and tools to support heath districts. This resulted in a subsidiary model of the intermediate level, the perceived efficacy of which varies according to the province over recent years. The "subsidiary" model of the intermediary health system level seems a good alternative to the "control" model in DRC.

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Kertesz, Stefan; Suo, Ying; Cashy, John P; Mor, Maria K; Schaefer, James H; Gundlapalli, Adi V; Gordon, Adam J

2018-05-12

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

The determinants of nursing home costs in Nebraska's proprietary nursing homes.

PubMed

Palm, D W; Nelson, S

1984-01-01

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.

Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults.

PubMed

Liu, Stephen K; Montgomery, Justin; Yan, Yu; Mecchella, John N; Bartels, Stephen J; Masutani, Rebecca; Batsis, John A

2016-10-01

To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Retrospective cohort study. Inpatient unit of a rural academic medical center. Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42-8.66). In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Opting out of an integrated healthcare system: dual-system use is associated with poorer glycemic control in veterans with diabetes.

PubMed

Helmer, Drew; Sambamoorthi, Usha; Shen, Yujing; Tseng, Chin-Lin; Rajan, Mangala; Tiwari, Anjali; Maney, Miriam; Pogach, Leonard

2008-06-01

To test for an association between quality of care and patient choice to obtain care outside an integrated healthcare delivery system. We used administrative data to define dual-system use (Veterans Health Administration (VHA) and Medicare) in 1999 for VHA users with diabetes over 65 years old. Quality of diabetes care was determined by the last hemoglobin A1c (HA1c) value in 2000. The distance to nearest VHA facility minus the distance to nearest non-federal hospital was the instrumental variable in a two-part regression model which controlled for observed and unobserved factors. In 1999, 57.4% of subjects received care from both VHA and Medicare providers; their mean proportion of visits to Medicare providers was 0.41 (median 0.38). After controlling for observed and unobserved factors, higher proportions of Medicare visits were significantly associated with higher HA1c values; a 40% increase in the proportion of Medicare visits by those who did not use Medicare was associated with a 0.23% point increase in HA1c value. Dual-system use was associated with higher HA1c values, suggesting that veterans who chose to receive care outside the integrated VHA may have worse intermediate clinical outcomes than those who received care exclusively within the system.

Factors promoting resident deaths at aged care facilities in Japan: a review.

PubMed

Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo

2018-03-01

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. © 2016 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

The microINR portable coagulometer: analytical quality and user-friendliness of a PT (INR) point-of-care instrument.

PubMed

Larsen, Pia Bükmann; Storjord, Elin; Bakke, Åsne; Bukve, Tone; Christensen, Mikael; Eikeland, Joakim; Haugen, Vegar Engeland; Husby, Kristin; McGrail, Rie; Mikaelsen, Solveig Meier; Monsen, Grete; Møller, Mette Fogh; Nybo, Jan; Revsholm, Jesper; Risøy, Aslaug Johanne; Skålsvik, Unni Marie; Strand, Heidi; Teruel, Reyes Serrano; Theodorsson, Elvar

2017-04-01

Regular measurement of prothrombin time as an international normalized ratio PT (INR) is mandatory for optimal and safe use of warfarin. Scandinavian evaluation of laboratory equipment for primary health care (SKUP) evaluated the microINR portable coagulometer (microINR ® ) (iLine Microsystems S.L., Spain) for measurement of PT (INR). Analytical quality and user-friendliness were evaluated under optimal conditions at an accredited hospital laboratory and at two primary health care centres (PHCCs). Patients were recruited at the outpatient clinic of the Laboratory of Medical Biochemistry, St Olav's University Hospital, Trondheim, Norway (n = 98) and from two PHCCs (n = 88). Venous blood samples were analyzed under optimal conditions on the STA-R ® Evolution with STA-SPA + reagent (Stago, France) (Owren method), and the results were compared to capillary measurements on the microINR ® . The imprecision of the microINR ® was 6% (90% CI: 5.3-7.0%) and 6.3% (90% CI: 5.1-8.3) in the outpatient clinic and PHCC2, respectively for INR ≥2.5. The microINR ® did not meet the SKUP quality requirement for imprecision ≤5.0%. For INR <2.5 at PHCC2 and at both levels in PHCC1, CV% was ≤5.0. The accuracy fulfilled the SKUP quality goal in both outpatient clinic and PHCCs. User-friendliness of the operation manual was rated as intermediate, defined by SKUP as neutral ratings assessed as neither good nor bad. Operation facilities was rated unsatisfactory, and time factors satisfactory. In conclusion, quality requirements for imprecision were not met. The SKUP criteria for accuracy was fulfilled both at the hospital and at the PHCCs. The user-friendliness was rated intermediate.

