WorldWideScience

Sample records for park service home

  1. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  2. Trampoline Park and Home Trampoline Injuries.

    Science.gov (United States)

    Kasmire, Kathryn E; Rogers, Steven C; Sturm, Jesse J

    2016-09-01

    Trampoline parks, indoor recreational facilities with wall-to-wall trampolines, are increasing in number and popularity. The objective was to identify trends in emergency department visits for trampoline park injuries (TPIs) and compare TPI characteristics with home trampoline injuries (HTIs). Data on trampoline injuries from the National Electronic Injury Surveillance System from 2010 to 2014 were analyzed. Sample weights were applied to estimate yearly national injury trends; unweighted cases were used for comparison of injury patterns. Estimated US emergency department visits for TPI increased significantly, from 581 in 2010 to 6932 in 2014 (P = .045), whereas HTIs did not increase (P = .13). Patients with TPI (n = 330) were older than patients with HTI (n = 7933) (mean 13.3 vs 9.5 years, respectively, P trampoline parks and homes. Compared with HTIs, TPIs were less likely to involve head injury (odds ratio [OR] 0.64; 95% confidence interval [CI], 0.46-0.89), more likely to involve lower extremity injury (OR 2.39; 95% CI, 1.91-2.98), more likely to be a dislocation (OR 2.12; 95% CI, 1.10-4.09), and more likely to warrant admission (OR 1.76; 95% CI, 1.19-2.61). TPIs necessitating hospital admission included open fractures and spinal cord injuries. TPI mechanisms included falls, contact with other jumpers, and flips. TPI patterns differed significantly from HTIs. TPIs are an emerging concern; additional investigation and strategies are needed to prevent injury at trampoline parks. Copyright © 2016 by the American Academy of Pediatrics.

  3. DOE Challenge Home Case Study: e2 Homes – Winter Park, Florida

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-01-01

    This Challenge Home case study describes the first certified DOE Challenge Home as constructed by e2 Homes. Completed in May 2012, the “Wilson Residence” in Winter Park, Florida, is a 4,305-ft2 custom home that scores a HERS 57 without solar and a better than zero net-energy HERS -7 with solar.

  4. NURE and the National Park Service

    International Nuclear Information System (INIS)

    Weaver, T.A.

    1979-01-01

    Under the National Resource Evaluation (NURE), massive amounts of geological, geochemical, and geophysical data, covering the entire conterminous 48 states and Alaska, are being collected and made public. In addition to NURE goals, these data are applicable to various other researches on and in the vicinity of lands controlled by the National Park Service. Airborne geophysical and hydrogeochemical survey NURE data have been made public for the majority of the area in the combined Mt. McKinley National Park and Denali National Monument. Besides indicating potential raw material deposits, these data are also useful for geologic mapping, water quality, pollution and othe geological, biological, and environmental studies in the park

  5. iParking: An Intelligent Indoor Location-Based Smartphone Parking Service

    OpenAIRE

    Liu, Jingbin; Chen, Ruizhi; Chen, Yuwei; Pei, Ling; Chen, Liang

    2012-01-01

    Indoor positioning technologies have been widely studied with a number of solutions being proposed, yet substantial applications and services are still fairly primitive. Taking advantage of the emerging concept of the connected car, the popularity of smartphones and mobile Internet, and precise indoor locations, this study presents the development of a novel intelligent parking service called iParking. With the iParking service, multiple parties such as users, parking facilities and service p...

  6. Melview Nursing Home, Prior Park, Clonmel, Tipperary

    LENUS (Irish Health Repository)

    Robinson, Katie

    2011-04-01

    Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

  7. iParking: an intelligent indoor location-based smartphone parking service.

    Science.gov (United States)

    Liu, Jingbin; Chen, Ruizhi; Chen, Yuwei; Pei, Ling; Chen, Liang

    2012-10-31

    Indoor positioning technologies have been widely studied with a number of solutions being proposed, yet substantial applications and services are still fairly primitive. Taking advantage of the emerging concept of the connected car, the popularity of smartphones and mobile Internet, and precise indoor locations, this study presents the development of a novel intelligent parking service called iParking. With the iParking service, multiple parties such as users, parking facilities and service providers are connected through Internet in a distributed architecture. The client software is a light-weight application running on a smartphone, and it works essentially based on a precise indoor positioning solution, which fuses Wireless Local Area Network (WLAN) signals and the measurements of the built-in sensors of the smartphones. The positioning accuracy, availability and reliability of the proposed positioning solution are adequate for facilitating the novel parking service. An iParking prototype has been developed and demonstrated in a real parking environment at a shopping mall. The demonstration showed how the iParking service could improve the parking experience and increase the efficiency of parking facilities. The iParking is a novel service in terms of cost- and energy-efficient solution.

  8. iParking: An Intelligent Indoor Location-Based Smartphone Parking Service

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2012-10-01

    Full Text Available Indoor positioning technologies have been widely studied with a number of solutions being proposed, yet substantial applications and services are still fairly primitive. Taking advantage of the emerging concept of the connected car, the popularity of smartphones and mobile Internet, and precise indoor locations, this study presents the development of a novel intelligent parking service called iParking. With the iParking service, multiple parties such as users, parking facilities and service providers are connected through Internet in a distributed architecture. The client software is a light-weight application running on a smartphone, and it works essentially based on a precise indoor positioning solution, which fuses Wireless Local Area Network (WLAN signals and the measurements of the built-in sensors of the smartphones. The positioning accuracy, availability and reliability of the proposed positioning solution are adequate for facilitating the novel parking service. An iParking prototype has been developed and demonstrated in a real parking environment at a shopping mall. The demonstration showed how the iParking service could improve the parking experience and increase the efficiency of parking facilities. The iParking is a novel service in terms of cost- and energy-efficient solution.

  9. iParking: An Intelligent Indoor Location-Based Smartphone Parking Service

    Science.gov (United States)

    Liu, Jingbin; Chen, Ruizhi; Chen, Yuwei; Pei, Ling; Chen, Liang

    2012-01-01

    Indoor positioning technologies have been widely studied with a number of solutions being proposed, yet substantial applications and services are still fairly primitive. Taking advantage of the emerging concept of the connected car, the popularity of smartphones and mobile Internet, and precise indoor locations, this study presents the development of a novel intelligent parking service called iParking. With the iParking service, multiple parties such as users, parking facilities and service providers are connected through Internet in a distributed architecture. The client software is a light-weight application running on a smartphone, and it works essentially based on a precise indoor positioning solution, which fuses Wireless Local Area Network (WLAN) signals and the measurements of the built-in sensors of the smartphones. The positioning accuracy, availability and reliability of the proposed positioning solution are adequate for facilitating the novel parking service. An iParking prototype has been developed and demonstrated in a real parking environment at a shopping mall. The demonstration showed how the iParking service could improve the parking experience and increase the efficiency of parking facilities. The iParking is a novel service in terms of cost- and energy-efficient solution. PMID:23202179

  10. DOE Zero Energy Ready Home Case Study: Sterling Brook Custom Homes — Village Park Eco Home, Double Park, TX

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2014-09-01

    This builder won a Custom Builder honor in the 2014 Housing Innovation Awards for this showcase home that serves as an energy-efficient model home for the custom home builder: 1,300 visitors toured the home, thousands more learned about the home’s advanced construction via the webpage, YouTube, Twitter, Facebook, Instagram, and Pinterest.

  11. Service Discovery At Home

    NARCIS (Netherlands)

    Sundramoorthy, V.; Scholten, Johan; Jansen, P.G.; Hartel, Pieter H.

    Service discovery is a fady new field that kicked off since the advent of ubiquitous computing and has been found essential in the making of intelligent networks by implementing automated discovery and remote control between deviies. This paper provides an ovewiew and comparison of several prominent

  12. Service discovery at home

    NARCIS (Netherlands)

    Sundramoorthy, V.; Scholten, Johan; Jansen, P.G.; Hartel, Pieter H.

    2003-01-01

    Service discovery is a fairly new field that kicked off since the advent of ubiquitous computing and has been found essential in the making of intelligent networks by implementing automated discovery and remote control between devices. This paper provides an overview and comparison of several

  13. Environmental impacts of informal settlements with second homes (vacation homes. A case study: Apuseni Nature Park.

    Directory of Open Access Journals (Sweden)

    OANA ALEXANDRA CIUPE

    2017-10-01

    Full Text Available The past decades has seen the rapid development of second homes in many country of the world. Therefore, secondary dwellings used for tourism-related purposes (vacation homes or second homes are a reality that becomes more pronounced and visible at both nationally and internationally level. However, the rapidity and the novelty of the phenomenon creates difficulties in terms of efficient management and suitable integration in spatial planning and urbanism plans, favoring - in a negative way - expanding of build-up areas (with second homes in a chaotic way. Since there has been no detailed investigation of second homes tourism from the perspective of informal settlements, this article follows a case-study design, with in-depth analysis of informal settlements with vacation homes found in Apuseni Nature Park. Based on long-term field research, will be exemplified 4 types of informal settlements with second homes (vacation homes identified in the case study. The aim of this paper is to critically analyse the effects of informal settlements with vacation homes on the natural environment.

  14. Home Care Services: Questions to Ask

    Science.gov (United States)

    Healthy Lifestyle Healthy aging Home care services range from medical care to help with daily household chores. If ... 12, 2017 Original article: http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/home-care-services/art- ...

  15. Formal home help services and institutionalization

    DEFF Research Database (Denmark)

    Yamada, Yukari; Siersma, Volkert; Avlund, Kirsten

    2012-01-01

    The effect of home help services has been inconsistent. Raising the hypothesis that receiving small amounts of home help may postpone or prevent institutionalization, the aim of the present study is to analyze how light and heavy use of home help services was related to the risk...... for institutionalization. The study was a secondary analysis of a Danish intervention study on preventive home visits in 34 municipalities from 1999 to 2003, including 2642 home-dwelling older people who were nondisabled and did not receive public home help services at baseline in 1999 and who lived at home 18 months...... after baseline. Cox regression analysis showed that those who received home help services during the first 18 months after baseline were at higher risk of being institutionalized during the subsequent three years than those who did not receive such services. However, receiving home help for less than 1h...

  16. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  17. Home care services for sick children

    DEFF Research Database (Denmark)

    Castor, Charlotte; Hallström, Inger; Hansson, Eva Helena

    2017-01-01

    as challenging for healthcare professionals in home care services used to providing care predominately for adults. DESIGN: An inductive qualitative design. METHOD: Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise......AIMS AND OBJECTIVES: To explore healthcare professionals' conceptions of caring for sick children in home care services. BACKGROUND: Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised...... using a phenomenographic analysis. RESULTS: Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges...

  18. Tools for valuing tree and park services

    Science.gov (United States)

    E.G. McPherson

    2010-01-01

    Arborists and urban foresters plan, design, construct, and manage trees and parks in cities throughout the world. These civic improvements create walkable, cool environments, save energy, reduce stormwater runoff, sequester carbon dioxide, and absorb air pollutants. The presence of trees and green spaces in cities is associated with increases in property values,...

  19. the Avian Park Service Learning Centre story

    African Journals Online (AJOL)

    The Ukwanda Centre for Rural Health (UCRH) opened in 2001, followed 10 years later by the establishment of the Ukwanda Rural Clinical School in one of the rural health districts of the Western Cape. This paper relates the journey of the Faculty with the underserviced community of Avian Park through the provision of ...

  20. Home Care Services and the Rural Elderly.

    Science.gov (United States)

    Hayslip, Bert, Jr.; And Others

    1980-01-01

    Independent studies examined a needs v an agency perspective on home health care service needs within a rural county. Interviews with 299 elderly, aged 60-93, revealed there were substantial needs for home health care services and the desire for services varied with residence within the county. (Author)

  1. Services for People Innovation Park – Planning Methodologies

    Directory of Open Access Journals (Sweden)

    Maria Angela Campelo de Melo

    2013-04-01

    Full Text Available This article aims to identify appropriate methodologies for the planning of a Services for People Innovation Park-SPIP, designed according to the model proposed by the Ibero-American Network launched by La Salle University of Madrid. Projected to form a network, these parks were conceived to provoke social change in their region, improving quality of life and social welfare, through knowledge, technology and innovation transfer and creation of companies focused on developing product and services to reduce social inequalities. Building a conceptual framework for the identification of planning methodologies compatible with the SPIP problemátique, this article analyses the theories of complex systems and adaptive planning, considering the particularities presented by Innovation Parks. The study deepens the understanding of the problems inherent in park planning, identifies the key issues to be considered during this process, and characterizes the SPIP as active adaptive complex system, suggesting methodologies more appropriate to its planning.

  2. Services for People Innovation Park – Planning Methodologies

    OpenAIRE

    Maria Angela Campelo de Melo; Lygia Magalhães Magacho

    2013-01-01

    This article aims to identify appropriate methodologies for the planning of a Services for People Innovation Park-SPIP, designed according to the model proposed by the Ibero-American Network launched by La Salle University of Madrid. Projected to form a network, these parks were conceived to provoke social change in their region, improving quality of life and social welfare, through knowledge, technology and innovation transfer and creation of companies focused on developing product and servi...

  3. Parks, Place and Pedagogy - Education Partnerships with the National Park Service

    Science.gov (United States)

    Vye, E. C.; Rose, W. I.; Nash, B.; Klawiter, M.; Huntoon, J. E.; Engelmann, C. A.; Gochis, E. E.; MiTEP

    2011-12-01

    The Michigan Teaching Excellence Program (MITEP) is a multi-year program of teacher leadership development that empowers science teachers in Grand Rapids, Kalamazoo, and Jackson to lead their schools and districts through the process of improving science teaching and learning. A component of this program is facilitated through partnership between academia, K-12 educators, and the National Park Service (NPS) that aims to develop place-based education strategies that improve diversity and Earth Science literacy. This tangible education method draws upon both the sense of place that National Parks offer and the art of interpretation employed by the park service. Combined, these deepen cognitive process and provide a more diverse reflection of what place means and the processes behind shaping what we see. Our partnerships present participants the opportunity to intern in a Midwest national park for 3-8 weeks during their third year in the program. In summer 2011, eleven teachers from the Grand Rapids school district participated in this innovative way of learning and teaching Earth Science. One goal was to develop geological interpretive materials desired and needed for the parks. Secondly, and important to place-based educational methodologies, these deliverables will be used as a way of bringing the parks to urban classrooms. Participants lived in the parks and worked directly with both national park and Michigan Tech staff to create lesson plans, podcasts, media clips, video, and photographic documentation of their experiences. These lesson plans will be hosted in the Views of the National Park website in an effort to provide innovative teaching resources nationally for teachers or free-choice learners wishing to access information on Midwest national parks. To the benefit of park staff, working with teachers from urban areas offered an opportunity for park staff to access diverse learners in urban settings unable to visit the park. The foundation has been laid for

  4. Home range sizes for burchell's zebra equus burchelli antiquorum from the Kruger National Park

    Directory of Open Access Journals (Sweden)

    G.L. Smuts

    1975-07-01

    Full Text Available Annual home range sizes were determined for 49 marked zebra family groups in the Kruger National Park. Sizes varied from 49 to 566 sq. km, the mean for the Park being 164 square kilometre. Mean home range sizes for different zebra sub-populations and biotic areas were found to differ considerably. Present herbivore densities have not influenced intra- and inter-specific tolerance levels to the extent that home range sizes have increased. Local habitat conditions, and particularly seasonal vegetational changes, were found to have the most profound influence on the shape and mean size of home ranges. The large home range sizes obtained in the Kruger Park, when compared to an area such as the Ngorongoro Crater, can be ascribed to a lower carrying capacity with respect to zebra, large portions of the habitat being sub-optimal, either seasonally or annually.

  5. Service Provisioning Framework for Digital Smart Home Services

    OpenAIRE

    Kazanavicius , Egidijus; Imbrasas , Darius; Razukas , Mantas

    2011-01-01

    Part 3: Digital Goods and Products; International audience; “Development and Management Framework of Smart Home Services (SNAPAS)” is an innovative system, which seeks to fill the market niche of Smart Home services and fully complies with the priorities of scientific development approved by the European Parliament and Council. Framework is characterized by an open component-based pluggable architecture, which provides new forms of interactive services in home environments, including the thir...

  6. Ecosystem services: Urban parks under a magnifying glass.

    Science.gov (United States)

    Mexia, Teresa; Vieira, Joana; Príncipe, Adriana; Anjos, Andreia; Silva, Patrícia; Lopes, Nuno; Freitas, Catarina; Santos-Reis, Margarida; Correia, Otília; Branquinho, Cristina; Pinho, Pedro

    2018-01-01

    Urban areas' population has grown during the last century and it is expected that over 60% of the world population will live in cities by 2050. Urban parks provide several ecosystem services that are valuable to the well-being of city-dwellers and they are also considered a nature-based solution to tackle multiple environmental problems in cities. However, the type and amount of ecosystem services provided will vary with each park vegetation type, even within same the park. Our main goal was to quantify the trade-offs in ecosystem services associated to different vegetation types, using a spatially detailed approach. Rather than relying solely on general vegetation typologies, we took a more ecologically oriented approach, by explicitly considering different units of vegetation structure and composition. This was demonstrated in a large park (44ha) located in the city of Almada (Lisbon metropolitan area, Portugal), where six vegetation units were mapped in detail and six ecosystem services were evaluated: carbon sequestration, seed dispersal, erosion prevention, water purification, air purification and habitat quality. The results showed that, when looking at the park in detail, some ecosystem services varied greatly with vegetation type. Carbon sequestration was positively influenced by tree density, independently of species composition. Seed dispersal potential was higher in lawns, and mixed forest provided the highest amount of habitat quality. Air purification service was slightly higher in mixed forest, but was high in all vegetation types, probably due to low background pollution, and both water purification and erosion prevention were high in all vegetation types. Knowing the type, location, and amount of ecosystem services provided by each vegetation type can help to improve management options based on ecosystem services trade-offs and looking for win-win situations. The trade-offs are, for example, very clear for carbon: tree planting will boost carbon

  7. Determining service improvement priority in a zoological park

    Directory of Open Access Journals (Sweden)

    Ronald Sukwadi

    2014-01-01

    Full Text Available Purpose: The objective of this research is to determine the service improvement priority based on tourist judgements and experiences on service quality in a zoological park. Design/methodology/approach: A powerful integrated model was developed to acquire accurate critical service attributes and their priority ranks that can promote tourist satisfaction and tourist loyalty. Drawing on relevant literature, a model was proposed based on tourists’ perspective by integrating structural equation model (SEM with SERVQUAL and refined Kano models. Findings and Originality/value: Based on the analysis of data through some quantitative tools, the study helped in prioritizing the critical service attributes, which, if adopted, improved, and implemented, could lead to satisfaction of tourists. This will help a zoological park to propose more efficient and value-added improvement policies of the service Research limitations/implications: The primary limitation in the scope its sample. Because the study involved only one Zoological Park in Indonesia, the results cannot be generalized across a national wide spectrum. Originality/value: The study was the first to successfully apply an integrated model in tourism sector, which has previously not been used. The study has hopefully opened up an area of research and methodology that could provide considerable further benefits for researchers interested in this topic. Moreover, the integrated model has proven to be useful in determining the priority rank of critical service quality attributes.

