Search

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution--and an effort to increase control over workers while minimizing costs--as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that 'low skilled' care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work. Le transfert des taches consiste a transferer certaines activites des professionnels de la sante aux travailleurs de soutien a domicile, et s'avere etre une strategic visant a assurer la prestation efficace des services de soutien a domicile au Canada et a l'etranger. En utilisant la theorie de l'economie politique feministe, cet article explore l'impact du transfert des taches sur les competences des travailleurs de soutien a domicile. Le transfert des taches peut etre interprets comme une forme de substitution a la baisse avec un controle accru des travailleurs et une minimisation des couts des services. Ceci se produit lorsque certaines des responsabilites des professionnels de la sante sont fragmentees en taches plus simples pour etre ensuite transferees aux travailleurs de soutien a domicile. Pourtant, le contenu de 46 entrevues avec des travailleurs de soutien a domicile et professionnels de la sante vient ebranler l'hypothese selon laquelle les travailleurs de soutien a domicile 'peu qualifies[R] auraient peu de controle sur leurs taches de travail. Les resultats de cette etude suggerent que les competences des travailleurs de soutien a domicile se complexifient lorsqu'il s'agit de taches transferees, et que ces travailleurs obtiennent parfois plus d'autonomie a l'emploi. Done, les travailleurs de soutien a domicile acquierent une plus grande autonomie et un controle plus significatif a l'emploi. Par consequent, le transfert des taches renforce les gratifications intrinseques du travail en relation d'aide et ce, en depit d'une pietre remuneration et de la sous-valorisation du metier., ACROSS CANADA AND INTERNATIONALLY, home care is an increasingly popular means of providing support to older people and those with long-term health conditions or disabilities--among policymakers and service providers because [...]

A cost-benefit analysis of post-acute care for Medicare patients revealed that home care costs less than services in a convalescent hospital.

Page 298 Randomised controlled trial of an educational strategy to increase school-based adolescent hepatitis B vaccination

Objective. This study uses data from the 1989 National Long Term Health Care Survey to examine how home health services use among 4,463 older persons affects the long-term monetary and human-capital resources of their caregivers. Methods. The study first estimates demands of older persons with disabilities for home health services. Then a bivariate probit model estimates the caregivers' decisions to accommodate their labor force activities and deplete their health. Results. Income status of 150 to 250 percent of poverty, residence in the South, and large family networks decrease the likelihood of home health services use. State-financed insurance, greater activity limitations, age, and education increase use of home health. Use of formal in-home care decreases human-capital resources (health) of caregivers. Older persons' use of formal home health care does not affect long-term monetary resources (earned in the labor market). Rather, having a backup caregiver and living with an older person with disabilities are more influential in preserving the caregiver's monetary resources. Conclusions. Older persons have not solely borne the long-term implications of changes in health care financing; implications also exist for caregivers. Thus, when financing restricts use of home health services, caregivers' health may decline prematurely.

Medicaid programs with policy inducements are motivating factors for health workers engaged in providing home health and hospice services to Medicaid recipients with AIDS. The increasing number of people with AIDS necessitates its comprehensive management with a well defined system of medical, nursing, social, and personal services. Comprehensive hospital-based acute care systems are also required. Enhanced payments, commensurate with the cost of providing care, need to be considered for providers who serve AIDS patients, over 60% of whom are financed by Medicaid programs.