Compassion satisfaction, burnout, and secondary traumatic stress in heart and vascular nurses.

PubMed

Young, Jennifer L; Derr, Denise M; Cicchillo, Vikki J; Bressler, Sonya

2011-01-01

Objectives for this project were to determine the prevalence of compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) in heart and vascular nurses to confirm whether differences exist between intensive care and intermediate care nurses. The Professional Quality of Life Scale Compassion Satisfaction and Compassion Fatigue: Version 5 developed by Stamm (2009) was used. Results showed that nurses who work in the heart and vascular intermediate care unit had average to high scores of CS, low to average levels of burnout, and low to average levels of STS. Nurses who work in the heart and vascular intensive care unit had average to high levels of CS, low to average levels of burnout, and low to average levels of STS. These findings suggest that leadership should be aware of the prevalence of STS and burnout in heart and vascular nurses. Raising awareness of STS and burnout in intensive care and intermediate care nurses can help in targeting more specific strategies that may prevent the onset of developing these symptoms.

'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-09-01

To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. Grounded theory. Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'. © 2016 John Wiley & Sons Ltd.

Exploring Space Management Goals in Institutional Care Facilities in China

PubMed Central

Zhang, Jiankun

2017-01-01

Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities. PMID:29065629

Exploring Space Management Goals in Institutional Care Facilities in China.

PubMed

Li, Lingzhi; Yuan, Jingfeng; Ning, Yan; Shao, Qiuhu; Zhang, Jiankun

2017-01-01

Space management has been widely examined in commercial facilities, educational facilities, and hospitals but not in China's institutional care facilities. Poor spatial arrangements, such as wasted space, dysfunctionality, and environment mismanagement, are increasing; in turn, the occupancy rate is decreasing due to residential dissatisfaction. To address these problems, this paper's objective is to explore the space management goals (SMGs) in institutional care facilities in China. Systematic literature analysis was adopted to set SMGs' principles, to identify nine theoretical SMGs, and to develop the conceptual model of SMGs for institutional care facilities. A total of 19 intensive interviews were conducted with stakeholders in seven institutional care facilities to collect data for qualitative analysis. The qualitative evidence was analyzed through open coding, axial coding, and selective coding. As a result, six major categories as well as their interrelationships were put forward to visualize the path diagram for exploring SMGs in China's institutional care facilities. Furthermore, seven expected SMGs that were explored from qualitative evidence were confirmed as China's SMGs in institutional care facilities by a validation test. Finally, a gap analysis among theoretical SMGs and China's SMGs provided recommendations for implementing space management in China's institutional care facilities.

75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-08

... at Health Care Facilities AGENCY: Environmental Protection Agency (EPA). ACTION: Notice. SUMMARY: EPA... Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted at hospitals, medical clinics... drafted a guidance document for health care facilities, which describes: Techniques for reducing or...

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

PubMed

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-09-11

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities

PubMed Central

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-01-01

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities. PMID:28892019

38 CFR 17.65 - Approvals and provisional approvals of community residential care facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... approvals of community residential care facilities. 17.65 Section 17.65 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Community Residential Care § 17.65 Approvals and provisional approvals of community residential care facilities. (a) An approval of a facility meeting all of...