  8. UNMET NEED IN TURKEY: HOME CARE SERVICE

    Directory of Open Access Journals (Sweden)

    Nuket SUBASI

    2006-02-01

    Full Text Available Home care services can be provided as an alternative to institutional care to people, in case of their demand, who need care because of aging and chronic diseases. Structured home care service in health system does not exist in Turkey. Relatives try to provide care at home to those people. In this cross-sectional study, household was selected as a sampling unit, determining prevalence of home care at the households and gathering some information about home care in Cankaya district of Ankara was intended. It was found that in one-month period before this study was carried out, home care services were provided at 8.7% of the households in Cankaya district. 62.5% of people who received home care service were women, 15.3% of them were belonging to 65-74 age group; 31.7% of those were illiterate and 12.5% had no social and health insurance. Among people, 15.4% were receiving home care after surgical operation, 15.4% were receiving care because of stroke and cerebrovascular diseases and 9.6% were cancer patients. 81.7% of adults who were taken care at home were found to be dependent at different levels while performing daily living activities, the most common treatment method was detected as oral medication (81.4%. These people were in need of preventive, curative and rehabilitative and supportive services. A home care service model, which takes into consideration the social characteristics of the country, should be developed at this district where there is a large elderly population. [TAF Prev Med Bull 2006; 5(1.000: 19-31

  9. Secure Service Discovery in Home Networks

    NARCIS (Netherlands)

    Scholten, Johan; van Dijk, H.W.; De Cock, Danny; Preneel, Bart; Kung, Antonio; d'Hooge, Michel

    2006-01-01

    This paper presents an architecture for secure service discovery for use in home networks. We give an overview and rationale of a cluster-based home network architecture that bridges different, often vendor specific, network technologies. We show how it integrates security, communication, and

  10. Car drivers’ knowledge and preferences regarding additional services at parking facilities

    NARCIS (Netherlands)

    van der Waerden, P.J.H.J.; de Bruin - Verhoeven, M.; Rodrigues da Silva, A.N.

    2017-01-01

    The paper presents a study on car drivers’ knowledge and preferences regarding additional services at parking facilities. The following eight services are investigated the presence of public toilets, parking spaces for challenged people, lockers, refreshment machines, elevators, charging points for

  11. National Parks

    Data.gov (United States)

    Department of Transportation — National Park Service unit boundaries (NTAD). These park boundaries signify legislative boundary definitions and local park names have been consolidated according to...

  12. Data reliability in home healthcare services

    NARCIS (Netherlands)

    Vavilis, S.; Zannone, N.; Petkovic, M.

    2013-01-01

    Home healthcare services are emerging as a new frontier in healthcare practices. Data reliability, however, is crucial for the acceptance of these new services. This work presents a semi-automated system to evaluate the quality of medical measurements taken by patients. The system relies on data

  13. Home Environment Service Knowledge Management System

    DEFF Research Database (Denmark)

    Zhang, Jiang; Rossello Busquet, Ana; Soler, José

    2011-01-01

    This paper makes three contributions to assist households to control their home devices in an easy way and to simplify the software installation and configuration processes across multi-vendor environments. First, a Home Environment Service Knowledge Management System is proposed, which is based...... on the knowledge implemented by ontology and uses the inference function of reasoner to find out available software services according to household requests. Second, this paper provides a concrete methodology to exploit and acquire conflict-free information from ontology knowledge by using a reasoner. At last......, a strategy of calculating the sequence of service dependency hierarchy is proposed by this paper....

  14. Volume of Home and Community Based Services and...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume of Home- and Community-Based Services and Time to Nursing-Home Placement The purpose of this study was to determine whether the volume of Home and Community...

  15. Changes in lion (Panthera leo) home range size in Waza National Park, Cameroon

    NARCIS (Netherlands)

    Tumenta, P.N.; Van't Zelfde, M.; Croes, B.M.; Buij, R.; Funston, P.J.; Haes, de H.A.U.; longh, De H.H.

    2013-01-01

    The spatial ecology of Africa lions (Panthera leo) was studied from 2007 to 2009 in Waza National Park, Cameroon, by equipping individual lions with GPS/VHF radio-collars. Mean home range estimates using 100% minimum convex polygons (MCP) and 95% kernel-density estimation (KDE) were respectively

  16. Adaptation to Sea Level Rise in Coastal Units of the National Park Service (Invited)

    Science.gov (United States)

    Beavers, R. L.

    2010-12-01

    83 National Park Service (NPS) units contain nearly 12,000 miles of coastal, estuarine and Great Lakes shoreline and their associated resources. Iconic natural features exist along active shorelines in NPS units, including, e.g., Cape Cod, Padre Island, Hawaii Volcanoes, and the Everglades. Iconic cultural resources managed by NPS include the Cape Hatteras Lighthouse, Fort Sumter, the Golden Gate, and heiaus and fish traps along the coast of Hawaii. Impacts anticipated from sea level rise include inundation and flooding of beaches and low lying marshes, shoreline erosion of coastal areas, and saltwater intrusion into the water table. These impacts and other coastal hazards will threaten park beaches, marshes, and other resources and values; alter the viability of coastal roads; and require the NPS to re-evaluate the financial, safety, and environmental implications of maintaining current projects and implementing future projects in ocean and coastal parks in the context of sea level rise. Coastal erosion will increase as sea levels rise. Barrier islands along the coast of Louisiana and North Carolina may have already passed the threshold for maintaining island integrity in any scenario of sea level rise (U.S. Climate Change Science Program Synthesis and Assessment Program Report 4.1). Consequently, sea level rise is expected to hasten the disappearance of historic coastal villages, coastal wetlands, forests, and beaches, and threaten coastal roads, homes, and businesses. While sea level is rising in most coastal parks, some parks are experiencing lower water levels due to isostatic rebound and lower lake levels. NPS funded a Coastal Vulnerability Project to evaluate the physical and geologic factors affecting 25 coastal parks. The USGS Open File Reports for each park are available at http://woodshole.er.usgs.gov/project-pages/. These reports were designed to inform park planning efforts. NPS conducted a Storm Vulnerability Project to provide ocean and coastal

  17. 36 CFR 6.8 - National Park Service solid waste responsibilities.

    Science.gov (United States)

    2010-07-01

    ..., DEPARTMENT OF THE INTERIOR SOLID WASTE DISPOSAL SITES IN UNITS OF THE NATIONAL PARK SYSTEM § 6.8 National Park Service solid waste responsibilities. (a) Beginning one year after January 23, 1995, a Superintendent will not permit or allow a person to dispose of solid waste at a National Park Service operated...

  18. 36 CFR 1501.1 - Cross reference to National Park Service regulations.

    Science.gov (United States)

    2010-07-01

    ... NATIONAL MEMORIAL TRUST GENERAL PROVISIONS § 1501.1 Cross reference to National Park Service regulations... (the Trust) adopts by cross reference the provisions of the National Park Service in 36 CFR chapter I... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Cross reference to National...

  19. 42 CFR 441.15 - Home health services.

    Science.gov (United States)

    2010-10-01

    ... Provisions § 441.15 Home health services. With respect to the services defined in § 440.70 of this subchapter, a State plan must provide that— (a) Home health services include, as a minimum— (1) Nursing services... 42 Public Health 4 2010-10-01 2010-10-01 false Home health services. 441.15 Section 441.15 Public...

  20. Social science in the national park service: an evolving mission and program

    Science.gov (United States)

    Richard H. Briceland

    1992-01-01

    In 1988 the director of the National Park Service requested that a social science program be established. Since that time a number of new research initiatives have been developed to address this need. This paper describes seven major steps taken thus far to meet social science needs of park superintendents, program managers, and park planners. Specific examples are...

  1. A Novel Web Service Based Home Energy Management System

    DEFF Research Database (Denmark)

    Rossello Busquet, Ana; Soler, José

    2011-01-01

    and optimize the energy consumption in home environments. The main element of HEMS is the home gateway. In this paper, a home gateway suitable for HEMS is presented. The home gateway proposed uses rules to implement the home energy management system. The rules can be downloaded though web services from a rule...... server. Furthermore, web services are used to provide modularity to the home gateway by enabling the deployment of the different logical components into different devices, if necessary....

  2. 42 CFR 440.70 - Home health services.

    Science.gov (United States)

    2010-10-01

    ... an acute illness to avoid the recipient's transfer to a nursing facility. (d) “Home health agency... 42 Public Health 4 2010-10-01 2010-10-01 false Home health services. 440.70 Section 440.70 Public...) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.70 Home health services. (a...

  3. Structural diversity: a multi-dimensional approach to assess recreational services in urban parks.

    Science.gov (United States)

    Voigt, Annette; Kabisch, Nadja; Wurster, Daniel; Haase, Dagmar; Breuste, Jürgen

    2014-05-01

    Urban green spaces provide important recreational services for urban residents. In general, when park visitors enjoy "the green," they are in actuality appreciating a mix of biotic, abiotic, and man-made park infrastructure elements and qualities. We argue that these three dimensions of structural diversity have an influence on how people use and value urban parks. We present a straightforward approach for assessing urban parks that combines multi-dimensional landscape mapping and questionnaire surveys. We discuss the method as well the results from its application to differently sized parks in Berlin and Salzburg.

  4. Parks and recreation employment status: implications from a civil service perspective

    Science.gov (United States)

    Joel Frater; Arthur Graham

    2002-01-01

    Current research on the credentialing process in parks, recreation and leisure services has focused primarily on accreditation and certification and has largely ignored the civil service exam as a credentialing toll or condition of employment in many state and municipal parks and recreation departments.

  5. Home health services in primary care: What can we do?

    Directory of Open Access Journals (Sweden)

    Yasemin Çayır

    2013-01-01

    Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

  6. Home ranges and habitat use of sloth bears Melursus ursinus inornatus in Wasgomuwa National Park, Sri Lanka

    Science.gov (United States)

    Ratnayeke, S.; Van Manen, F.T.; Padmalal, U.K.G.K.

    2007-01-01

    We studied home ranges and habitat selection of 10 adult sloth bears Melursus ursinus inornatus at Wasgomuwa National Park, Sri Lanka during 2002-2003. Very little is known about the ecology and behaviour of M. u. inornatus, which is a subspecies found in Sri Lanka. Our study was undertaken to assess space and habitat requirements typical of a viable population of M. u. inornatus to facilitate future conservation efforts. We captured and radio-collared 10 adult sloth bears and used the telemetry data to assess home-range size and habitat use. Mean 95% fixed kernel home ranges were 2.2 km2 (SE = 0.61) and 3.8 km2 (SE = 1.01) for adult females and males, respectively. Although areas outside the national park were accessible to bears, home ranges were almost exclusively situated within the national park boundaries. Within the home ranges, high forests were used more and abandoned agricultural fields (chenas) were used less than expected based on availability. Our estimates of home-range size are among the smallest reported for any species of bear. Thus, despite its relatively small size, Wasgomuwa National Park may support a sizeable population of sloth bears. The restriction of human activity within protected areas may be necessary for long-term viability of sloth bear populations in Sri Lanka as is maintenance of forest or scrub cover in areas with existing sloth bear populations and along potential travel corridors. ?? Wildlife Biology 2007.

  7. National Park Service Vegetation Inventory Program, Cuyahoga Valley National Park, Ohio

    Science.gov (United States)

    Hop, Kevin D.; Drake, J.; Strassman, Andrew C.; Hoy, Erin E.; Menard, Shannon; Jakusz, J.W.; Dieck, J.J.

    2013-01-01

    The National Park Service (NPS) Vegetation Inventory Program (VIP) is an effort to classify, describe, and map existing vegetation of national park units for the NPS Natural Resource Inventory and Monitoring (I&M) Program. The NPS VIP is managed by the NPS Biological Resources Management Division and provides baseline vegetation information to the NPS Natural Resource I&M Program. The U.S. Geological Survey (USGS) Vegetation Characterization Program lends a cooperative role in the NPS VIP. The USGS Upper Midwest Environmental Sciences Center, NatureServe, and NPS Cuyahoga Valley National Park (CUVA) have completed vegetation classification and mapping of CUVA.Mappers, ecologists, and botanists collaborated to identify and describe vegetation types within the National Vegetation Classification Standard (NVCS) and to determine how best to map them by using aerial imagery. The team collected data from 221 vegetation plots within CUVA to develop detailed descriptions of vegetation types. Data from 50 verification sites were also collected to test both the key to vegetation types and the application of vegetation types to a sample set of map polygons. Furthermore, data from 647 accuracy assessment (AA) sites were collected (of which 643 were used to test accuracy of the vegetation map layer). These data sets led to the identification of 45 vegetation types at the association level in the NVCS at CUVA.A total of 44 map classes were developed to map the vegetation and general land cover of CUVA, including the following: 29 map classes represent natural/semi-natural vegetation types in the NVCS, 12 map classes represent cultural vegetation (agricultural and developed) in the NVCS, and 3 map classes represent non-vegetation features (open-water bodies). Features were interpreted from viewing color-infrared digital aerial imagery dated October 2010 (during peak leaf-phenology change of trees) via digital onscreen three-dimensional stereoscopic workflow systems in geographic

  8. Integration of Tactical EMS in the National Park Service.

    Science.gov (United States)

    Smith, William Will R

    2017-06-01

    The National Park Service (NPS) has domestic responsibility for emergency medical services (EMS) in remote and sometimes tactical situations in 417 units covering over 34 million hectares (84 million acres). The crossover between conflicting patient care priorities and complex medical decision making in the tactical, technical, and wilderness/remote environments often has many similarities. Patient care in these diverse locations, when compared with military settings, has slightly different variables but often similar corresponding risks to the patients and providers. The NPS developed a Tactical EMS (TEMS) program that closely integrated many principles from: 1) Tactical Combat Casualty Care (TCCC); 2) Tactical Emergency Casualty Care (TECC); 3) and other established federal and civilian TEMS programs. Combining these best practices into the NPS TEMS Program allowed for standardized training and implementation across not only the NPS, but also paralleled other military/federal/civilian TEMS programs. This synchronization is critical when an injury occurs in a joint tactical operation, either planned (drug interdiction) or unplanned (active shooter response), so that patient care can be uniform and efficient. The components identified for a sustainable TEMS program began with strong medical oversight, protocol development with defined phases of care, identifying specialized equipment, and organized implementation with trained TEMS instructors. Ongoing TEMS program management is continuously improving situationally appropriate training and integrating current best practices as new research, equipment, and tactics are developed. The NPS TEMS Program continues to provide ongoing training to ensure optimal patient care in tactical and other NPS settings. Copyright © 2017 Wilderness Medical Society. All rights reserved.

  9. Enhancing Visitor Experiences Using Thematic Interpretation in Park Guiding Service in Sarawak National Parks

    Directory of Open Access Journals (Sweden)

    Amin Victor Luna

    2014-01-01

    Full Text Available Enhancing visitor experiences is arguably the primary and most important goal for interpretation by many protected area managers and tourism business. However, little research has been conducted in Sarawak, Malaysia to directly quantify the effects of thematic interpretation has on tourist experiences. Drawing on the TORE-model of interpretation and through the inception of Park Guiding Training and Licensing System in Sarawak since 2007, this quantitative study examines the effectiveness of thematic interpretive guided tours delivered by park guides at Bako National Park, Sarawak, with the assumption that it will further enhance visitor experiences. A descriptive analysis and Pearson's product-moment correlation analysis of sub-indicators of the global evaluation of interpretation of site, and sub-indicators of elaboration surveyed from visitors of purposively sampled park guides revealed a strong measurement and correlation coefficients of visitors’ overall quality of thematic intepretive guided tours effecting visitor satisfaction and experiences. These findings provide empirical evidence that good thematic interpretive guided tour makes a positive impacts on visitor experiences, thus making training of tourism businesses' employees as park guides as a good investment. The suggestions for further research in influencing visitor attitude and shaping visitor behaviour are offered.

  10. Adoption of Lean Thinking and Service Improvement for Care Home Service

    OpenAIRE

    Chuang-Chun Chiou

    2014-01-01

    Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Sim...