Objectives. To investigate whether care of elderly and disabled patients could be more cost-effective after a short-term hospital stay, we examined the impact of a primary home care intervention program on functional status, and costs of care after 6 moths. Methods. When clinically ready for discharge from the hospital, chronically ill patients with dependence in one to five functions in personal activities of daily living were randomized to physician-led primary home care with a 24-hour service, and the controls were offered ordinary care. Physical, cognitive, social, and medical functions were assessed in 110 team subjects and 73 controls. Data regarding inpatient days and outpatient visits were collected and converted to costs. Result. Team patients demonstrated better instrumental activities of daily living and outdoor walking and significantly fewer diagnoses and drugs at 6 months. They used less inpatient and more outpatient care compared with the control patients. Significant cost reductions were found in the team group. Conclusions. This primary home care intervention program is cost-effective, at least for a selection of patients at risk for long-term hospital care. (Am J Public Health. 1993;83:356-362), A primary home care intervention program may be a cost-effective method to care for elderly and disabled Swedish patients who are at risk for long-term hospitalization. Among 183 chronically ill patients who needed assistance with one to five daily living activities, 110 received specialized care from a physician-led primary home care team and 73 received ordinary care in the hospital or at home over a six-month period. The patients cared for by the primary home care team had significantly fewer new diagnoses than those who were received ordinary care. The number of drugs prescribed to patients cared for by the primary home care team did not increase; the number prescribed to those who received ordinary care did. The number of readmissions to the hospital were approximately the same among patients in both treatment groups. More of the patients who received ordinary care were in the hospital at the end of the six-month follow-up period, compared with those cared for by the primary home care treatment team.

Children requiring special machines or technology for respiratory support (breathing) may be treated in the hospital or at home. Even though home care can be much less expensive than hospital care, many insurance companies will not reimburse fully for home care, but will for hospital care. Families who can not afford the extra costs of home care must keep their children in the hospital. Congress and some state legislatures have passed laws permitting that public funds allowed for hospital care be used for home care. Unfortunately, not many people know about or have taken advantage of these legislative changes. The state of Maryland enacted the Medicaid Home and Community-Based Services Waiver Program in 1985. This study examined the cost of home care versus that of hospital care for respiratory technology-dependent children covered by this program. Projected costs for home care and institutional care were established using data from the Coordinating Center for Home and Community Care (CCHCC). The data were obtained from the cases of 10 children requiring respiratory care who were eligible for and used the new program. Six of the children were on mechanical ventilation and four were receiving oxygen. First year costs for the mechanical ventilation patients who remained at home averaged $109,836; costs were estimated to be $188,909 for institutional care. First year costs for the children who required oxygen averaged $63,650 for home care and were estimated to be $146,836 for institutional care. The major cost of both home and institutional care was attributed to nursing services. If this program provided funds for home care of 50 children, the potential savings could amount to $4 million per year. These results demonstrate that encouraging and providing benefits for home care of children who require respiratory support can result in a substantial savings in health care costs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Institutions that provide long-term care services for disabled elders living in the community receive limited funding from public and private sectors. However, the growing number of persons aged 65 years and older and the rising costs of long-term care have increased interest in new ways of funding home and community-based care. Both state and federal governments are taking steps to increase funding and services for disabled elderly persons. Insurance companies are also beginning to offer plans that cover long-term care in the home and community. Certain criteria are used to determine whether a person is eligible for these benefits. One key criterion is disability, which can be measured by the need for human help with activities of daily living (ADLs), such as eating, toileting, and dressing. Another measure of disability is the inability to perform instrumental activities of daily living (IADL), such as meal preparation, taking medication, and grocery shopping. However, need for IADL assistance is not a widely used disability criterion for eligibility of home care benefits. Studies have indicated that persons with one or more IADL limitations often require placement in a nursing home. The relation of the minimum number of ADL and IADL limitations, type of help, and duration of disability required to the number of elderly persons eligible for home care benefits, was examined. The results showed that 411,000 elders met the current ADL disability criteria, although four million individuals would be eligible if IADL limitations were considered as additional criteria. The identification of disability criteria influences the number of elderly persons who qualify for or are excluded from receiving home care benefits. (Consumer Summary produced by Reliance Medical Information, Inc.)

CASH IN ON THE HOME HEALTH-CARE BOOM The struggle to contain health-care costs often looks like an ominous cloud, but it may have a silver lining for you as an [...]