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

PubMed

Hernandez, Susan E; Taylor, Leslie; Grembowski, David; Reid, Robert J; Wong, Edwin; Nelson, Karin M; Liu, Chuan-Fen; Fihn, Stephan D; Hebert, Paul L

2016-03-01

Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. Cross-sectional, facility-level analysis of PACT implementation measures in 2012. Veterans Health Administration hospital-based and community-based primary care facilities. We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minority based on the percent of their own veteran population. Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management). Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.

Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

PubMed

Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

2013-06-01

This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

Health Facilities

MedlinePlus

Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, ... psychiatric care centers. When you choose a health facility, you might want to consider How close it ...

Measuring facility capability to provide routine and emergency childbirth care to mothers and newborns: An appeal to adjust for delivery caseload of facilities

PubMed Central

Allen, Stephanie M.; Opondo, Charles; Campbell, Oona M. R.

2017-01-01

Background Measurement of Emergency Obstetric Care capability is common, and measurement of newborn and overall routine childbirth care has begun in recent years. These assessments of facility capabilities can be used to identify geographic inequalities in access to functional health services and to monitor improvements over time. This paper develops an approach for monitoring the childbirth environment that accounts for the delivery caseload of the facility. Methods We used data from the Kenya Service Provision Assessment to examine facility capability to provide quality childbirth care, including infrastructure, routine maternal and newborn care, and emergency obstetric and newborn care. A facility was considered capable of providing a function if necessary tracer items were present and, for emergency functions, if the function had been performed in the previous three months. We weighted facility capability by delivery caseload, and compared results with those generated using traditional “survey weights”. Results Of the 403 facilities providing childbirth care, the proportion meeting criteria for capability were: 13% for general infrastructure, 6% for basic emergency obstetric care, 3% for basic emergency newborn care, 13% and 11% for routine maternal and newborn care, respectively. When the new caseload weights accounting for delivery volume were applied, capability improved and the proportions of deliveries occurring in a facility meeting capability criteria were: 51% for general infrastructure, 46% for basic emergency obstetric care, 12% for basic emergency newborn care, 36% and 18% for routine maternal and newborn care, respectively. This is because most of the caseload was in hospitals, which generally had better capability. Despite these findings, fewer than 2% of deliveries occurred in a facility capable of providing all functions. Conclusion Reporting on the percentage of facilities capable of providing certain functions misrepresents the capacity to provide care at the national level. Delivery caseload weights allow adjustment for patient volume, and shift the denominator of measurement from facilities to individual deliveries, leading to a better representation of the context in which facility births take place. These methods could lead to more standardized national datasets, enhancing their ability to inform policy at a national and international level. PMID:29049412

[The effects of multimedia-assisted instruction on the skin care learning of nurse aides in long-term care facilities].

PubMed

Wu, Yu-Ling; Kao, Yu-Hsiu

2014-08-01

Skin care is an important responsibility of nurse aides in long-term care facilities, and the nursing knowledge, attitudes, and skills of these aides significantly affects quality of care. However, the work schedule of nurse aides often limits their ability to obtain further education and training. Therefore, developing appropriate and effective training programs for nurse aides is critical to maintaining and improving quality of care in long-term care facilities. This study investigates the effects of multimedia assisted instruction on the skin care learning of nurse aides working in long-term care facilities. A quasi-experimental design and convenient sampling were adopted in this study. Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan County, Taiwan. The experimental group received 3 weeks of multimedia assisted instruction. The control group did not receive this instruction. The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care Behavior Checklist were used for assessment before and after the intervention. (1) Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were significantly higher than pretest scores for the intervention group. There was no significant difference between pretest and posttest scores for the control group. (2) A covariance analysis of pretest scores for the two groups showed that the experimental group earned significantly higher average scores than their control group peers for skin care knowledge, attitudes, behavior, and the skin care checklist. The multimedia assisted instruction demonstrated significant and positive effects on the skin care leaning of nurse aides in long-term care facilities. This finding supports the use of multimedia assisted instruction in the education and training of nurse aides in long-term care facilities in the future.

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

PubMed

Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Resident and facility characteristics associated with care-need level deterioration in long-term care welfare facilities in Japan.