  11. Coordinating the Web of Services for a Smart Home

    NARCIS (Netherlands)

    Kaldeli, Eirini; Warriach, Ehsan Ullah; Lazovik, Alexander; Aiello, Marco

    Domotics, concerned with the realization of intelligent home environments, is a novel field which can highly benefit from solutions inspired by service-oriented principles to enhance the convenience and security of modern home residents. In this work, we present an architecture for a smart home,

  12. Assessing the risk of foliar injury from ozone on vegetation in parks in the U.S. National Park Service's Vital Signs Network

    International Nuclear Information System (INIS)

    Kohut, Robert

    2007-01-01

    The risk of ozone injury to plants was assessed in support of the National Park Service's Vital Signs Monitoring Network program. The assessment examined bioindicator species, evaluated levels of ozone exposure, and investigated soil moisture conditions during periods of exposure for a 5-year period in each park. The assessment assigned each park a risk rating of high, moderate, or low. For the 244 parks for which assessments were conducted, the risk of foliar injury was high in 65 parks, moderate in 46 parks, and low in 131 parks. Among the well-known parks with a high risk of ozone injury are Gettysburg, Valley Forge, Delaware Water Gap, Cape Cod, Fire Island, Antietam, Harpers Ferry, Manassas, Wolf Trap Farm Park, Mammoth Cave, Shiloh, Sleeping Bear Dunes, Great Smoky Mountains, Joshua Tree, Sequoia and Kings Canyon, and Yosemite. - An assessment of the risk of foliar ozone injury on plants was conducted for 269 parks in support of the U.S. National Park Service's Vital Signs Monitoring Network Program

  13. Assessing the risk of foliar injury from ozone on vegetation in parks in the U.S. National Park Service's Vital Signs Network

    Energy Technology Data Exchange (ETDEWEB)

    Kohut, Robert [Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, NY 14853 (United States)], E-mail: rjk9@cornell.edu

    2007-10-15

    The risk of ozone injury to plants was assessed in support of the National Park Service's Vital Signs Monitoring Network program. The assessment examined bioindicator species, evaluated levels of ozone exposure, and investigated soil moisture conditions during periods of exposure for a 5-year period in each park. The assessment assigned each park a risk rating of high, moderate, or low. For the 244 parks for which assessments were conducted, the risk of foliar injury was high in 65 parks, moderate in 46 parks, and low in 131 parks. Among the well-known parks with a high risk of ozone injury are Gettysburg, Valley Forge, Delaware Water Gap, Cape Cod, Fire Island, Antietam, Harpers Ferry, Manassas, Wolf Trap Farm Park, Mammoth Cave, Shiloh, Sleeping Bear Dunes, Great Smoky Mountains, Joshua Tree, Sequoia and Kings Canyon, and Yosemite. - An assessment of the risk of foliar ozone injury on plants was conducted for 269 parks in support of the U.S. National Park Service's Vital Signs Monitoring Network Program.

  14. 78 FR 72703 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service...

    Science.gov (United States)

    2013-12-03

    ... of an inventory of human remains and associated funerary objects under the control of Canyonlands....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service.... Department of the Interior, National Park Service, Canyonlands National Park, has completed an inventory of...

  15. A multidimensional approach to case mix for home health services

    Science.gov (United States)

    Manton, Kenneth G.; Hausner, Tony

    1987-01-01

    Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services. PMID:10312187

  16. Development of Fuzzy Logic Forecast Models for Location-Based Parking Finding Services

    Directory of Open Access Journals (Sweden)

    Zhirong Chen

    2013-01-01

    Full Text Available Park-and-ride (PnR facilities provided by Australian transport authorities have been an effective way to encourage car drivers to use public transport such as trains and buses. However, as populations grow and vehicle running costs increase, the demand for more parking spaces has escalated. Often, PnR facilities are filled to capacity by early morning and commuters resort to parking illegally in streets surrounding stations. This paper reports on the development of a location-based parking finding service for PnR users. Based on their current location, the system can inform users which is the best station to park their cars during peak period. Two criteria—parking availability and the shortest travel time—were used to evaluate the best station. Fuzzy logic forecast models were used to estimate the uncertainty of parking availability during the peak parking demand period. A prototype using these methods has been developed based on a case study of the Oats Street and Carlisle PnR facilities in Perth, Western Australia. The system has proved to be efficacious and has the potential to be applied to other parking systems.

  17. Optical broadband in-home networks for converged service delivery

    NARCIS (Netherlands)

    Shi, Y.

    2013-01-01

    Broadband access networks, and in particular fibre-to-the-home (FTTH) networks, are offering abundantly available bandwidth in the local loop with high quality of services. Under such broadband connectivity conditions, in-home networks should not represent the bottleneck for high capacity service

  18. Interoperation, Composition and Simulation of Services at Home

    NARCIS (Netherlands)

    Kaldeli, Eirini; Warriach, Ehsan Ullah; Bresser, Jaap; Lazovik, Alexander; Aiello, Marco; Maglio, PP; Weske, M; Yang, J; Fantinato, M

    2010-01-01

    Pervasive computing environments such as our future homes are the prototypical example of a dynamic, complex system where Service-Oriented Computing techniques will play an important role. A home equipped with heterogeneous devices, whose services and location constantly change, needs to behave as a

  19. Vocational Home Economics Curriculum Guide for Occupational Home and Institutional Services.

    Science.gov (United States)

    Dewald, Margaret R.

    The training program outlined in this guide focuses upon the development of students for gainful employment through a two-year course of study in home and institutional services. Instructional topics are provided in nine areas: orientation to home and institutional services, cleaning supplies and equipment, cleaning surfaces, cleaning clothes and…

  20. Memory Management of Multimedia Services in Smart Homes

    Science.gov (United States)

    Kamel, Ibrahim; Muhaureq, Sanaa A.

    Nowadays there is a wide spectrum of applications that run in smart home environments. Consequently, home gateway, which is a central component in the smart home, must manage many applications despite limited memory resources. OSGi is a middleware standard for home gateways. OSGi models services as dependent components. Moreover, these applications might differ in their importance. Services collaborate and complement each other to achieve the required results. This paper addresses the following problem: given a home gateway that hosts several applications with different priorities and arbitrary dependencies among them. When the gateway runs out of memory, which application or service will be stopped or kicked out of memory to start a new service. Note that stopping a given service means that all the services that depend on it will be stopped too. Because of the service dependencies, traditional memory management techniques, in the operating system literatures might not be efficient. Our goal is to stop the least important and the least number of services. The paper presents a novel algorithm for home gateway memory management. The proposed algorithm takes into consideration the priority of the application and dependencies between different services, in addition to the amount of memory occupied by each service. We implement the proposed algorithm and performed many experiments to evaluate its performance and execution time. The proposed algorithm is implemented as a part of the OSGi framework (Open Service Gateway initiative). We used best fit and worst fit as yardstick to show the effectiveness of the proposed algorithm.

  1. Comparative analysis of partnership behaviors in the National Park Service

    Science.gov (United States)

    Melissa S. Weddell; Brett A. Wright; Kenneth F. Backman

    2008-01-01

    The partnership phenomenon has received considerable attention as an alternative management strategy for public agencies. The growing use of partnerships has created a need to understand key elements of partnership success and failure, how partnerships address park and recreation management paradoxes, and guidelines for best practices (Mowen & Kerstetter, 2006)....

  2. A model for ageing-home-care service process improvement

    OpenAIRE

    Yu, Shu-Yan; Shie, An-Jin

    2017-01-01

    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  3. Descriptive study of services offered to users of parks bio healthy of Galicia

    Directory of Open Access Journals (Sweden)

    Víctor Arufe Giráldez

    2013-07-01

    Full Text Available The worry of the citizens for the health grows year after year, up to the point that numerous town halls have invested an important budget item in the creation of parks of physical activity for major, parks bio healthy or geriatric parks since some authors name. These parks can be defined as green spaces that numerous equipments integrates for the development of the physical condition inside an urban area or extraurban. His design is focused towards the offer of sports practice for adult population. Across this work one tries to analyze of descriptive form some of the services with those who count these parks. The sample was formed by 30 parks bio healthy of Galicia, constructed between the year 2010 and 2012. The withdrawal of information was realized across a created ad hoc questionnaire. The variables that surrendered to study for this work are the availability of a source with drinkable water, availability of a public bathroom, presence of a professional of the sport, been of the machines and information for the user on the use of the machines. The results state that many of the town halls promoters of parks bio healthy do not bear in mind the presentation of a few minimal services that are necessary for the practice of the physical exercise (fiscal year in major persons, in order to guarantee an ideal care of his health.

  4. Keeping it wild in the National Park Service: A user guide to integrating wilderness character into park planning, management, and monitoring

    Science.gov (United States)

    Peter Landres; Suzy Stutzman; Wade Vagias; Carol Cook; Christina Mills; Tim Devine; Sandee Dingman; Adrienne Lindholm; Miki Stuebe; Melissa Memory; Ruth Scott; Michael Bilecki; Ray O' Neil; Chris Holbeck; Frank Turina; Michael Haynie; Sarah Craighead; Chip Jenkins; Jeremy Curtis; Karen Trevino

    2014-01-01

    This User Guide was developed to help National Park Service (NPS) staff effectively and efficiently fulfill the mandate from the 1964 Wilderness Act and NPS policy to "preserve wilderness character" now and into the future. This mandate applies to all congressionally designated wilderness and other park lands that are, by policy, managed as wilderness,...

  5. The Role of Web Services at Home

    NARCIS (Netherlands)

    Aiello, Marco

    2006-01-01

    The increase in computational power and the networking abilities of home appliances are revolutionizing the way we interact with our homes. This trend is growing stronger and opening a number of technological challenges. From the point of view of distributed systems, there is a need to design

  6. The Role of Web Services at Home

    NARCIS (Netherlands)

    Aiello, Marco

    2005-01-01

    The increase in computational power and the networking abilities of home appliances are revolutionizing the way we interact with our homes. This trend is growing stronger and opening a number of technological challenges. From the point of view of distributed systems, there is a need to design

  7. Influence of home care services on caregivers' burden and satisfaction.

    Science.gov (United States)

    Kim, Eun-Young; Yeom, Hyun-E

    2016-06-01

    To examine the factors affecting the burden and satisfaction of family caregivers, focusing on the beneficial impacts of home care service use. Long-term care for older patients is a multifaceted process that brings both burden and satisfaction to family caregivers. It is expected that home care services offered by the Korean long-term care insurance may contribute to decreasing the burden of family caregivers and enhancing their satisfaction by assisting with practical caregiving tasks. A cross-sectional study. A convenience sample of 157 family caregivers was recruited from five home care service agencies in South Korea. Information about the caregivers, caregiving history, older care recipients and use of home care services was assessed. The effects of home care service use on caregiving burden and satisfaction were tested using hierarchical multiple regression analyses after adjusting for the characteristics of the caregivers, caregiving history and older care recipients. There was no significant influence of home care service use on reducing caregiving burden or on increasing caregivers' satisfaction. Although several factors were associated with caregiving burden and satisfaction, family functioning was the most unique factor to significantly affect both caregiving burden and satisfaction. Home care services might not automatically have a positive impact on caregivers' burden and satisfaction, but maintaining healthy family functioning is an important issue for family caregivers. The findings highlight the important need to reconsider ways to provide home care services and to develop nursing interventions to reinforce supportive family functioning. Practical strategies for providing home care services should be developed through a concrete assessment of the family dynamics and the needs of family caregivers. Health professionals should play a pivotal role in performing the assessment and in developing interventions to strengthen supportive family functioning

  8. A critique of wildlife radio-tracking and its use in National Parks: a report to the National Park Service

    Science.gov (United States)

    Mech, L. David; Barber, Shannon M.

    2002-01-01

    Because of the naturalness of National Parks and because of the public’s strong interest in the parks, the National Park Service (NPS) must gather as much information as needed to help understand and preserve the natural functioning of its ecosystems, and especially of its wildlife. The most useful technique for studying wildlife is radio-tracking, or wildlife telemetry. Radio-tracking is the technique of determining information about an animal through the use of radio signals from or to a device carried by the animal.The basic components of a traditional radio-tracking system are (1) a transmitting subsystem consisting of a radio transmitter, a power source and a propagating antenna, and (2) a receiving subsystem including a “pick-up” antenna, a signal receiver with reception indicator (speaker and/or display) and a power source. Most radio tracking systems involve transmitters tuned to different frequencies (analogous to different AM/FM radio stations) that allow individual identification.Three distinct types of radio-tracking are in use today: (1)conventional, very-high-frequency (VHF) radio tracking, (2) satellite tracking, and (3) Global Positioning System (GPS) tracking. VHF radio-tracking is the standard technique that has been in use since 1963.However, radio-tracking can be considered intrusive in that it requires live-capturing animals and attaching a collar or other device to them. A person must then monitor signals from the device, thus usually requiring people in the field in vehicles, aircraft, and on foot. Nevertheless, most national parks have recognized the benefits of radio-tracking and have hosted radio-tracking studies for many years; in some parks, hundreds of animals have been, or are being, so studied.As a result, some NPS staff are concerned about actual or potential intrusiveness of radio-tracking. Ideally, wildlife studies would still be done but with no intrusion on animals or conflict with park visitors.Thus the NPS has decided to

  9. The homes of tomorrow: service composition and advanced user interfaces

    Directory of Open Access Journals (Sweden)

    Claudio Di Ciccio

    2011-12-01

    Full Text Available Home automation represents a growing market in the industrialized world. Today’s systems are mainly based on ad hoc and proprietary solutions, with little to no interoperability and smart integration. However, in a not so distant future, our homes will be equipped with many sensors, actuators and devices, which will collectively expose services, able to smartly interact and integrate, in order to offer complex services providing even richer functionalities. In this paper we present the approach and results of SM4ALL- Smart hoMes for All, a project investigating automatic service composition and advanced user interfaces applied to domotics.

  10. 75 FR 17763 - National Park Service Benefits-Sharing Final Environmental Impact Statement Record of Decision

    Science.gov (United States)

    2010-04-07

    ... management in connection with the allocation of benefits from valuable discoveries, inventions, and other... share the benefits with the National Park Service. Another alternative prohibits scientific research... Service and researchers who study material associated with a Scientific Research and Collecting Permit to...

  11. Accuracy of Caregiver Proxy Reports of Home Care Service Use.

    Science.gov (United States)

    Chappell, Neena L; Kadlec, Helena

    2016-12-01

    Although much of the research on service use by older adults with dementia relies on proxy reports by informal caregivers, little research assesses the accuracy of these reports, and that which does exist, does not focus on home care services. This brief report compares proxy reports by family caregivers to those with dementia with provincial Ministry of Health records collected for payment and monitoring. The four home care services examined include home nursing care, adult day care, home support, and respite care. Data come from a province-wide study of caregivers in British Columbia, Canada. Caregiver reports are largely consistent with Ministry records, ranging from 81.0% agreement for home support to 96.6% for respite care. Spouses living with the care recipient (the vast majority of the sample) are the most accurate. Others, whether living with the care recipient or not, have only a 50-50 chance of being correct.

  12. Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

    Science.gov (United States)

    Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K

    2018-01-01

    We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

  13. Guiding people with early dementia home with the talkmehome service

    NARCIS (Netherlands)

    Christian Hesselman; Martine de Jong; Marcel Roest; Marike Hettinga; Matti Groot; Lammie van den Bosch; Jeffrey Brangert; Jan M. Nauta

    2012-01-01

    People suffering from mild dementia may get lost during a walk, which can be dangerous for them and adds to the anxiety felt by their informal caregivers. TalkMeHome is a new service that allows these people to get home safely in such situations using their mobile phone. They can call a remote care

  14. Network and Service Monitoring in Heterogeneous Home Networks

    NARCIS (Netherlands)

    Delphinanto, A.

    2012-01-01

    Home networks are becoming dynamic and technologically heterogeneous. They consist of an increasing number of devices which offer several functionalities and can be used for many different services. In the home, these devices are interconnected using a mixture of networking technologies (for

  15. [Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services].

    Science.gov (United States)

    Oh, Eui Geum; Lee, Hyun Joo; Kim, Yukyung; Sung, Ji Hyun; Park, Young Su; Yoo, Jae Yong; Woo, Soohee

    2015-10-01

    The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

  16. Mobile home automation-merging mobile value added services and home automation technologies

    OpenAIRE

    Rosendahl, Andreas; Hampe, Felix J.; Botterweck, Goetz

    2007-01-01

    non-peer-reviewed In this paper we study mobile home automation, a field that emerges from an integration of mobile application platforms and home automation technologies. In a conceptual introduction we first illustrate the need for such applications by introducing a two-dimensional conceptual model of mobility. Subsequently we suggest an architecture and discuss different options of how a user might access a mobile home automation service and the controlled devices. As another contrib...

  17. EINSTEIN-HOME DISCOVERY OF 24 PULSARS IN THE PARKES MULTI-BEAM PULSAR SURVEY

    Energy Technology Data Exchange (ETDEWEB)

    Knispel, B.; Kim, H.; Allen, B.; Aulbert, C.; Bock, O.; Eggenstein, H.-B.; Fehrmann, H.; Machenschalk, B. [Albert-Einstein-Institut, Max-Planck-Institut fuer Gravitationsphysik, D-30167 Hannover (Germany); Eatough, R. P.; Keane, E. F.; Kramer, M. [Max-Planck-Institut fuer Radioastronomie, D-53121 Bonn (Germany); Anderson, D. [University of California at Berkeley, Berkeley, CA 94720 (United States); Crawford, F.; Rastawicki, D. [Department of Physics and Astronomy, Franklin and Marshall College, P.O. Box 3003, Lancaster, PA 17604 (United States); Hammer, D.; Papa, M. A.; Siemens, X. [Physics Department, University of Wisconsin-Milwaukee, Milwaukee, WI 53211 (United States); Lyne, A. G. [Jodrell Bank Centre for Astrophysics, School of Physics and Astronomy, University of Manchester, Manchester M13 9PL (United Kingdom); Miller, R. B. [Department of Physics, West Virginia University, 111 White Hall, Morgantown, WV 26506 (United States); Sarkissian, J., E-mail: benjamin.knispel@aei.mpg.de [CSIRO Parkes Observatory, Parkes, NSW 2870 (Australia); and others

    2013-09-10

    We have conducted a new search for radio pulsars in compact binary systems in the Parkes multi-beam pulsar survey (PMPS) data, employing novel methods to remove the Doppler modulation from binary motion. This has yielded unparalleled sensitivity to pulsars in compact binaries. The required computation time of Almost-Equal-To 17, 000 CPU core years was provided by the distributed volunteer computing project Einstein-Home, which has a sustained computing power of about 1 PFlop s{sup -1}. We discovered 24 new pulsars in our search, 18 of which were isolated pulsars, and 6 were members of binary systems. Despite the wide filterbank channels and relatively slow sampling time of the PMPS data, we found pulsars with very large ratios of dispersion measure (DM) to spin period. Among those is PSR J1748-3009, the millisecond pulsar with the highest known DM ( Almost-Equal-To 420 pc cm{sup -3}). We also discovered PSR J1840-0643, which is in a binary system with an orbital period of 937 days, the fourth largest known. The new pulsar J1750-2536 likely belongs to the rare class of intermediate-mass binary pulsars. Three of the isolated pulsars show long-term nulling or intermittency in their emission, further increasing this growing family. Our discoveries demonstrate the value of distributed volunteer computing for data-driven astronomy and the importance of applying new analysis methods to extensively searched data.

