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This article examines the way that aged care workers and clients are devalued. It is argued that they share a stigmatised and marginalised position, not experiencing recognition at individual, rights or societal levels. The research draws on a qualitative, ethnographic study of aged care and disability support, with Honneth’s recognition theory used to analyse the intersection of practice and meaning in this work. The study reveals that workers’ and clients’ presentations of a competent self are compromised by external signals of mistrust and devaluing, forms of misrecognition. These include low wages and status for workers, public and policy discourses that position them and their clients as mendicant or undeserving, and demeaning treatment from organisations. In turn, those participants who lacked a sense of themselves as uniquely valuable, as deserving of rights, and as contributing to the shared project of society, displayed practices and perspectives that were disabling of themselves and one another. Their interactions were characterised by distrust, resistance and mutual disabling. Boomageddon and silver tsunami scenarios are part of the problem; such discourses of misrecognition must be contested. [ABSTRACT FROM AUTHOR]

The mean global prevalence of tension-type headache (TTH) in adult is 42 %. To date, there have been no Italian studies on TTH prevalence in the adult general population. Therefore, we conducted a cross-sectional study, called PACE, aimed at detecting the prevalence of primary headaches in the city of Parma's adult general population. 904 subjects representative of Parma's adult general population were interviewed face to face by a physician of our Headache Centre. Crude past-year prevalence for definite TTH was 19.4 % (95 % CI 16.8-21.9; 18.4 %, 95 % CI 14.6-22.3 in men, and 20.1 %, 95 % CI 16.6-23.6 in women), namely, 9.0 % (95 % CI 7.1-10.8) for infrequent TTH, 9.8 % (95 % CI 7.9-11.8) for frequent TTH, and 0.6 % (95 % CI 0.1-1) for chronic TTH. Crude prevalence for probable TTH was 2.3 % (95 % CI 1.3-3.3; 2 %, 95 % CI 0.6-3.4 in men, and 2.6 %, 95 % CI 1.2-3.9 in women). Our results indicate a TTH prevalence (19.4 %) at the lower limit of data ranges for Western countries, and prevalence rates for infrequent forms (9 %) do not appear different from those of frequent forms (9.8 %). [ABSTRACT FROM AUTHOR]

Abstract: Outcomes from a partially integrated model of managed long‐term care—The VNS CHOICE program (VCP)—were compared to those from a fully capitated model—the Program of All‐Inclusive Care for the Elderly (PACE). A retrospective cohort design examined discharge, morbidity, and functional status for 3,200 individuals over 18 months. Although the two populations were close in average functional status, the PACE sample was sicker and more cognitively impaired. Higher rates of death were found in the PACE program (22 percent vs. 10 percent over 18 months) and a greater likelihood of decline in instrumental activities of daily living; higher functional disability scores (ADLs) predicted discharge in PACE but not in VCP. When propensity score stratification was used to compare like populations, the impact of program enrolment on outcomes became statistically insignificant, suggesting that a partially capitated model performs at least as well as the fully capitated PACE model. [ABSTRACT FROM AUTHOR]