PubMed

Jin, Xueying; Tamiya, Nanako; Jeon, Boyoung; Kawamura, Akira; Takahashi, Hideto; Noguchi, Haruko

2018-05-01

To determine the resident and facility characteristics associated with residents' care-need level deterioration in long-term care welfare facilities in Japan. A nationally representative sample of 358 886 residents who lived in 3774 long-term care welfare facilities for at least 1 year from October 2012 was obtained from long-term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long-term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow-up to define the resident and facility characteristics associated with resident care-need level deteriorations (lost to follow-up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow-up model). Adjusting for the covariates, at the resident level, older age and lower care-need level at baseline were more likely to show deterioration in the care-need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed-model facilities (partly private room settings) were less likely to experience care-need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care-need level deterioration only in the model including lost to follow-up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care-need level deterioration only in the model excluding lost to follow-up. The present study could help identify residents who are at risk of care-need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758-766. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

77 FR 21580 - Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for Fiscal Year (FY) 2013 AGENCY... (MIPs) for certain Federal Housing Administration (FHA) Multifamily Housing, Health Care Facilities, and...; with a 15 basis point increase for all other market-rate multifamily housing, health care facility, and...

Marketing in the long-term care continuum.

PubMed

Laurence, J Nathan; Kash, Bita A

2010-04-01

Today, long-term care facilities are composed of independent, assisted living, and skilled nursing facilities along with many variations of those themes in between. The clientele for these various types of facilities differ because of the level of care the facility provides as well as the amenities long-term care consumers are looking for. However, there many similarities and common approaches to how reaching the target audience through effective marketing activities. Knowing who the target audience is, how to reach them, and how to communicate with them will serve any facility well in this competitive market. Developing marketing strategies for long-term care settings is as important as understanding what elements of care can be marketed individually as a niche market. Determining the market base for a facility is equally crucial since the target populations differ among the three types of facilities. By reviewing current marketing articles and applying marketing practices, we have crafted some general principles for which each facility type can learn from. Finally, we will discuss the types of marketing and how they related to the spectrum of long-term care facilities.

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

PubMed Central

McGregor, Margaret J.; Cohen, Marcy; McGrail, Kimberlyn; Broemeling, Anne Marie; Adler, Reva N.; Schulzer, Michael; Ronald, Lisa; Cvitkovich, Yuri; Beck, Mary

2005-01-01

Background Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care. Results The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18–0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15–0.30, p < 0.001) provided by support staff. Interpretation Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities. PMID:15738489

Adverse event reporting in Czech long-term care facilities.

PubMed

Hěib, Zdenřk; Vychytil, Pavel; Marx, David

2013-04-01

To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

47 CFR 64.1310 - Payphone compensation procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... tendered for a quarter, the chief financial officer of the Completing Carrier shall submit to each payphone... Intermediate Carrier is a facilities-based long distance carrier that switches payphone calls to other facilities-based long distance carriers. (c) Unless the payphone service provider agrees to other reporting...

A security/safety survey of long term care facilities.

PubMed

Acorn, Jonathan R

2010-01-01

What are the major security/safety problems of long term care facilities? What steps are being taken by some facilities to mitigate such problems? Answers to these questions can be found in a survey of IAHSS members involved in long term care security conducted for the IAHSS Long Term Care Security Task Force. The survey, the author points out, focuses primarily on long term care facilities operated by hospitals and health systems. However, he believes, it does accurately reflect the security problems most long term facilities face, and presents valuable information on security systems and practices which should be also considered by independent and chain operated facilities.

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

21 CFR 58.43 - Animal care facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Animal care facilities. 58.43 Section 58.43 Food... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Facilities § 58.43 Animal care facilities. (a) A testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

Combustion chemistry of ethanol: Ignition and speciation studies in a rapid compression facility [On the combustion chemistry of ethanol: Ignition and speciation studies in a rapid compression facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barraza-Botet, Cesar L.; Wagnon, Scott W.; Wooldridge, Margaret S.