  18. Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes.

    Science.gov (United States)

    Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John

    2017-02-01

    We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.

  19. Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs.

    Science.gov (United States)

    Halvorsen, Kjell H; Granas, Anne Gerd; Engeland, Anders; Ruths, Sabine

    2012-09-01

    To examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Cross-sectional study comprising 11,254 patients aged ≥ 65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug-drug interactions through a Norwegian Web-based tool. The impact of care setting on exposure to selected drug groups, potentially inappropriate medications, and drug interactions was calculated, adjusting for patients' age, gender, and number of drugs used. Patients in nursing homes and home nursing services used on average 5.7 (SD = 2.6) multidose dispensed regular drugs. Twenty-six percent used at least one potentially inappropriate medication, 31% in nursing homes and 25% in home nursing services, p nursing homes (18%) and home nursing services (9%), p nursing homes, more patients in home nursing services used cardiovascular drugs and fewer patients used psychotropic drugs. Altogether, 8615 drug-drug interactions were identified in 55% of patients, 48% in nursing homes and 57% in home nursing services, p quality of drug prescribing in nursing homes compared with home nursing services. Explanations as to why these differences exist need to be further explored. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Elephant (Loxodonta africana home ranges in Sabi Sand Reserve and Kruger National Park: a five-year satellite tracking study.

    Directory of Open Access Journals (Sweden)

    Bindi Thomas

    Full Text Available During a five-year GPS satellite tracking study in Sabi Sand Reserve (SSR and Kruger National Park (KNP we monitored the daily movements of an elephant cow (Loxodonta africana from September 2003 to August 2008. The study animal was confirmed to be part of a group of seven elephants therefore her position is representative of the matriarchal group. We found that the study animal did not use habitat randomly and confirmed strong seasonal fidelity to its summer and winter five-year home ranges. The cow's summer home range was in KNP in an area more than four times that of her SSR winter home range. She exhibited clear park habitation with up to three visits per year travelling via a well-defined northern or southern corridor. There was a positive correlation between the daily distance the elephant walked and minimum daily temperature and the elephant was significantly closer to rivers and artificial waterholes than would be expected if it were moving randomly in KNP and SSR. Transect lines established through the home ranges were surveyed to further understand the fine scale of the landscape and vegetation representative of the home ranges.

  1. Elephant (Loxodonta africana) home ranges in Sabi Sand Reserve and Kruger National Park: a five-year satellite tracking study.

    Science.gov (United States)

    Thomas, Bindi; Holland, John D; Minot, Edward O

    2008-01-01

    During a five-year GPS satellite tracking study in Sabi Sand Reserve (SSR) and Kruger National Park (KNP) we monitored the daily movements of an elephant cow (Loxodonta africana) from September 2003 to August 2008. The study animal was confirmed to be part of a group of seven elephants therefore her position is representative of the matriarchal group. We found that the study animal did not use habitat randomly and confirmed strong seasonal fidelity to its summer and winter five-year home ranges. The cow's summer home range was in KNP in an area more than four times that of her SSR winter home range. She exhibited clear park habitation with up to three visits per year travelling via a well-defined northern or southern corridor. There was a positive correlation between the daily distance the elephant walked and minimum daily temperature and the elephant was significantly closer to rivers and artificial waterholes than would be expected if it were moving randomly in KNP and SSR. Transect lines established through the home ranges were surveyed to further understand the fine scale of the landscape and vegetation representative of the home ranges.

  2. Human-assisted sound event recognition for home service robots.

    Science.gov (United States)

    Do, Ha Manh; Sheng, Weihua; Liu, Meiqin

    This paper proposes and implements an open framework of active auditory learning for a home service robot to serve the elderly living alone at home. The framework was developed to realize the various auditory perception capabilities while enabling a remote human operator to involve in the sound event recognition process for elderly care. The home service robot is able to estimate the sound source position and collaborate with the human operator in sound event recognition while protecting the privacy of the elderly. Our experimental results validated the proposed framework and evaluated auditory perception capabilities and human-robot collaboration in sound event recognition.

  3. Engaging and Empowering the National Park Service to apply Earth Observations to Management Decisions

    Science.gov (United States)

    Clayton, A.; Ross, K. W.; Crepps, G.; Childs-Gleason, L. M.; Ruiz, M. L.; Rogers, L.; Allsbrook, K. N.

    2017-12-01

    Since 2015, the NASA DEVELOP National Program has partnered with the National Park Service (NPS) engaging more than 120 program participants, working on over 22 projects across approximately 27 unique park units. These projects examined a variety of cultural and environmental concerns facing the NPS including landscape disturbance, invasive species mapping, archaeological site preservation, and water resources monitoring. DEVELOP, part of NASA's Applied Sciences' Capacity Building program, conducts 10-week feasibility projects which demonstrate the utility of NASA's Earth observations as an additional tool for decision-making processes. This presentation will highlight several of these projects and discuss the progress of capacity building working with individual, regional, and institutional elements within the National Park Service.

  4. Social Support and the Receipt of Home Care Services.

    Science.gov (United States)

    Chappell, Neena L.

    1985-01-01

    Compares differences between elderly who use formal home care services and those who do not. Data revealed users as less healthy and less active and as receiving more assistance from both formal and informal sources. Suggests that formal and informal services complement rather than substitute for one another. (NRB)

  5. On Managed Services Lanes and their Use in Home Networks

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Nooren, P.A.; Delphinanto, A.; Fledderus, E.R

    2013-01-01

    Home networks show an increasing level of heterogeneity regarding the devices connected, network technologies used, and services supported. Heterogeneity inhibits quality assurance for new services, such as online gaming, energy management, and health care. This paper focuses on the role that the

  6. 75 FR 57978 - Notice of Intent; Request for Comments on Adoption of the National Park Service's Wetland and...

    Science.gov (United States)

    2010-09-23

    ... Code: 7B] Notice of Intent; Request for Comments on Adoption of the National Park Service's Wetland and... adopt the National Park Service's (NPS) existing final environmental impact statement/environmental... (CSCC) to assist with implementing restoration activities that have been identified and reviewed under...

  7. 77 FR 58868 - Teleconference for the National Park Service Alaska Region's Subsistence Resource Commission Program

    Science.gov (United States)

    2012-09-24

    ... Wildlife Updates 8. NPS Staff Reports 9. New Business 10. Public and other Agency Comments 11. Select Time... Subsistence Collections Environmental Assessment Update b. SRC Letters 10. New Business a. Susitna-Watana...: National Park Service, Interior. ACTION: Notice of open public meetings. SUMMARY: The Lake Clark National...

  8. 75 FR 51103 - Notice of Public Meetings for the National Park Service (NPS) Alaska Region's Subsistence...

    Science.gov (United States)

    2010-08-18

    ... SRC and Wrangell-St. Elias SRC plan to meet to develop and continue work on National Park Service (NPS... reconvene on Thursday, October 7, 2010, from 9 a.m. to 5 p.m. or until business is completed. This meeting will be held at Fast Eddy's Motel and Restaurant located at Mile 1313 on the Alaska Highway in Tok, AK...

  9. EnviroAtlas Proximity to Parks Web Service

    Data.gov (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas web service supports research and online mapping activities related to EnviroAtlas (https://www.epa.gov/enviroatlas). This EnviroAtlas dataset shows...

  10. A Home-Based Palliative Care Consult Service for Veterans.

    Science.gov (United States)

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

  11. Medicare Home Health Services: A Difficult Program to Control

    Science.gov (United States)

    1981-09-25

    represent about one-third of all visits provided under the program. Family and friends altio provide similar services to the elderly and consequently...example, that the individual is to be confined to his or her home but that this does not necessarily mean that the patient is bedridden . At the same...34feebleness" and "insecurity" cannot be considered home- bound. We believe that in many cases (particularly for the elderly ) it would be extremely

  12. Planning contract and networks of home services

    Directory of Open Access Journals (Sweden)

    José Eudoro Narváez Viteri

    2010-06-01

    Full Text Available This article highlights the worrying increase in public investment in infrastructure works due to deficiencies at the stage of study and design, particularly in public utility services networks. Some cities lack real technical drawings and updated underground networks, especially in the former. Hence, no reliable information is difficult to require contractors, consultants about study designs appropriate public service networks in evident contradiction with the principle of contractual planning.

  13. Switched Broadband Services For The Home

    Science.gov (United States)

    Sawyer, Don M.

    1990-01-01

    In considering the deployment of fiber optics to the residence, two critical questions arise: what are the leading services that could be offered to justify the required investment; and what is the nature of the business that would offer these services to the consumer ? This talk will address these two questions together with the related issue of how the "financial engine" of today's television distribution infrastructure - TV advertising - would be affected by an open access system based on fiber optics coupled with broadband switching. On the business side, the talk concludes that the potential for open ended capacity expansion, fair competition between service providers, and new interactive services inherent in an open access, switched broadband system are the critical items in differentiating it from existing video and TV distribution systems. On the question of broadband services, the talk will highlight several new opportunities together with some findings from recent market research conducted by BNR. The talk will show that there are variations on existing services plus many new services that could be offered and which have real consumer appeal. The postulated open access system discussed here is visualized as having ultimately 1,000 to 2,000 video channels available to the consumer. Although this may appear to hopelessly fragment the TV audience and destroy the current TV advertising infrastructure, the technology of open access, switched broadband will present many new advertising techniques, which have the potential to be far more effective than those available today. Some of these techniques will be described in this talk.

  14. Description of the Implementation of Home Care Servicer at RS Murni Teguh, Medan

    OpenAIRE

    Manalu, Ayu P Sary

    2014-01-01

    Home care service constitutes providing service and nurses’ equipment for patients and their families at home in order to keep their health, education, prevention from diseases, palliative therapy, and rehabilitation. Home care service at RS Murni Teguh, Medan, has its specification in management, compared with home care service in other places. The objective of the research was to find out the description of the implementation of home care service at RS Murni Teguh, Medan. The research used ...

  15. Energy Consumption Information Services for Smart Home Inhabitants

    Science.gov (United States)

    Schwanzer, Michael; Fensel, Anna

    We investigate services giving users an adequate insight on his or her energy consumption habits in order to optimize it in the long run. The explored energy awareness services are addressed to inhabitants of smart homes, equipped with smart meters, advanced communication facilities, sensors and actuators. To analyze the potential of such services, a game at a social network Facebook has been designed and implemented, and the information about players' responses and interactions within the game environment has been collected and analyzed. The players have had their virtual home energy usage visualized in different ways, and had to optimize the energy consumption basing on their own perceptions of the consumption information. Evaluations reveal, in particular, that users are specifically responsive to information shown as a real-time graph and as costs in Euro, and are able to produce and share with each other policies for managing their smart home environments.

  16. [eLearning service for home palliative care].

    Science.gov (United States)

    Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

    2008-12-01

    In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.

  17. Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.

    Science.gov (United States)

    Thomas, Kali S; Keohane, Laura; Mor, Vincent

    2014-11-01

    We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.

  18. Estimating savings in parking demand using shared vehicles for home-work commuting

    OpenAIRE

    Kondor, Dániel; Zhang, Hongmou; Tachet, Remi; Santi, Paolo; Ratti, Carlo

    2017-01-01

    The increasing availability and adoption of shared vehicles as an alternative to personally-owned cars presents ample opportunities for achieving more efficient transportation in cities. With private cars spending on the average over 95\\% of the time parked, one of the possible benefits of shared mobility is the reduced need for parking space. While widely discussed, a systematic quantification of these benefits as a function of mobility demand and sharing models is still mostly lacking in th...

  19. Medicaid Home Care Services and Survival in New York City

    Science.gov (United States)

    Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

    2005-01-01

    Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

  20. Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs

    OpenAIRE

    Halvorsen, Kjell H.; Granås, Anne Gerd; Engeland, Anders; Ruths, Sabine

    2012-01-01

    Tverrsnittstudie, undersøker og sammenligner forskrivningskvaliteten hos eldre som bor i sykehjem og hjemme. Purpose: to examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services. Methods: Cross-sectional study comprising 11 254 patients aged ≥65 years in nursing homes (n = 2986) and home nursing services (n = 8268). Potentially inappropriate medications were identified by using the Norwegian General Practice criteria and drug–drug in...

  1. 75 FR 13808 - Missouri & Valley Park Railroad Corporation-Discontinuance of Service Exemption-in St Louis...

    Science.gov (United States)

    2010-03-23

    ... DEPARTMENT OF TRANSPORTATION Surface Transportation Board [STB Docket No. AB-1057X] Missouri & Valley Park Railroad Corporation--Discontinuance of Service Exemption--in St Louis County, MO On March 3... Subdivision between milepost 18.36 and milepost 20.50, near West Valley Park, St. Louis County, MO.\\2\\ The...

  2. Webcasting in home and hospice care services: virtual communication in home care.

    Science.gov (United States)

    Smith-Stoner, Marilyn

    2011-06-01

    The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.

  3. Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home.

    Science.gov (United States)

    Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

    2017-07-01

    To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  4. Home range and habitat use of reintroduced Javan Deer in Panaitan Island, Ujung Kulon National Park

    Directory of Open Access Journals (Sweden)

    Pairah

    2015-09-01

    Full Text Available The Javan deer which inhabit Panaitan Island (± 175 Km2 were reintroduced from Peucang Island (± 4.5 Km2 during 1978–1982 (3 males: 13 females. The information of home range and habitat use of these animals were needed for wildlife habitat management especially in the small island habitat. We measured the home range size and habitat use of Javan deer in Peucang Island and Panaitan Island and compared them. The home range size was measured using Minimum Convex Polygon and then the polygon of home ranges were used to measure the habitat use. The results showed that in general the home range size in all age class of Javan deer between both islands did not differ significantly, only subadult males in Peucang Island which have a larger home range size than subadult males in Panaitan Island. Javan deer in Panaitan Island have found suitable conditions.

  5. Contracting out local road and park services: Economic effects and their strategic, contractual, and competitive conditions

    DEFF Research Database (Denmark)

    Lindholst, Andrej Christian; Petersen, Ole Helby; Houlberg, Kurt

    2018-01-01

    such as markets, contracts, municipal strategies and contracting history influence these outcomes. Drawing on original survey data from Danish municipalities, we find that competitive tendering has on average reduced costs. Further analysis shows that savings are not associated with lower quality, thus indicating......The economic rationale for contracting out local services is increasingly contested by empirical research. This article aims to contribute to this literature, first by scrutinising the economic effects of contracting out in local road and park services and, second, by exploring how characteristics...... realise larger savings, whereas the characteristics of markets and contracts do not seem to explain variations in cost savings....

  6. Mental health services for homebound elders from home health nursing agencies and home care agencies.

    Science.gov (United States)

    Zeltzer, Barry B; Kohn, Robert

    2006-04-01

    This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies.

  7. National Park Service Organic Act prohibits turning the doorstep of Canyonlands National Park into a nuclear wasteland

    International Nuclear Information System (INIS)

    Bryan, J.A.

    1986-01-01

    The protection national parks enjoy under the Organic Act of 1916 is now threatened by the enlarging and advancing needs of American society, with the most destructive threat posed by excessive or incongruent development on land adjacent to the parks. The need to store high-level nuclear waste has prompted DOE to ignore the protective mandate of the Act, and the Interior Secretary has made no move to correct DOE's error. Judicial intervention is not available until park values are immediately threatened. Federal action could violate the Act's standards and irreparably scar Canyonlands National Park. Decisions of this magnitude should be made in the open, with the federal government and public cooperating in an informed manner and acknowledging what is at stake

  8. Needs of home care services for the bedridden patient’s problems living in their home

    Directory of Open Access Journals (Sweden)

    Nuran Akdemir

    2011-03-01

    Full Text Available The study was carry out as an semi-experimental study to identify the difficulties confronted by bedridden patients with stroke to give them necessary counseling services and to improve models of home care service.Method: The research sample is composed of 38 patients discarged from Hacettepe University İbni Sina Hospital and Health Ministry Ankara Numune Hospital Neurology services following cerebro-vascular accident. The data derived from the research is evaluated through percentage usage. Patients included in the study were visited average 5 times during the research.Result: During the home visiting, it is found out that most of the patients were in need of information concerning insufficient hygienic care, other illnesses, use of medication, discharge system problems like constipation and diarhea and dietary/nutritional; it is also observed that they are experiencing psycho-social diffuculties. The study results put forward suggestions in realizing progression and to form model of systematic home care services.

  9. Service First: Embracing the Scholarship on Teaching and Learning through Active Engagement in Parks, Recreation, and Tourism Education

    Science.gov (United States)

    Schwab, Keri; Greenwood, Brian; Dustin, Daniel

    2014-01-01

    In this article, we turn the tripartite responsibility of teaching, scholarship, and service inside out. Rather than considering service to be a poor stepchild to scholarship and teaching, we reason that service as engaged scholarship should be the centerpiece of academic life, especially in an applied discipline like parks, recreation, and…

  10. Home care: from adequate funding to integration of services.

    Science.gov (United States)

    Hébert, Réjean

    2009-01-01

    With the aging of the population, the healthcare system needs to shift from the actual hospital-centred system developed in the past century for dealing with acute diseases and a young population toward a home-centred system, more appropriate for serving older people with chronic diseases. Funding of home care should not only be significantly increased but also be managed differently. We propose the introduction of an autonomy support benefit (ASB) to cover costs related to disabilities, irrespective of living environment, and to set up a public universal autonomy insurance program that will cover the ASB. This insurance should be at least partly capitalized to provide for the aging of the population and to ensure intergenerational equity. Also, since the home is a much more complicated service-delivery environment than the hospital, these services must be coordinated and integrated. The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) is a coordination-type model of integration that was implemented and evaluated in three areas (one urban and two rural) in and around Sherbrooke, Quebec. A four-year longitudinal quasi-experimental study with over 1,500 participants demonstrated its efficiency in improving system effectiveness at no extra cost.