Background. In rebalancing from nursing homes (NHs), states are increasing access of NH-certified dually eligible (Medicare/Medicaid) patients to community waiver programs and Programs of All-Inclusive Care for the Elderly (PACE). Prior evaluations suggest Medicaid's PACE capitation exceeds its spending for comparable admissions in alternative care, although the latter may be underestimated. We test whether Medicaid payments to PACE are lower than predicted fee-for-service outlays in a long-term care admission cohort. Methods. Using grade-of-membership methods, we model health deficits for dual eligibles aged 55 or more entering waiver, PACE, and NH in South Carolina (n = 3,988). Clinical types, membership vectors, and program type prevalences are estimated. We calculate a blend, fitting PACE between fee-for-service cohorts, whose postadmission 1-year utilization was converted to attrition-adjusted outlays. PACE's capitation is compared with blend-based expenditure predictions. Results. Four clinical types describe population health deficits/service needs. The waiver cohort is most represented in the least impaired type (1: 47.1%), NH entrants in the most disabled (4: 38.5%). Most prevalent in PACE was a dementia type, 3 (32.7%). PACE's blend was waiver: 0.5602 (95% CI: 0.5472, 0.5732) and NH: 0.4398 (0.4268, 0.4528). Average Medicaid attrition–adjusted 1-year payments for waiver and NH were $4,177 and $77,945. The mean predicted cost for PACE patients in alternative long-term care was $36,620 ($35,662 and $37,580). PACE's Medicaid capitation was $27,648—28% below the lower limit of predicted fee-for-service payments. Conclusions. PACE's capitation was well under outlays for equivalent patients in alternative care—a substantial savings for Medicaid. Our methods provide a rate-setting element for PACE and other managed long-term care. [ABSTRACT FROM PUBLISHER]

Purpose: To compare disability rates resulting from several modes of survey administration in a single sample of frail elders. Design and Methods: Using the same battery of six ADL questions we compared the resulting level of disability across several modes of administration: mail survey with telephone follow-up, in person interview, and evaluation by a registered nurse, further comparing self and proxy responses where both were available. We also created a crosswalk between these measures and clinical evaluations by rehabilitation therapists, allowing another point of comparison. Results: Disability rates varied substantially by mode of survey administration and all survey modes yielded lower rates of disability than those we derived from clinical assessments. Implications: Relying on self-report in evaluating functional status may underestimate disability in clinical evaluations, level of care determinations and service planning. Researchers and policymakers should also take mode of administration effects into account when estimating or comparing disability rates. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented in response to the article "The PACE Evaluation: Initial Findings," by L. G. Branch, R. F. Coulam, and Y. A. Zimmerman on the evaluation of Programs of All-inclusive Care for the Elderly (PACE) sponsored by the U.S. Health Care Financing Administration, with information on patient "skimming," or avoiding clients with challenging conditions.

Background: The PACE Plus trial was a multi-center, double-blinded, superiority randomized controlled trial (RCT) conducted in patients from Dutch general practice to investigate the efficacy of paracetamol and NSAIDs in acute non-specific low back pain (LBP). Because insufficient numbers of patients could be recruited (only four out of the required 800 patients could be recruited over a period of 6 months), the trial was prematurely terminated in February 2017, 6 months after the start of recruitment. This article aims to transparently communicate the discontinuation of PACE Plus and to make recommendations for future studies.Methods: General Practitioners (GPs) from 36 participating practices received a one-question survey in which they were asked to give the three most important factors that in their opinion contributed to failure of patient recruitment.Results: GPs of 33 out of 36 (92%) participating practices sent a response. A total of 81 factors were reported. These have been categorized into patient factors (26 out of 81 comments, 32%), GP factors (39 out of 81 comments, 48%) and research factors (16 out of 81 comments, 20%).Discussion: Patient recruitment in the PACE Plus trial may have failed due to inefficient medication distribution, recruitment of incident rather than prevalent cases, a design that was too complicated, adequate self-management of LBP, patient expectations different from the trial's scope and lack of time of participating GPs. Substantial differences in design may explain why the preceding PACE trial did manage to successfully complete patient recruitment.Conclusion: Although the PACE Plus trial was terminated as a result of insufficient patient inclusion, the research questions addressed in this trial remain relevant but unanswered. We hope that lessons learned from the discontinuation of PACE Plus and corresponding recommendations may be helpful in the design of upcoming research projects in LBP in general practice.Trial Registration: Dutch Trial Registration NTR6089, registered September 14th 2016. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The PACE Evaluation: Initial Findings," by L. G. Branch, R. F. Coulam, and Y. A. Zimmerman on the evaluation of Programs of All-inclusive Care for the Elderly (PACE) sponsored by the U.S. Health Care Financing Administration, with information on patient "skimming," or avoiding clients with challenging conditions.