Here, ethanol remains the most important alternative fuel for the transportation sector. This work presents new experimental data on ethanol ignition, including stable species measurements, obtained with the University of Michigan rapid compression facility. Ignition delay times were determined from pressure histories of ignition experiments with stoichiometric ethanol–air mixtures at pressures of ~3–10 atm. Temperatures (880–1150 K) were controlled by varying buffer gas composition (Ar, N 2, CO 2). High-speed imaging was used to record chemiluminescence during the experiments, which showed homogeneous ignition events. The results for ignition delay time agreed well with trends on the basis of previous experimentalmore » measurements. Speciation experiments were performed using fast gas sampling and gas chromatography to identify and quantify ethanol and 11 stable intermediate species formed during the ignition delay period. Simulations were carried out using a chemical kinetic mechanism available in the literature, and the agreement with the experimental results for ignition delay time and the intermediate species measured was excellent for the majority of the conditions studied. From the simulation results, ethanol + HO 2 was identified as an important reaction at the experimental conditions for both the ignition delay time and intermediate species measurements. Further studies to improve the accuracy of the rate coefficient for ethanol + HO 2 would improve the predictive understanding of intermediate and low-temperature ethanol combustion.« less

Combustion chemistry of ethanol: Ignition and speciation studies in a rapid compression facility [On the combustion chemistry of ethanol: Ignition and speciation studies in a rapid compression facility

DOE PAGES

Barraza-Botet, Cesar L.; Wagnon, Scott W.; Wooldridge, Margaret S.

2016-08-31

Here, ethanol remains the most important alternative fuel for the transportation sector. This work presents new experimental data on ethanol ignition, including stable species measurements, obtained with the University of Michigan rapid compression facility. Ignition delay times were determined from pressure histories of ignition experiments with stoichiometric ethanol–air mixtures at pressures of ~3–10 atm. Temperatures (880–1150 K) were controlled by varying buffer gas composition (Ar, N 2, CO 2). High-speed imaging was used to record chemiluminescence during the experiments, which showed homogeneous ignition events. The results for ignition delay time agreed well with trends on the basis of previous experimentalmore » measurements. Speciation experiments were performed using fast gas sampling and gas chromatography to identify and quantify ethanol and 11 stable intermediate species formed during the ignition delay period. Simulations were carried out using a chemical kinetic mechanism available in the literature, and the agreement with the experimental results for ignition delay time and the intermediate species measured was excellent for the majority of the conditions studied. From the simulation results, ethanol + HO 2 was identified as an important reaction at the experimental conditions for both the ignition delay time and intermediate species measurements. Further studies to improve the accuracy of the rate coefficient for ethanol + HO 2 would improve the predictive understanding of intermediate and low-temperature ethanol combustion.« less

Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-06-01

Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

The Sepsis Early Recognition and Response Initiative (SERRI)

PubMed Central

Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Pinn, Teresa T.; Tran, Shirley K.; Nicolas, Juan C.; Rose, Alexis L.; Shirkey, Beverly A.; Disbot, Maureen; Masud, Faisal; Wray, Nelda P.

2016-01-01

Duration of Initiative 48 months and currently ongoing. Setting The Houston Methodist Hospital System and affiliated hospitals (3 facilities with 2 hospital-run skilled nursing facilities in and around Houston), St. Joseph’s Regional Health Center (1 acute care hospital and 2 skilled nursing facilities in Bryan, Texas), Hospital Corporation of America (2 acute care facilities in Houston, 1 acute care facility in McAllen, Texas [Rio Grande Valley]), Kindred Healthcare (2 long term acute care facilities in Houston), Select Medical Specialty Hospitals (2 long term acute care facilities in Houston). Whom This Should Concern Hospital administrators, quality and safety officers, performance improvement and patient safety professionals, clinic managers, infection control and prevention staff, and other physicians, nurses, and clinical staff. PMID:26892701

Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling.

PubMed

Ricci-Cabello, Ignacio; Stevens, Sarah; Dalton, Andrew R H; Griffiths, Robert I; Campbell, John L; Valderas, Jose M

2018-02-01

To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes." This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives. © Health Research and Educational Trust.