  11. Do Medicaid home and community based service waivers save money?

    Science.gov (United States)

    Harrington, Charlene; Ng, Terence; Kitchener, Martin

    2011-10-01

    This article estimates the potential savings to the Medicaid program of using 1915c Home and Community Based Services (HCBS) waivers rather than institutional care. For Medicaid HCBS waiver expenditures of $25 billion in 2006, we estimate the national savings to be over $57 billion, or $57,338 per waiver participant in 2006 compared with the cost of Medicaid institutional care (for which all waiver participants are eligible). When taking into account a potential 50% "woodwork effect" (for people who might have refused institutional services), the saving would be $21 billion. This analysis demonstrates that HCBS waiver programs present significant direct financial savings to Medicaid long-term care (LTC) programs.

  12. Counselling and Psychological Services for Clients at the Shelter Home

    Directory of Open Access Journals (Sweden)

    Ľudmila Fonferová

    2014-07-01

    Full Text Available Problem: The paper is dealing with a psychological approach to the work with families and their children at a shelter home. It describes the circumstances and conditions for the work in the specific socio-therapeutic environment of the Horni Pocernice Shelter Home. The main research question - 'What are the options of psychological intervention and psychotherapeutic work with clients in the scope of services offered by the shelter home in Horni Pocernice'- works with the hypopaper that psychology and psychotherapy have their place within and next to social services. For clients who use services of this shelter home is this work essential and contributes to better understanding of their life situation and their social relations. Effectivity of psychological work in the environment of a shelter home is in a great deal connected to its acceptance, inner belief and understanding of its real possibilities by every single social worker. Lack of understanding, distorted expectations both on the side of social workers and psychologists complicate or even prevent psychotherapeutic work with clients for whom the requirements and demands of social workers are determining during their stay. Methods: This paper is based on the design of ethnographic field research. Empirical design of this research is defined by the premises of the shelter home and the time period from 2007 to 2012. Therapeutic possibilities of clients are examined from the position of psychologist and psychotherapist of this centre who offers his/her services once a week for about 5 to 7 hours. The research sample was being created during the collection of data in the examined period and its analysis when it was early established with respect to the research question that all available cases typical for full collection will be included (there were 646 clients in the examined period. Results: The answer to the main research question concerns two variables which are related to each other. The

  13. Ecosystem Services Valuation of Lakeside Wetland Park beside Chaohu Lake in China

    Directory of Open Access Journals (Sweden)

    Tan Li

    2016-07-01

    Full Text Available Wetland ecosystems are one of the three great ecosystems on Earth. With a deepening of research on wetland ecosystems, researchers have paid more and more attention to wetland ecosystem services such as flood mitigation, climate control, pollution prevention, soil-erosion prevention, biodiversity maintenance, and bio-productivity protection. This study focuses on a lakeside wetland ecosystem in Hefei, a city in central China, and estimates the value of ecosystem services such as material production, air purification, water conservation, biodiversity, recreation, species conservation, education and scientific research. We adopted the market value method, carbon tax method, afforestation cost method, shadow engineering method and contingent value method (CVM using questionnaire survey data during the study period. The results show that the total value of the ecosystem services of Lakeside Wetland Park was 144 million CNY in 2015. Among these services, the value of society service is the maximum at 91.73 million CNY, followed by ecological service and material production service (42.23 million CNY and 10.43 billion CNY in 2015 respectively. When considering wetland ecosystems for economic development, other services must be considered in addition to material production to obtain a longer-term economic value. This research reveals that there is scope for more comprehensive and integrated model development, including multiple wetland ecosystem services and appropriate handling of wetland ecosystem management impacts.

  14. 76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

    Science.gov (United States)

    2011-11-21

    ... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

  15. Behavioral health service utilization and preferences of older adults receiving home-based aging services.

    Science.gov (United States)

    Gum, Amber M; Iser, Lindsay; Petkus, Andrew

    2010-06-01

    To examine use of behavioral health services, treatment preferences, and facilitators and barriers to service use in older adults receiving home-based services within the aging network. Cross-sectional survey. Interviews were conducted in participants' homes. One hundred forty-two clients receiving home-based aging services. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Brief Symptom Inventory-18; Discrimination-Devaluation Scale; utilization of behavioral health services; and preferences, facilitators, and barriers for behavioral health services. Use of psychotropic medication was high (54.2%), primarily received in primary care settings (58.8%), with a few visits a year (54.0%). Participants were more likely to be taking psychotropic medication if they were younger and white. Approximately one-third of participants on antidepressant or antianxiety medication still met criteria for an Axis I disorder. Twenty-one participants (14.8%) reported receiving counseling within the past year, with a few visits or less a year for most (57.1%). Almost all were willing to see at least one professional (97.2%) and try prescribed medications or counseling (90.1%). The most common barriers to service use were practical: affordability (71.8%), difficulty traveling (62.7%), and lack of transportation (45.8%). Aging network clients receiving home-based services have ready access to psychotropic medications but receive very few specialty behavioral health services and medication monitoring visits. They are willing to use a variety of behavioral health services and perceive mainly practical barriers to using services. The aging network has significant potential to enhance access to service utilization; strategies for integrating behavioral health services in the aging network are discussed.

  16. Mapping outdoor recreationists' perceived social values for ecosystem services at Hinchinbrook Island National Park, Australia

    Science.gov (United States)

    van Riper, Carena J.; Kyle, Gerard T.; Sutton, Stephen G.; Barnes, Melinda; Sherrouse, Benson C.

    2012-01-01

    Coastal ecosystems are increasingly faced with human impacts. To better understand these changing conditions, biophysical and economic values of nature have been used to prioritize spatial planning efforts and ecosystem-based management of human activities. Less is known, however, about how to characterize and represent non-material values in decision-making. We collected on-site and mailback survey data (n = 209), and analyzed these data using the Social Values for Ecosystem Services (SolVES) GIS application to incorporate measures of social value and natural resource conditions on Hinchinbrook Island National Park, Australia. Our objectives in this paper are to: 1) determine the spatial distribution and point density of social values for ecosystem services; 2) examine the relationship between social values and natural resource conditions; and 3) compare social value allocations between two subgroups of outdoor recreationists. Results suggest that high priority areas exist on Hinchinbrook's land and seascapes according to the multiple values assigned to places by outdoor recreationists engaged in consumptive (e.g., fishing) and non-consumptive (e.g., hiking) activities. We examine statistically significant spatial clustering across two subgroups of the survey population for three value types that reflect Recreation, Biological Diversity, and Aesthetic qualities. The relationship between the relative importance of social values for ecosystem services and spatially-defined ecological data is explored to guide management decision-making in the context of an island national park setting.

  17. Arsenic Removal from Drinking Water by Adsorptive Media - U.S. EPA Demonstration Project at Hot Springs Mobile Home Park in Willard, Utah - Final Performance Evaluation Report

    Science.gov (United States)

    This report documents activities performed for and results obtained from the arsenic removal treatment technology demonstration project at the Hot Springs Mobile Home Park (HSMHP) in Willard, UT. The objectives of the project were to evaluate the effectiveness of Adsorbsia™ GTO™...

  18. ARSENIC REMOVAL FROM DRINKING WATER BY ADSORPTIVE MEDIA U.S. EPA DEMONSTRATION PROJECT AT SPRING BROOK MOBILE HOME PARK IN WALES, ME SIX-MONTH EVALUATION REPORT

    Science.gov (United States)

    This report documents the activities performed during and the results obtained from the first six months of the arsenic removal treatment technology demonstration project at the Spring Brook Mobile Home Park in Wales, ME. The objectives of the project are to evaluate the effectiv...

  19. ARSENIC REMOVAL FROM DRINKING WATER BY ADSORPTIVE MEDIA U.S. EPA DEMONSTRATION PROJECT AT CHATEAU ESTATES MOBILE HOME PARK IN SPRINGFIELD, OH. SIX-MONTH EVALUATION REPORT

    Science.gov (United States)

    This report documents the activities performed for and the results obtained from the first six months of the arsenic removal treatment technology demonstration project at the Chateau Estates Mobile Home Park at Springfield, OH. The objectives of the project are to evaluate the ef...

  20. ARSENIC REMOVAL FROM DRINKING WATER BY IRON REMOVAL USEPA DEMONSTRATION PROJECT AT BIG SAUK LAKE MOBILE HOME PARK IN SAUK CENTRE, MN. SIX MONTH EVALUATION REPORT

    Science.gov (United States)

    This report documents the activities performed and the results obtained from the first six months of the arsenic removal treatment technology demonstration project at the Big Sauk Lake Mobile Home Park (BSLMHP) in Sauk Centre, MN. The objectives of the project are to evaluate the...

  1. At Home with Jane Austen: Imagining the Colonial Connection in Mansfield Park

    Directory of Open Access Journals (Sweden)

    Blanka Grzegorczyk

    2009-11-01

    Full Text Available This article examines Jane Austen's Mansfield Park in the context of the complex relationship between imaginative literature and the experience of empire. Specifically, it argues that the way Austen's novel plays with the imperial experience is more ambivalent than many critics have indicated. It suggests that underlying the imaginative conceptualization of the relations between metropole and colony are certain evasions and contradictions in which the novel consciously abounds. A close reading of the novel demonstrates how issues related to metropole and colony may be articulated within the literary mainstream, and why such narrative articulation is important.

  2. The Water-Quality Partnership for National Parks—U.S. Geological Survey and National Park Service, 1998–2016

    Science.gov (United States)

    Nilles, Mark A.; Penoyer, Pete E; Ludtke, Amy S.; Ellsworth, Alan C.

    2016-07-13

    The U.S. Geological Survey (USGS) and the National Park Service (NPS) work together through the USGS–NPS Water-Quality Partnership to support a broad range of policy and management needs related to high-priority water-quality issues in national parks. The program was initiated in 1998 as part of the Clean Water Action Plan, a Presidential initiative to commemorate the 25th anniversary of the Clean Water Act. Partnership projects are developed jointly by the USGS and the NPS. Studies are conducted by the USGS and findings are used by the NPS to guide policy and management actions aimed at protecting and improving water quality.The National Park Service manages many of our Nation’s most highly valued aquatic systems across the country, including portions of the Great Lakes, ocean and coastal zones, historic canals, reservoirs, large rivers, high-elevation lakes and streams, geysers, springs, and wetlands. So far, the Water-Quality Partnership has undertaken 217 projects in 119 national parks. In each project, USGS studies and assessments (http://water.usgs.gov/nps_partnership/pubs.php) have supported science-based management by the NPS to protect and improve water quality in parks. Some of the current projects are highlighted in the NPS Call to Action Centennial initiative, Crystal Clear, which celebrates national park water-resource efforts to ensure clean water for the next century of park management (http://www.nature.nps.gov/water/crystalclear/).New projects are proposed each year by USGS scientists working in collaboration with NPS staff in specific parks. Project selection is highly competitive, with an average of only eight new projects funded each year out of approximately 75 proposals that are submitted. Since the beginning of the Partnership in 1998, 189 publications detailing project findings have been completed. The 217 studies have been conducted in 119 NPS-administered lands, extending from Denali National Park and Preserve in Alaska to Everglades

  3. 76 FR 7232 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Dinosaur...

    Science.gov (United States)

    2011-02-09

    .... Department of the Interior, National Park Service, Dinosaur National Monument, Dinosaur, CO AGENCY: National... Service, Dinosaur National Monument, Dinosaur, CO, has completed an inventory of human remains and... Indian tribe that believes itself to be culturally affiliated with the human remains may contact Dinosaur...

  4. Valuation of tropical forest services and mechanisms to finance their conservation and sustainable use: A case study of Tapantí National Park, Costa Rica

    NARCIS (Netherlands)

    Bernard, F.; Groot, de R.S.; Campos, J.J.

    2009-01-01

    The Tapanti National Park in Costa Rica comprises a precious but vulnerable tropical rain forest area. The monetary values of ecosystem services that are provided by this park are estimated in order to assess the mechanisms to finance the park's conservation and sustainable use. The main ecosystem

  5. Research and implementation of geographic information service mode in digital home

    Science.gov (United States)

    Lei, B.; Liu, K.; Gan, Y.; Zhong, M.

    2014-04-01

    Accompanying infrastructure improvements and networking technology innovation, the development of digital home service industry has gotten more and more attention. However, the digital home service levels have not sufficiently met rising demand from users. Therefore, it is urgent to propose and develop new service modes for the digital home. Geographic information services can provide various spatial information services such as map search, spatial information query. It has become an inevitable trend to implement geographic information services in the digital home. This paper proposes three new geographic information services modes for the digital home after sufficient requirement analysis: pushed information service mode, interactive information service mode, personalized information service mode. The key technologies to implement geographic information services on digital televisions are studied, involving digital television middleware technology, network transmission technology and visualization technology. According to the service modes' characteristics mentioned above, a service system in the digital home is established to implement geographic information services on the basis of digital television. The implementation of geographic information services in the digital home not only enriches the digital home services content, but also promotes geographic information from specialization to public popularity.

  6. AVTA federal fleet PEV readiness data logging and characterization study for the National Park Service: Grand Canyon National Park

    Energy Technology Data Exchange (ETDEWEB)

    Schey, Stephen [Intertek Testing Services, Phoenix, AZ (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States); Nienhueser, Ian [Intertek Testing Services, Phoenix, AZ (United States)

    2014-08-01

    This report focuses on the Grand Canyon National Park (GCNP) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively PEVs) can fulfill the mission requirements.

  7. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for the National Park Service: Golden Gate National Recreation Area

    Energy Technology Data Exchange (ETDEWEB)

    Stephen Schey; Jim Francfort

    2014-03-01

    charging events could occur at the vehicle home base, high-use work areas, or intermediately along routes that the vehicles frequently travel. Replacement of vehicles in the current fleet would result in significant reductions in the emission of greenhouse gases and petroleum use, while also reducing fuel costs. The San Francisco Bay Area is a leader in the adoption of PEVs in the United States. PEV charging stations, or more appropriately identified as electric vehicle supply equipment, located on the GGNRA facility would be a benefit for both GGNRA fleets and general public use. Fleet drivers and park visitors operating privately owned PEVs benefit by using the charging infrastructure. ITSNA recommends location analysis of the GGNRA site to identify the optimal placement of the electric vehicle supply equipment station. ITSNA recognizes the support of Idaho National Laboratory and ICF International for their efforts to initiate communication with the National Parks Service and GGNRA for participation in the study. ITSNA is pleased to provide this report and is encouraged by the high interest and support from the National Park Service and GGNRA personnel.

  8. 75 FR 8920 - Grant of Authority for Subzone Status; IKEA Distribution Services (Distribution of Home...

    Science.gov (United States)

    2010-02-26

    ... Status; IKEA Distribution Services (Distribution of Home Furnishings and Accessories); Baltimore, MD... subzone at the warehouse and distribution facility of IKEA Distribution Services, located in Perryville... and distribution at the facility of IKEA Distribution Services, located in Perryville, Maryland...

  9. Mental status of the elderly receiving home health services and the associated stress of home helpers.

    Science.gov (United States)

    Nagatomo, I; Takigawa, M

    1998-01-01

    One hundred and ninety elderly people receiving home health service were investigated. The intellectual levels, depressive state evaluated by the Cornell scale for depression in dementia (CSDD) scale, abnormal behaviors evaluated by the dementia behavior disturbance (DBD) scale, and activities of daily living (ADL) were examined. These assessments were performed by 72 skilled home helpers who also assessed the severity of their own level of stress using the Burnout scale. The intellectual level and mood-related signs, based on the CSDD scale, of the elderly living with families or with a spouse were diminished significantly as compared to the elderly living alone. The elderly living with families also performed worse on all ADL categories except for visual acuity as compared to the elderly living with a spouse or living alone. There was no significant correlation between the Burnout scale score and age or frequency of working as a home helper. These results suggest that elderly people living with families as compared to the elderly living with a spouse or living alone have greater mental health needs as well as more profound physical limitations.

  10. Allocation of home care services by municipalities in Norway: a document analysis.

    Science.gov (United States)

    Holm, Solrun G; Mathisen, Terje A; Sæterstrand, Torill M; Brinchmann, Berit S

    2017-09-22

    In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices. A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients). In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance. Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.

  11. Home healthcare services in Taiwan: a nationwide study among the older population

    Directory of Open Access Journals (Sweden)

    Lai Hsiu-Yun

    2010-09-01

    Full Text Available Abstract Background Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan. Methods Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored. Results Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9% patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%. More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%. Conclusions Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.

  12. A service model for delivering care closer to home.

    Science.gov (United States)

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

  13. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for the National Park Service: Fort Vancouver National Historic Site

    Energy Technology Data Exchange (ETDEWEB)

    Stephen Schey; Jim Francfort

    2014-03-01

    Battelle Energy Alliance, LLC, managing and operating contractor for the U.S. Department of Energy’s Idaho National Laboratory, is the lead laboratory for the U.S. Department of Energy’s Advanced Vehicle Testing. Battelle Energy Alliance, LLC contracted with Intertek Testing Services, North America (ITSNA) to collect data on federal fleet operations as part of the Advanced Vehicle Testing Activity’s Federal Fleet Vehicle Data Logging and Characterization study. The Advanced Vehicle Testing Activity study seeks to collect data to validate the use of advanced electric drive vehicle transportation. This report focuses on the Fort Vancouver National Historic Site (FVNHS) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of electric vehicles (EVs) into the agencies’ fleet. Individual observations of the selected vehicles provided the basis for recommendations related to EV adoption and whether a battery electric vehicle (BEV) or plug-in hybrid electric vehicle (PHEV) (collectively plug-in electric vehicles) could fulfill the mission requirements. FVNHS identified three vehicles in its fleet for consideration. While the FVNHS vehicles conduct many different missions, only two (i.e., support and pool missions) were selected by agency management to be part of this fleet evaluation. The logged vehicles included a pickup truck and a minivan. This report will show that BEVs and PHEVs are capable of performing the required missions and providing an alternative vehicle for both mission categories, because each has sufficient range for individual trips and time available each day for charging to accommodate multiple trips per day. These charging events could occur at the vehicle’s home base, high-use work areas, or in intermediate areas along routes that the vehicles frequently travel. Replacement of vehicles in the current fleet would result in

  14. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    Directory of Open Access Journals (Sweden)

    Peng Qingchao

    2016-01-01

    Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

  15. Home care clients in the last year of life: is material deprivation associated with service characteristics?

    Science.gov (United States)

    Goodridge, Donna; Buckley, Alan; Marko, Josh; Steeves, Megan; Turner, Hollie; Whitehead, Steve

    2011-09-01

    To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

  16. Improving Older Adults' Functional Ability through Service Use in a Home Care Program in Hong Kong

    Science.gov (United States)

    Cheung, Chau-kiu; Ngan, Raymond Man-hung

    2005-01-01

    Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…

  17. 42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.

    Science.gov (United States)

    2010-10-01

    ... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities and home health agencies. 415.204 Section 415.204 Public Health CENTERS FOR MEDICARE & MEDICAID...

  18. Photovoltaic applications in the southwest for the National Park Service. [10 to 100 kW

    Energy Technology Data Exchange (ETDEWEB)

    Peatfield, C.R.; Jarvinen, P.O.

    1977-04-28

    Nearly three megawatts of electrical power are produced annually by diesel/electric generator sets at National Park Service sites, according to a survey conducted jointly by the NPS and MIT/Lincoln Laboratory. To prove the economic viability of photovoltaic power generation systems to meet NPS electric power needs as well as to stimulate public acceptance and reliance on solar-generated electricity, NPS and MIT/LL are cooperating in a Field Tests and Applications Project sponsored by the U.S. Energy Research and Development Administration. The power level for the applications will be in the range from 10 to 100 kW. Ten of the most promising NPS sites were visited and evaluated. Based on ten criteria, Natural Bridges National Monument in Utah was selected as the optimum first pick. The FT and A Project and evaluation details for the ten sites are described.

  19. Measurements of seasonal and daily radon daughter concentration fluctuations in National Park Service caves

    International Nuclear Information System (INIS)

    Yarborough, K.A.

    1977-01-01

    The National Park Service (NPS) is studying levels of airborne alpha radiation from radon and thoron in all NPS administered caves in which tours for visitors are regularly conducted. The NPS research has the dual but complementary objectives of safeguarding health at the NPS administered caves, and to develop data on alpha radiation levels and on natural airflows in NPS caves. The results reported here for NPS caves describe concepts hypothesized for the objectives. In addition the data can be used by various agencies to clarify health standards for exposures to low airborne alpha radiation levels in cave environments. These results show daily and seasonal trends and the influence of natural ventilation by air circulation for each cave investigated

  20. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    OpenAIRE

    Peng Qingchao

    2016-01-01

    Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explor...

  1. Relationship between home care service use and changes in the care needs level of Japanese elderly.

    Science.gov (United States)

    Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto

    2009-12-21

    With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to

  2. Supporting home care for the dying: an evaluation of healthcare professionals' perspectives of an individually tailored hospice at home service.

    Science.gov (United States)

    Jack, Barbara A; Baldry, Catherine R; Groves, Karen E; Whelan, Alison; Sephton, Janice; Gaunt, Kathryn

    2013-10-01

    To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. An evaluation study. Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey. Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. This service offers various components of a hospice

  3. 78 FR 78380 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort...

    Science.gov (United States)

    2013-12-26

    ... completion of an inventory of human remains under the control of Fort Bowie National Historic Site, Bowie, AZ....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort... completed an inventory of human remains, in consultation with the appropriate Indian tribes or Native...

  4. 78 FR 78378 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Grant...

    Science.gov (United States)

    2013-12-26

    ... Repatriation Act (NAGPRA), 25 U.S.C. 3003, of the completion of an inventory of human remains under the control....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Grant... Historic Site has completed an inventory of human remains, in consultation with the appropriate Indian...

  5. Pharmacist Advancement of Transitions of Care to Home (PATCH) Service.

    Science.gov (United States)

    Trang, Joseph; Martinez, Amanda; Aslam, Sadaf; Duong, Minh-Tri

    2015-11-01

    There is a paucity of literature on a well-defined role of a pharmacist in different aspects of transition of care service (TCS). Although health care institutions have specific details on the discharge process, there is a need for a sustainable TCS with a well-defined role of pharmacists. To describe the impact of a pharmacist-led TCS on acute health care utilization, clinic quality indicators, and identification and resolution of medication-related problems (MRPs). A pharmacist-managed TCS service, referred to as the Pharmacist Advancement of Transitions of Care to Home (PATCH) service, was established at an academic medical center, where high-risk patients received a postdischarge phone call from a pharmacist followed by a face-to-face meeting with the pharmacist and the patient's primary care provider (PCP). In a prospective transitions of care group (n = 74), outcomes of patients such as acute health care utilization (an emergency department visit or an inpatient readmission, within 30 days post discharge), clinic quality indicators, and identification and resolution of MRPs were compared to a retrospective control group (n = 87) who received the standard of care. Utilization of acute health care services was significantly lower in the prospective group compared to the retrospective control group (23% vs 41.4%; P = .013). A total of 49 MRPs were discovered in patients who received the TCS. Pharmacists play an integral role in improving the transitions of care to reduce acute health care utilization. In addition, they may improve care transitions by optimizing clinic quality indicators and by identifying and resolving MRPs.

  6. Primary Caregivers Satisfaction and its Related Factors in Home Health Care Services

    Directory of Open Access Journals (Sweden)

    Shu-Ping Wei

    2011-06-01

    Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.”

  7. A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service.

    Science.gov (United States)

    Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia

    2014-05-01

    Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. © 2014 The Authors. Health and Social Care in the Community published by John

  8. Home Visit Services Provided for Elderly Dwellers in Isfahan Province: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Zamane Vafaei

    2015-06-01

    Conclusion: As the home visit services might be effective for providing health care for the aged people and increasing their quality of life, policymaking to spread these services seems to be crucial especially for Iran.

  9. Regional variations in the use of home care services in Ontario, 1993/95

    OpenAIRE

    Coyte, P C; Young, W

    1999-01-01

    BACKGROUND: Although regional variations in the use of many health care services have been reported, little attention has been devoted to home care practices. Given the dramatic shift in care settings from hospitals to private homes, it is important to determine the extent to which home care practices vary by geographic region. METHODS: Data from the Canadian Institute for Health Information and the Ontario Home Care Administration System database were used to assess regional variations in ra...

  10. Extended architecture for home base stations with multimedia services

    NARCIS (Netherlands)

    Voicu, A.; Jarnikov, D.S.

    2011-01-01

    This paper describes the use of mobile access points (home node base stations, femtocells) for providing TV streaming to mobile devices inside the home. The research is focused on finding commonalities between architectures of the home node base station for different technologies. The result is a

  11. Training and in-service training of home economics extension ...

    African Journals Online (AJOL)

    Home economics is traditionally a femaledominated profession. Home economists employed in the KwaZulu-Natal agricultural and rural development extension delivery system are mainly responsible for serving a predominantly female clientele, namely rural women. These home economists focus on women's domestic ...

  12. Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees.

    Science.gov (United States)

    Li, Qijuan; Keohane, Laura M; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N

    2017-07-01

    Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. To determine the association of home health copayments with use of home health services. A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Introduction of copayments for home health care between 2007 and 2011. Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

  13. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

    Science.gov (United States)

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

    2007-01-01

    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  14. Literature Review of the Evidence Base for a Hospice at Home Service

    OpenAIRE

    Stosz, Laura

    2008-01-01

    This literature review aimed to identify the evidence base for a hospice at home service at the end of life for facilitating death at home to narrow the gap between preference and reality. This study defines ‘hospice at home’ as hospice style care provided in the home environment; this means specialist palliative care, equipment and medication is available 24/7. However, services operating under this term are not uniform across the literature. Terms encountered in the literature that are used...

  15. The Influence Of Business Partnership And Competitive Strategy On Business Performance Of Recreation Park Services Industry In West Java Indonesia

    Directory of Open Access Journals (Sweden)

    Kurniawan

    2015-08-01

    Full Text Available Recreational parks services industry in West Java have problems due to low business performance caused by the difficulty of companies to compete whereas tourism services right now are yet offered unique characteristics products due to the product is relatively similar with competitors. Based on that background the research aims to obtain a study on the influence of business partnerships and competitive strategy on business performance in recreation park service industries in West Java. Research conducted using an explanatory survey. In this study the target population is a company incorporated in the tourism service industry in West Java. Time horizon is a cross-sectional which research is done in one time simultaneously. The data analyzed through verification. Hypothesis is tested using partial least square PLS. The research findings reveal that there is a simultaneous and partial influence of business partnerships and competitive strategy on business performance. The influence of competitive strategy is more dominant than business partnership in improving business performance the rest influenced by other factors not examined in this study. Based on that it would need to the management of recreation park services companies in West Java to increase the competitive strategy as the first priority in efforts to improve business performance.

  16. Carer preferences for home support services in later stage dementia.

    Science.gov (United States)

    Kampanellou, Eleni; Chester, Helen; Davies, Linda; Davies, Sue; Giebel, Clarissa; Hughes, Jane; Challis, David; Clarkson, Paul

    2017-11-01

    To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia. Preferences from 100 carers, recruited through carers' organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support 'package'. The most preferred attributes were 'respite care, available regularly to fit your needs' (coefficient 1.29, p = home care provided regularly for as long as needed' (coefficient 0.93, p = home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.

  17. Rehabilitation services after the implementation of the nursing home prospective payment system: differences related to patient and nursing home characteristics.

    Science.gov (United States)

    Murray, Patrick K; Love, Thomas E; Dawson, Neal V; Thomas, Charles L; Cebul, Randall D

    2005-11-01

    The prospective payment system (PPS) for nursing homes was designed to curtail the rapid expansion of Medicare costs for skilled nursing care. This study examines the changes that occurred in nursing home patients and rehabilitation services following the PPS. Free-standing Medicare and/or Medicaid certified nursing homes in Ohio. The percent of new admissions receiving therapy and the amount of rehabilitation therapy provided. A total of 7006 first admissions in 1994-6 (pre-PPS) and 61,569 first admissions in 2000-1 (post-PPS). A logistic model predicting likelihood of rehabilitation was developed and validated in pre-PPS admissions and applied to the post-PPS patients. Rehabilitation services were compared in the pre-PPS and post-PPS cohorts overall, stratified by quintile of predicted score, diagnosis group, and by nursing home profit status. Post-PPS patients had less cognitive impairment, more depression, and more family support. The amount of rehabilitation services declined the most in the higher quintiles of predicted likelihood of rehabilitation and among patients with stroke. The percent of patients receiving rehabilitation services increased the most in the lowest quintile and among patients with medical conditions. These changes were greater in for-profit nursing homes. The implementation of the PPS in nursing homes has been associated with a decrease in the amount of rehabilitation services, targeted at those predicted to receive higher amounts and an increased frequency of providing services targeted at those predicted to be less likely to receive them. The outcomes of the changes deserve further study.

  18. 75 FR 3488 - Notice of Public Meetings for the National Park Service Alaska Region's Subsistence Resource...

    Science.gov (United States)

    2010-01-21

    ... held on Saturday, February 20, 2010, from 7 p.m. to 8:30 p.m. and Sunday, February 21, 2010, from 9 a.m... Clarence Summers, Subsistence Manager, Tel. (907) 644-3603. The proposed meeting agenda for each meeting... Agenda. 6. Status of SRC Membership. 7. SRC Member Reports. 8. Park Subsistence Manager's Report. 9. Park...

  19. 76 FR 1458 - Public Meeting for the National Park Service Alaska Region's Subsistence Resource Commission (SRC...

    Science.gov (United States)

    2011-01-10

    ... Plan Update. c. Subsistence Uses of Horns, Antlers, Bones and Plants EA Update. 13. New Business. 14... guarantee that we will be able to do so. Wrangell-St. Elias National Park SRC Meeting Date and Location: The... if all business is completed. For Further Information on the Gates of the Arctic National Park SRC...

  20. The relationship between older Americans act in-home services and low-care residents in nursing homes.

    Science.gov (United States)

    Thomas, Kali S

    2014-03-01

    The aim of the study was to investigate the relationship between supportive services provided under Title III-B of the Older Americans Act (OAA) and the prevalence of low-care residents in nursing homes (NHs). State Program Reports (state-level expenditure and utilization data for each OAA service) and NH facility-level data were analyzed using a two-way fixed effects model. Results suggest that every additional 1% of the population age 65+ that receives personal care services is associated with a 0.8% decrease in the proportion of low-care residents in NHs. Despite efforts to rebalance long-term care, there are still many NH residents who have the functional capacity to live in a less restrictive environment. This is among the first studies to suggest that states that have invested in their in-home supportive services, particularly personal care services provided through the OAA, have proportionally fewer of these people.

  1. The influence of a mental health home visit service partnership intervention on the caregivers' home visit service satisfaction and care burden.

    Science.gov (United States)

    Cheng, Jui-Fen; Huang, Xuan-Yi; Lin, Mei-Jue; Wang, Ya-Hui; Yeh, Tzu-Pei

    2018-02-01

    To investigate a community-based and hospital-based home visit partnership intervention in improving caregivers' satisfaction with home service and reducing caregiver burden. The community-oriented mental healthcare model prevails internationally. After patients return to the community, family caregivers are the patients' main support system and they also take the most of the burden of caring for patients. It is important to assist these caregivers by building good community healthcare models. A longitudinal quasi-experimental quantitative design. The experimental group (n = 109) involved "partnership" intervention, and the control group (n = 101) maintained routine home visits. The results were measured before the intervention, 6 and 12 months after the partnership intervention. Six months after the partnership intervention, the satisfaction of the experimental group was higher than the control group for several aspects of care. Although the care burden was reduced in the experimental group, there was no significant difference between the two groups. This study confirms that the partnership intervention can significantly improve caregiver satisfaction with home services, without reducing the care burden. The community-based and hospital-based mental health home visit service partnership programme could improve the main caregiver's satisfaction with the mental health home visit services, while the reduction in care burden may need government policies for the provision of more individual and comprehensive assistance. © 2017 John Wiley & Sons Ltd.

  2. Home health nursing care services in Greece during an economic crisis.

    Science.gov (United States)

    Adamakidou, T; Kalokerinou-Anagnostopoulou, A

    2017-03-01

    The purpose of this review was to describe public home healthcare nursing services in Greece. The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided. © 2016 International Council of Nurses.

  3. Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

    Science.gov (United States)

    Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

    2013-01-01

    ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

  4. Place of death among older Americans: does state spending on home- and community-based services promote home death?

    Science.gov (United States)

    Muramatsu, Naoko; Hoyem, Ruby L; Yin, Hongjun; Campbell, Richard T

    2008-08-01

    The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

  5. Use of mental health services by nursing home residents after hurricanes.

    Science.gov (United States)

    Brown, Lisa M; Hyer, Kathryn; Schinka, John A; Mando, Ahed; Frazier, Darvis; Polivka-West, Lumarie

    2010-01-01

    A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.

  6. Can home care services achieve cost savings in long-term care for older people?

    Science.gov (United States)

    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  7. Scenario Planning Provides a Framework for Climate Change Adaptation in the National Park Service

    Science.gov (United States)

    Welling, L. A.

    2012-12-01

    Resource management decisions must be based on future expectations. Abundant evidence suggests climate change will have highly consequential effects on the Nation's natural and cultural resources, but specific impacts are difficult to accurately predict. This situation of too much information but not enough specificity can often lead to either paralysis or denial for decision makers. Scenario planning is an emerging tool for climate change adaptation that provides a structured framework for identifying and exploring critical drivers of change and their uncertain outcomes. Since 2007, the National Park Service (NPS) has been working with its partners to develop and apply a scenario-based approach for adaptation planning that integrates quantitative, model-driven, climate change projections with qualitative, participatory exercises to explore management and policy options under a range of future conditions. Major outcomes of this work are (1) increased understanding of key scientific results and uncertainties, (2) incorporation of alternative perspectives into park and landscape level planning, (3) identification of "no brainer" and "no gainer" actions, (4) strengthening of regional science-management partnerships, and (5) overall improved capacity for flexible decision making. The basic approach employed by NPS for scenario planning follows a typical adaptive management process: define the focal question, assess the relevant science, explore plausible futures, identify effective strategies, prioritize and implement actions, and monitor results. Many science and management partners contributed to the process, including NOAA Regional Integrated Science and Assessment teams (RISAs) and Regional Climate Centers (RCCs), USGS Research Centers, and other university and government scientists. The Global Business Network, an internationally recognized leader in scenario development, provided expert facilitation and training techniques. Climate science input is provided

  8. Provision of NHS generalist and specialist services to care homes in England: review of surveys.

    Science.gov (United States)

    Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

    2016-03-01

    The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

  9. An evaluation of the implementation of integrated community home-based care services in Vhembe District, South Africa

    Directory of Open Access Journals (Sweden)

    Gandi J Moetlo

    2011-01-01

    Conclusion: Community home-based caregivers are largely able to implement home-based care services but would need more support (training, financial, career structure, and health system to improve on their services.

  10. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    Science.gov (United States)

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. © 2016 Royal College of Physicians.

  11. Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

    Science.gov (United States)

    Armstrong, Joshua J; Sims-Gould, Joanie; Stolee, Paul

    Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.

  12. The exhausting dilemmas faced by home-care service providers when enhancing participation among older adults receiving home care.

    Science.gov (United States)

    Vik, Kjersti; Eide, Arne H

    2012-09-01

    Older adults wish to stay at home, participate in society and manage on their own as long as possible. Many older adults will, however, eventually become dependent on care and help to maintain their daily living. Thus, to enhance activity and participation also among older adults that receive home-based services, there is a strong need for development of knowledge-based practice regarding participation. The specific aim of this study is to explore how service providers perceive that their working conditions influence on their possibilities to promote participation among older adults, and more specifically, how they perceive the influence of their working conditions. A purposeful sampling strategy was applied, and six focus groups with professionals in two municipalities were conducted. The focus groups comprised four and six participants of varying ages, length of working experience and professions. A total of 30 service providers participated. The data were analysed by a constant comparative method following the guidelines from Grounded Theory. The analysis identified the categories 'encountering needs that cannot be met', 'expectations about participation', 'organisation of services' and 'professional standards' influencing the service delivery. During this analytical process, 'being on the verge' emerged as a core category that describes the service providers' experience of a stressful workday, i.e. when they had the feeling of working against their own professional standards and being pushed to their limits. The findings indicate how the professional standards of service providers on the whole are in line with health policy for in-home services. Policy objectives are, however, not always followed owing to different constraints at the level of service delivery. Along the path from political ideals to the practical execution of services, external circumstances related to the organisation of services are perceived as crucial. © 2012 The Authors. Scandinavian

  13. Willingness to Pay for Home-Based Rehabilitation Service Among Older Adults.

    Science.gov (United States)

    Li, Xuemei; Wan, Xia; Pang, Yajuan; Zhou, Lanshu

    2018-06-18

    This study aims to investigate the willingness to pay (WTP) for a home-based rehabilitation service and explore the influencing factors of WTP among older adults in Shanghai, China. A cross-sectional design was used. A questionnaire survey based on the contingent valuation method was conducted by face-to-face survey over 3 months. Only 242 (44%) participants were willing to pay for a home-based rehabilitation service. The median amount they were willing to pay was RMB 8 (US$1.15) per visit. Older adults who had higher monthly income, had at least one partner who worked, and had medical insurance were willing to pay more for the service. Older adults showed low WTP for a home-based rehabilitation service. Economic status and health condition are the significant influencing factors of WTP. Studies on recipients' precise needs and ability to pay are required before home-based services are implemented.

  14. 76 FR 21404 - National Park Service Alaska Region's Subsistence Resource Commission (SRC) Program

    Science.gov (United States)

    2011-04-15

    ... National Park SRC will meet at the Shungnak Public School, 907-437-2151, in Shungnak, Alaska on Wednesday... changed, a notice will be published in local newspapers and announced on local radio stations prior to the...

  15. 42 CFR 403.764 - Basis and purpose of religious nonmedical health care institutions providing home service.

    Science.gov (United States)

    2010-10-01

    ... care institutions providing home service. 403.764 Section 403.764 Public Health CENTERS FOR MEDICARE... Basis and purpose of religious nonmedical health care institutions providing home service. (a) Basis... and 1878 of the Act regarding Medicare payment for items and services provided in the home setting...

  16. 78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

    Science.gov (United States)

    2013-11-14

    ... providers of home health services and hospice care. The preamble of that final rule stated the effective... 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and...

  17. Agency ownership, patient payment source, and length of service in home care, 1992 2000.

    Science.gov (United States)

    Han, Beth; McAuley, William J; Remsburg, Robin E

    2007-08-01

    Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. We examined length of service among 37,364 home care patients using the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys. We used Kaplan-Meier methods and Cox regression models. After we adjusted for patient and agency characteristics, our results revealed that agency ownership was not associated with length of service for patients with private insurance, Medicare, Medicaid, Medicare plus Medicaid, or Medicare plus private insurance. This finding was consistent from 1992 through 2000. Length of service among patients with Medicare decreased significantly from 1998 through 2000, but length of service among patients with Medicaid did not change significantly from 1992 through 2000. Agency ownership is not associated with patient length of service in home care. Regardless of the policy changes in the home care arena in the 1990s, for-profit and not-for-profit home health agencies behaved similarly with regard to length of service among patients within differently structured payment systems.

  18. Home Garden Ecosystem Services Valuation through a Gender Lens: A Case Study in the Catalan Pyrenees

    Directory of Open Access Journals (Sweden)

    Laura Calvet-Mir

    2016-07-01

    Full Text Available Ecosystem services have become a critical issue in the environmental literature, however knowledge on whether women and men similarly value ecosystem services is still nascent. We aim at advancing the understanding of the relation between gender and environmental perceptions through the analysis of values assigned by women and men to ecosystem services supplied by home gardens in Vall Fosca (Catalan Pyrenees, north-eastern Spain. We found that women give a higher value than men to all ecosystem services. Overall, women’s valuation of the full range of ecosystem services provided by home gardens was 7.55% higher than men’s valuation. Gender socialization influences the way people interact with and value the environment, including highly managed environments such as home gardens. We argue that considering gendered differences in ecosystem services valuation may lead to policies more effective in enhancing ecosystem services provision.

  19. The Association between Freedom of Choice and Effectiveness of Home Care Services.

    Science.gov (United States)

    Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

    2016-03-31

    The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

  20. Potential and challenges in home care service process optimization : a route optimization approach

    OpenAIRE

    Nakari, Pentti J. E.

    2016-01-01

    Aging of the population is an increasing problem in many countries, including Finland, and it poses a challenge to public services such as home care. Vehicle routing optimization (VRP) type optimization solutions are one possible way to decrease the time required for planning home visits and driving to customer addresses, as well as decreasing transportation costs. Although VRP optimization is widely and succesfully applied to commercial and industrial logistics, the home care ...

  1. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

    Science.gov (United States)

    Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming

    2017-01-01

    The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  2. Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

    Directory of Open Access Journals (Sweden)

    Chia-Ching Chen

    2017-11-01

    Full Text Available ObjectivesThe purposes of this study are: (1 to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC service use; (2 to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3 to investigate health outcome disparity based on substitutability.Methodology and dataThe methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR, which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly.ResultsThere exists a complement relationship between the informal home care (IHC and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services.ConclusionPolicy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

  3. Case-mix reimbursement for nursing home services: Simulation approach

    Science.gov (United States)

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  4. Case-mix reimbursement for nursing home services: simulation approach.

    Science.gov (United States)

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  5. Home care services for sick children: Healthcare professionals' conceptions of challenges and facilitators.

    Science.gov (United States)

    Castor, Charlotte; Hallström, Inger; Hansson, Helena; Landgren, Kajsa

    2017-09-01

    To explore healthcare professionals' conceptions of caring for sick children in home care services. Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised as challenging for healthcare professionals in home care services used to providing care predominately for adults. An inductive qualitative design. Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise using a phenomenographic analysis. Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges such as feelings of inadequacy and fear and professional growth such as increased competence and satisfaction. Conceptions of whether the home or the hospital was the best place for care differed. Adapting to the child's care was conceived as important. Cooperation with paediatric departments and a well-functioning team work were important organisational aspects. Providing home care for children was a challenging but rewarding task for healthcare professionals used to care for adults. To provide care with a child perspective was experienced as important even though there were conflicting conceptions of how this should be done. Close cooperation with paediatric departments and teamwork were prerequisites that make up for the low number of paediatric patients and facilitate confidence and competence. A sufficient number of referred children and enabling healthcare professionals to be part of the re-organising and implementation processes might facilitate the home care services for sick children. Enough time and good teamwork must be emphasised. Early referrals, continuous cooperation with paediatric clinics complemented with

  6. [The admission to Nursing Homes and Home care services of elderly patients: analysis of the trend from 2008 to 2011 in a North Italian district].

    Science.gov (United States)

    Caporale, Loretta; Czaplejewicz, Monika; Odasmini, Bruna

    2014-01-01

    The effects of the economic crisis impact on several aspects, included the use of health and social services. To analyze the effects of the economic recession on the request of in-home and long run social-health services. Retrospective research. The databases of a In-home Nursing Service, the Social Services and the Welfare area of a Social-Health Local Service in North of Italy have been consulted, with reference to the period between 31st December 2008 to 31st December 2011. From 2008 to 2011 the users supported by the In-Home Nursing Service increased by 30.3% while a decrease in the waiting lists for public and private nursing homes was observed. The users of In-Home Assistance Service decreased by 11%, as well as recipients of In-Home Meal Service (33%). Since 2008, the number of regional economic allowance beneficiaries dramatically increased; these allowances are dispensed as a support to In-Home Nursing Service and to social frailty. Profound changes of the offer and use of long term care services is evident. The endurance of this trend could impair the In-Home Nursing Services ability to answer to health needs of citizens. Health care professionals should strengthen the educational interventions to improve the level of patients'self care.

  7. Pediatric Tape: Accuracy and Medication Delivery in the National Park Service

    Directory of Open Access Journals (Sweden)

    Danielle D. Campagne

    2015-10-01

    Full Text Available Introduction: The objective is to evaluate the accuracy of medication dosing and the time to medication administration in the prehospital setting using a novel length-based pediatric emergency resuscitation tape. Methods: This study was a two-period, two-treatment crossover trial using simulated pediatric patients in the prehospital setting. Each participant was presented with two emergent scenarios; participants were randomized to which case they encountered first, and to which case used the National Park Service (NPS emergency medical services (EMS length-based pediatric emergency resuscitation tape. In the control (without tape case, providers used standard methods to determine medication dosing (e.g. asking parents to estimate the patient’s weight; in the intervention (with tape case, they used the NPS EMS length-based pediatric emergency resuscitation tape. Each scenario required dosing two medications (Case 1 [febrile seizure] required midazolam and acetaminophen; Case 2 [anaphylactic reaction] required epinephrine and diphenhydramine. Twenty NPS EMS providers, trained at the Parkmedic/Advanced Emergency Medical Technician level, served as study participants. Results: The only medication errors that occurred were in the control (no tape group (without tape: 5 vs. with tape: 0, p=0.024. Time to determination of medication dose was significantly shorter in the intervention (with tape group than the control (without tape group, for three of the four medications used. In case 1, time to both midazolam and acetaminophen was significantly faster in the intervention (with tape group (midazolam: 8.3 vs. 28.9 seconds, p=0.005; acetaminophen: 28.6 seconds vs. 50.6 seconds, p=0.036. In case 2, time to epinephrine did not differ (23.3 seconds vs. 22.9 seconds, p=0.96, while time to diphenhydramine was significantly shorter in the intervention (with tape group (13 seconds vs. 37.5 seconds, p<0.05. Conclusion: Use of a length-based pediatric emergency

  8. Energy intensity and greenhouse gas emission of a purchase in the retail park service sector: An integrative approach

    International Nuclear Information System (INIS)

    Farreny, Ramon; Gabarrell, Xavier; Rieradevall, Joan

    2008-01-01

    The aim of this paper is to describe the energetic metabolism of a retail park service system under an integrative approach. Energy flow accounting was applied to a case study retail park in Spain, representative of the sector across Europe, after redefining the functional unit to account for both direct energy use (buildings, gardens and outdoor lighting) and indirect energy use (employee and customer transportation). A life cycle assessment (LCA) was then undertaken to determine energy global warming potential (GWP) and some energy intensity and greenhouse gases (GHG) emission indicators were defined and applied. The results emphasise the importance of service systems in global warming policies, as a potential emission of 9.26 kg CO 2 /purchase was obtained for the case study, relating to a consumption of 1.64 KOE of energy, of which 21.9% was spent on buildings and 57.9% on customer transportation. Some strategies to reduce these emissions were considered: increased supply, energy efficiency, changes in distribution of modes of transport, changes in location and changes in the mix of land uses. A combination of all of these elements in a new retail park could reduce GHG emissions by more than 50%, as it is planning strategies, which seem to be the most effective. (author)

  9. The acoustic climate at the rest and service areas – parking lots by the Silesian section of A4 motorway

    Directory of Open Access Journals (Sweden)

    Robert WIESZAŁA

    2012-01-01

    Full Text Available The aim of this article is to describe the state of the acoustic climate at the rest and service areas (MOPs situated by A4 motorway in Silesia The analysis includes the research results conducted at these parking lots from May till August 2010. The research was conducted with the digital noise meter, which was connected with the computer during measurement. The research results indicate the essential differences in the noise intensity between the particular rest and service area reaching up to 12 dB(A, in spite of the similar value of the traffic noise in all of the places where the research was conducted. It was assumed that the level of noise on each of the parking lots should be similar to standing norms for the recreation areas i.e. below 55 dB(A. The research conducted at 4 MOPs indicated that only at two of them, MOP Halemba and Wirek, these norms are fulfilled. The lack of the proper anti-noise protection in the form of the sound absorbing screens at the parking lots situated by the motorway causes the situation in which the level of noise at the places devoted to rest highly decreases the possibility to relax before the next stage of a journey.

  10. Volcanism in national parks: summary of the workshop convened by the U.S. Geological Survey and National Park Service, 26-29 September 2000, Redding, California

    Science.gov (United States)

    Guffanti, Marianne; Brantley, Steven R.; McClelland, Lindsay

    2001-01-01

    Spectacular volcanic scenery and features were the inspiration for creating many of our national parks and monuments and continue to enhance the visitor experience today (Table 1). At the same time, several of these parks include active and potentially active volcanoes that could pose serious hazards - earthquakes, mudflows, and hydrothermal explosions, as well as eruptions - events that would profoundly affect park visitors, employees, and infrastructure. Although most parks are in relatively remote areas, those with high visitation have daily populations during the peak season equivalent to those of moderate-sized cities. For example, Yellowstone and Grand Teton national parks can have a combined daily population of 80,000 during the summer, with total annual visitation of 7 million. Nearly 3 million people enter Hawai`i Volcanoes National Park every year, where the on-going (since 1983) eruption of Kilauea presents the challenge of keeping visitors out of harm's way while still allowing them to enjoy the volcano's spellbinding activity.

  11. A generic service interfacing approach for home networking

    NARCIS (Netherlands)

    Chen, S.; Lukkien, J.J.; Bosman, R.P.; Verhoeven, R.

    2010-01-01

    This paper presents a generic service interfacing approach which enables the interoperability of networked devices and the reusability of services. Services are specified through a set of interfaces which are language and deployment platform independent. External service orchestration is applied to

  12. Socioeconomic disparities in home health care service access and utilization: a scoping review.

    Science.gov (United States)

    Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie

    2012-10-01

    Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage

  13. Why Hospitals and Payers are Recommending Home Care Upon Discharge Instead of SNF or Traditional Home Health Services--Alternative Payment Model Hospital Incentives Aligning with Patient Choice.

    Science.gov (United States)

    Luke, Josh

    2016-01-01

    Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely non-medical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.

  14. A cost-constrained model of strategic service quality emphasis in nursing homes.

    Science.gov (United States)

    Davis, M A; Provan, K G

    1996-02-01

    This study employed structural equation modeling to test the relationship between three aspects of the environmental context of nursing homes; Medicaid dependence, ownership status, and market demand, and two basic strategic orientations: low cost and differentiation based on service quality emphasis. Hypotheses were proposed and tested against data collected from a sample of nursing homes operating in a single state. Because of the overwhelming importance of cost control in the nursing home industry, a cost constrained strategy perspective was supported. Specifically, while the three contextual variables had no direct effect on service quality emphasis, the entire model was supported when cost control orientation was introduced as a mediating variable.

  15. Design Of Toyota Home Service Applications For AUTO2000 Based On Android

    OpenAIRE

    Aswin, Arief Rahmadian

    2016-01-01

    AUTO2000 is a network of sales services, maintenance, repair and supply of spare parts Toyota that was established in 1975 under the name Astra Motor Sales, in 1989 changed its name to AUTO2000 with management that has been handled entirely by PT. Astra International Tbk. Services provided by AUTO2000 one of which is a service of Toyota Home Service, a service provided by the service vehicle Auto 2000 where customers can service their vehicles without having to come to the dealership Auto 200...

  16. Services Inside the Smart Home : A Simulation and Visualization Tool

    NARCIS (Netherlands)

    Lazovik, E.; Dulk, P. den; Groote, M. de; Lazovik, A.; Aiello, M.; Baresi, L; Chi, CH; Suzuki, J

    2009-01-01

    Pervasive systems, and domotics in particular, is an application area where heterogeneity is the norm: with thousands of autonomous heterogeneous devices live together and need to interoperate. One of the greatest difficulties in developing middleware for smart homes is that this kind of systems are

  17. Home/community-based services: a two-tier approach.

    Science.gov (United States)

    Aponte, H J; Zarski, J J; Bixenstine, C; Cibik, P

    1991-07-01

    A two-tier model for work with high-risk families is presented. It combines multiple-family groups in the community with home-based family therapy for individual families. The ecostructural conceptual framework of the model is discussed, and its application is illustrated by a case vignette.

  18. 76 FR 62090 - Public Meeting for the National Park Service (NPS) Alaska Region's Subsistence Resource...

    Science.gov (United States)

    2011-10-06

    ...' Workshop. 12. New Business. a. Gates of the Arctic National Park SRC Draft Hunting Plan Recommendation 10... location are changed, a notice will be published in local newspapers and announced on local radio stations prior to the meeting date. SRC meeting locations and dates may need to be changed based on inclement...

  19. 77 FR 30320 - National Park Service Alaska Region's Subsistence Resource Commission

    Science.gov (United States)

    2012-05-22

    ... Introductions 3. Administrative Announcements 4. Old Business a. SRC Hunting Plan Recommendations (HP 10-01) b... Date and Location: The Gates of the Arctic National Park SRC teleconference meeting will be held on Tuesday, June 19, 2012, from 1 p.m. to 4 p.m. or until business is completed at the Gates of the Arctic...

  20. Developing and utilising a new funding model for home-care services in New Zealand.

    Science.gov (United States)

    Parsons, Matthew; Rouse, Paul; Sajtos, Laszlo; Harrison, Julie; Parsons, John; Gestro, Lisa

    2018-05-01

    Worldwide increases in the numbers of older people alongside an accompanying international policy incentive to support ageing-in-place have focussed the importance of home-care services as an alternative to institutionalisation. Despite this, funding models that facilitate a responsive, flexible approach are lacking. Casemix provides one solution, but the transition from the well-established hospital system to community has been problematic. This research seeks to develop a Casemix funding solution for home-care services through meaningful client profile groups and supporting pathways. Unique assessments from 3,135 older people were collected from two health board regions in 2012. Of these, 1,009 arose from older people with non-complex needs using the interRAI-Contact Assessment (CA) and 2,126 from the interRAI-Home-Care (HC) from older people with complex needs. Home-care service hours were collected for 3 months following each assessment and the mean weekly hours were calculated. Data were analysed using a decision tree analysis, whereby mean hours of weekly home-care was the dependent variable with responses from the assessment tools, the independent variables. A total of three main groups were developed from the interRAI-CA, each one further classified into "stable" or "flexible." The classification explained 16% of formal home-care service hour variability. Analysis of the interRAI-HC generated 33 clusters, organised through eight disability "sub" groups and five "lead" groups. The groupings explained 24% of formal home-care services hour variance. Adopting a Casemix system within home-care services can facilitate a more appropriate response to the changing needs of older people. © 2017 John Wiley & Sons Ltd.

  1. Home delivery of medication - the role of a patient information leaflet on maximising service uptake.

    Science.gov (United States)

    Watson, L; Ahmed, N; Mccall, H; Minton, J; Benn, P; Edwards, S; Waters, L

    2014-12-01

    There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences

    Directory of Open Access Journals (Sweden)

    Dale B

    2013-10-01

    Full Text Available Bjørg Dale,1 Sigrun Hvalvik21Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 2Centre for Caring Research – Southern Norway, Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes.Methods: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach.Results: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional

  3. Home

    Science.gov (United States)

    Military Commission Seal VWAP Login Home Go ABOUT US Organization Overview Organizational Chart Families VWAP Login CCTV Sites Travel Media MC News CCTV Sites Travel Today at OMC Home Today at OMC Daily

  4. Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.

    Science.gov (United States)

    Walus, Ashley N; Woloschuk, Donna M M

    2017-01-01

    Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research

  5. Simple & Secure: Attitude and behaviour towards security and usability in internet products and services at home

    NARCIS (Netherlands)

    Wolthuis, R.; Broenink, E.G.; Fransen, F.; Schultz, S.; Vries, A. de

    2010-01-01

    This paper is the result of research on the security perception of users in ICT services and equipment. We analyze the rationale of users to have an interest in security and to decide to change security parameters of equipment and services. We focus on the home environment, where more and more

  6. Agency Ownership, Patient Payment Source, and Length of Service in Home Care, 1992-2000

    Science.gov (United States)

    Han, Beth; McAuley, William J.; Remsburg, Robin E.

    2007-01-01

    Purpose: Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. Design and Methods: We examined length of…

  7. RoboCup@Home Scientific Competition and Benchmarking for Domestic Service Robots

    NARCIS (Netherlands)

    Wisspeintner, Thomas; van der Zant, Tijn; Iocchi, Luca; Schiffer, Stefan

    2009-01-01

    Being part of the RoboCup initiative, the ROBOCUP@HOME league targets the development and deployment of autonomous service and assistive robot technology being essential for future personal domestic applications. The domain of domestic service and assistive robotics implicates a wide range of

  8. 42 CFR 440.180 - Home or community-based services.

    Science.gov (United States)

    2010-10-01

    ...) If the recipients are compensated, they are compensated at less than 50 percent of the minimum wage... or above the minimum wage is unlikely and who, because of their disabilities, need intensive ongoing... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.180 Home or...

  9. Physical activity levels of older adults receiving a home care service.

    Science.gov (United States)

    Burton, Elissa; Lewin, Gill; Boldy, Duncan

    2013-04-01

    The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.

  10. Transformation by stealth: the retargeting of home care services in Finland.

    Science.gov (United States)

    Kröger, Teppo; Leinonen, Anu

    2012-05-01

    This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth. © 2011 Blackwell Publishing Ltd.

  11. Experiences of the home-dwelling elderly in the use of telecare in home care services: a qualitative systematic review protocol.

    Science.gov (United States)

    Karlsen, Cecilie; Ludvigsen, Mette S; Moe, Carl E; Haraldstad, Kristin; Thygesen, Elin

    2017-05-01

    The objective of this systematic review is to identify and synthesize the best evidence on the home-dwelling elderly's experiences with the use of telecare in home care services. Furthermore, the study will identify experiences with telecare devices and examine what beliefs the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place.Review question 1: How do the home-dwelling elderly experience the use of telecare in the context of home care services?Review question 2: How do the home-dwelling elderly experience telecare devices?Review question 3: What beliefs do the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place?

  12. Development and Psychometric Testing of a Novel Food Service Satisfaction Questionnaire for Food Service Staff of Aged Care Homes.

    Science.gov (United States)

    Miller, M; Hamilton, J; Scupham, R; Matwiejczyk, L; Prichard, I; Farrer, O; Yaxley, A

    2018-01-01

    Food service staff are integral to delivery of quality food in aged care homes yet measurement of their satisfaction is unable to be performed due to an absence of a valid and reliable questionnaire. The aim of this study was to develop and perform psychometric testing for a new Food Service Satisfaction Questionnaire developed in Australia specifically for use by food service staff working in residential aged care homes (Flinders FSSQFSAC). A mixed methods design utilizing both a qualitative (in-depth interviews, focus groups) and a quantitative approach (cross sectional survey) was used. Content validity was determined from focus groups and interviews with food service staff currently working in aged care homes, related questionnaires from the literature and consultation with an expert panel. The questionnaire was tested for construct validity and internal consistency using data from food service staff currently working in aged care homes that responded to an electronic invitation circulated to Australian aged care homes using a national database of email addresses. Construct validity was tested via principle components analysis and internal consistency through Cronbach's alpha. Temporal stability of the questionnaire was determined from food service staff undertaking the Flinders FSSQFSAC on two occasions, two weeks apart, and analysed using Pearson's correlations. Content validity for the Flinders FSSQFSAC was established from a panel of experts and stakeholders. Principle components analysis revealed food service staff satisfaction was represented by 61-items divided into eight domains: job satisfaction (α=0.832), food quality (α=0.871), staff training (α=0.922), consultation (α=0.840), eating environment (α=0.777), reliability (α=0.695), family expectations (α=0.781) and resident relationships (α=0.429), establishing construct validity in all domains, and internal consistency in all (α>0.5) except for "resident relationships" (α=0.429). Test

  13. Adaptive software architecture based on confident HCI for the deployment of sensitive services in Smart Homes.

    Science.gov (United States)

    Vega-Barbas, Mario; Pau, Iván; Martín-Ruiz, María Luisa; Seoane, Fernando

    2015-03-25

    Smart spaces foster the development of natural and appropriate forms of human-computer interaction by taking advantage of home customization. The interaction potential of the Smart Home, which is a special type of smart space, is of particular interest in fields in which the acceptance of new technologies is limited and restrictive. The integration of smart home design patterns with sensitive solutions can increase user acceptance. In this paper, we present the main challenges that have been identified in the literature for the successful deployment of sensitive services (e.g., telemedicine and assistive services) in smart spaces and a software architecture that models the functionalities of a Smart Home platform that are required to maintain and support such sensitive services. This architecture emphasizes user interaction as a key concept to facilitate the acceptance of sensitive services by end-users and utilizes activity theory to support its innovative design. The application of activity theory to the architecture eases the handling of novel concepts, such as understanding of the system by patients at home or the affordability of assistive services. Finally, we provide a proof-of-concept implementation of the architecture and compare the results with other architectures from the literature.

  14. Exploration of the administrative aspects of the delivery of home health care services: a qualitative study.

    Science.gov (United States)

    Shahsavari, Hooman; Nasrabadi, Alireza Nikbakht; Almasian, Mohammad; Heydari, Heshmatolah; Hazini, Abdolrahim

    2018-01-01

    Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task. The purpose of this study was to explore the administrative aspects of the delivery of home health care services. This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method. 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories. Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

  15. Effect of home care service on the quality of life in patients with gynecological cancer.

    Science.gov (United States)

    Aktas, Demet; Terzioglu, Fusun

    2015-01-01

    The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (phome care services to be efficient in improving the quality of life in patients with gynecological cancer.

  16. [Challenges for home care services in the pain management of cancer patients : A qualitative study].

    Science.gov (United States)

    Gnass, I; Krutter, S; Nestler, N

    2018-03-21

    People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

  17. Adaptive Software Architecture Based on Confident HCI for the Deployment of Sensitive Services in Smart Homes

    Science.gov (United States)

    Vega-Barbas, Mario; Pau, Iván; Martín-Ruiz, María Luisa; Seoane, Fernando

    2015-01-01

    Smart spaces foster the development of natural and appropriate forms of human-computer interaction by taking advantage of home customization. The interaction potential of the Smart Home, which is a special type of smart space, is of particular interest in fields in which the acceptance of new technologies is limited and restrictive. The integration of smart home design patterns with sensitive solutions can increase user acceptance. In this paper, we present the main challenges that have been identified in the literature for the successful deployment of sensitive services (e.g., telemedicine and assistive services) in smart spaces and a software architecture that models the functionalities of a Smart Home platform that are required to maintain and support such sensitive services. This architecture emphasizes user interaction as a key concept to facilitate the acceptance of sensitive services by end-users and utilizes activity theory to support its innovative design. The application of activity theory to the architecture eases the handling of novel concepts, such as understanding of the system by patients at home or the affordability of assistive services. Finally, we provide a proof-of-concept implementation of the architecture and compare the results with other architectures from the literature. PMID:25815449

  18. Home visits during pregnancy: consequences on pregnancy outcome, use of health services, and women's situations.

    Science.gov (United States)

    Blondel, B; Bréart, G

    1995-08-01

    This review of eight randomized controlled trials assessed two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. In both categories, pregnancy outcome was not improved when women received home visits. The summary odds ratio for preterm delivery (better integration of hospital and home services might allow a more rational use of health services for women with complications. In addition, we need to define more precisely the content of home visits providing social support. For this, further research is required on how emotional support, health education, and advice influence the health of women and infants and mother-child interactions.

  19. A systematic review of integrated working between care homes and health care services

    Science.gov (United States)

    2011-01-01

    Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

  20. Using conflict theory to explore the role of nursing home social workers in home- and community-based service utilization.

    Science.gov (United States)

    Fogler, Sarah

    2009-11-01

    Nursing home social work (NHSW) practitioners are central to home- and community-based service (HCBS) utilization. They assist residents with long-term care (LTC) decision-making and coordinate community-based LTC supports and services for older adults transitioning back into the community after a rehabilitative nursing home (NH) stay. As members of multiple groups, they must simultaneously balance the needs of NH residents, the NH organization, and social policies related to LTC. To date, policy research on HCBS has been atheoretical in that it has not accounted for the possible inherent conflicts that adversely affect the discharge planning practices of NHSW practitioners. This article applies the Conflict Theory to (a) explore the competing interests of the NH industry and the nation's government, (b) examine the potential effect of these competing interests on the effectiveness of NHSW discharge planning practices, and (c) present a conceptual framework to further investigate the relationship between NHSW and both individual LTC outcomes and national policy initiatives aimed at increasing HCBS utilization.

  1. Technology support to a telehealth in the home service: Qualitative observations.

    Science.gov (United States)

    Taylor, Alan; Wade, Victoria; Morris, Greg; Pech, Joanne; Rechter, Stuart; Kidd, Michael; Carati, Colin

    2016-07-01

    The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery. © The Author(s) 2015.

  2. Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services.

    Science.gov (United States)

    Håland, Erna; Røsstad, Tove; Osmundsen, Tonje C

    2015-11-01

    The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services. © The Author(s) 2015.

  3. Arsenic Removal from Drinking Water by Iron Removal - U.S. EPA Demonstration Project at Big Sauk Lake Mobile Home Park in Sauk Centre, MN Final Performance Evaluation Report

    Science.gov (United States)

    This report documents the activities performed and the results obtained from the one-year arsenic removal treatment technology demonstration project at the Big Sauk Lake Mobile Home Park (BSLMHP) in Sauk Centre, MN. The objectives of the project are to evaluate (1) the effective...

  4. Models of home care services for persons with dementia: a narrative review.

    Science.gov (United States)

    Low, Lee-Fay; Fletcher, Jennifer

    2015-10-01

    Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

  5. Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

    Science.gov (United States)

    Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

    2015-01-01

    Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

  6. 42 CFR 424.22 - Requirements for home health services.

    Science.gov (United States)

    2010-10-01

    ... achieving its purpose, and necessitates a registered nurse be involved in the development, management, and evaluation of a patient's care plan, the physician will include a brief narrative describing the clinical... individual had received inpatient hospital or SNF services. (2) Timing and signature. The certification of...

  7. Evaluation of Integrating the Invasive Species Forecasting System to Support National Park Service Decisions on Fire Management Activities and Invasive Plant Species Control

    Science.gov (United States)

    Ma, Peter; Morisette, T.; Rodman, Ann; McClure, Craig; Pedelty, Jeff; Benson, Nate; Paintner, Kara; Most, Neal; Ullah, Asad; Cai, Weijie; hide

    2007-01-01

    The USGS and NASA, in conjunction with Colorado State University, George Mason University and other partners, have developed the Invasive Species Forecasting System (ISFS), a flexible tool that capitalizes on NASA's remote sensing resource to produce dynamic habitat maps of invasive terrestrial plant species across the United States. In 2006 ISFS was adopted to generate predictive invasive habitat maps to benefit noxious plant and fire management teams in three major National Park systems: The Greater Yellowstone Area (Yellowstone / Grand Tetons National Parks), Sequoia and Kings Canyon National Park, and interior Alaskan (between Denali, Gates of The Arctic and Yukon-Charley). One of the objectives of this study is to explore how the ISFS enhances decision support apparatus in use by National Park management teams. The first step with each park system was to work closely with park managers to select top-priority invasive species. Specific species were chosen for each study area based on management priorities, availability of observational data, and their potential for invasion after fire disturbances. Once focal species were selected, sources of presence/absence data were collected from previous surveys for each species in and around the Parks. Using logistic regression to couple presence/absence points with environmental data layers, the first round of ISFS habitat suitability maps were generated for each National Park system and presented during park visits over the summer of 2006. This first engagement provided a demonstration of what the park service can expect from ISFS and initiated the ongoing dialog on how the parks can best utilized the system to enhance their decisions related to invasive species control. During the park visits it was discovered that separate "expert opinion" maps would provide a valuable baseline to compare against the ISFS model output. Opinion maps are a means of spatially representing qualitative knowledge into a quantitative two

  8. Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

    Science.gov (United States)

    Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan P; Marquard, Jenna L; Bowles, Kathryn H

    2013-01-01

    Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home

  9. Exploring home visits in a faith community as a service-learning opportunity.

    Science.gov (United States)

    du Plessis, Emmerentia; Koen, Magdalene P; Bester, Petra

    2013-08-01

    Within South Africa the Psychiatric Nursing Science curriculum in undergraduate Baccalaureate nursing education utilizes home visits as a service-learning opportunity. In this context faith communities are currently unexplored with regards to service-learning opportunities. With limited literature available on this topic, the question was raised as to what are these students' and family members' experience of home visits within a faith community. To explore and describe nursing students' and family members' experiences of home visits within a faith community. A qualitative approach was used that was phenomenological, explorative and descriptive and contextual in nature. The research was conducted within a faith community as service learning opportunity for Baccalaureate degree nursing students. This community was situated in a semi-urban area in the North-West Province, South Africa. Eighteen (n=18) final year nursing students from different cultural representations, grouped into seven groups conducted home visits at seven (n=7) families. Comprehensive reflective reporting after the visits, namely that the students participated in a World Café data collection technique and interviews were conducted with family members. Three main themes emerged: students' initial experiences of feeling overwhelmed but later felt more competent; students' awareness of religious and cultural factors; and students' perception of their role. Two main themes from the family members emerged: experiencing caring and growth. There is mutual benefit for nursing students and family members. Students' experiences progress during home visits from feeling overwhelmed and incompetent towards a trusting relationship. Home visits in a faith community seems to be a valuable service learning opportunity, and the emotional competence, as well as spiritual and cultural awareness of nursing students should be facilitated in preparation for such home visits. Copyright © 2012 Elsevier Ltd. All rights

  10. IAServ: an intelligent home care web services platform in a cloud for aging-in-place.

    Science.gov (United States)

    Su, Chuan-Jun; Chiang, Chang-Yu

    2013-11-12

    As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients' needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.

  11. Which need characteristics influence healthcare service utilization in home care arrangements in Germany?

    Science.gov (United States)

    Dorin, Lena; Turner, Suzi C; Beckmann, Lea; große Schlarmann, Jörg; Faatz, Andreas; Metzing, Sabine; Büscher, Andreas

    2014-05-22

    We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.

  12. IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place

    Directory of Open Access Journals (Sweden)

    Chang-Yu Chiang

    2013-11-01

    Full Text Available As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.

  13. Are our homes ready for services? A domotic infrastructure based on the Web service stack

    NARCIS (Netherlands)

    Aiello, Marco; Dustdar, Schahram

    2008-01-01

    The increase in computational power and the networking abilities of home appliances are revolutionizing the way we interact with our homes. This trend is growing stronger and opening a number of technological challenges. From the point of view of distributed systems, there is a need to design

  14. Applying the International Classification of Functioning, Disability and Health to guide home health care services planning and delivery in Thailand.

    Science.gov (United States)

    Pimdee, Atipong; Nualnetr, Nomjit

    2017-01-01

    Home health care is an essential service for home-bound patients in Thailand. In this action research study, we used the International Classification of Functioning, Disability and Health (ICF) framework to modify home health care services provided by a university hospital. Staff responsible for delivering the services (physical therapist, nurses, and Thai traditional medicine practitioners) participated in the development of an ICF-based assessment tool and home health care service procedure. After an 8-month trial of implementing these changes, professional satisfaction and empowerment were high among the home health care team members. Patients and their caregivers were also satisfied with the services. In conclusion, the ICF is an effective means of guiding home health care.

  15. A Survey of Intelligent Car Parking System

    OpenAIRE

    Faheem; S.A. Mahmud; G.M. Khan; M. Rahman; H. Zafar

    2013-01-01

    The industrialization of the world, increase in population, slow paced city development and mismanagement of the available parking space has resulted in parking related problems. There is a dire need for a secure, intelligent, efficient and reliable system which can be used for searching the unoccupied parking facility, guidance towards the parking facility, negotiation of the parking fee, along with the proper management of the parking facility. Intelligent Parking Service is a part of Intel...

  16. 'That would have been beneficial': LGBTQ education for home-care service providers.

    Science.gov (United States)

    Daley, Andrea; MacDonnell, Judith A

    2015-05-01

    This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer (LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to good-quality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse home-care service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, 'provider education' and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives. © 2014 John Wiley & Sons Ltd.

  17. Home and Community-Based Service Use by Vulnerable Older Adults.

    Science.gov (United States)

    Weaver, Raven H; Roberto, Karen A

    2017-06-01

    The purpose of this study was to identify different types of clients who use home and community-based services. Enrollment characteristics of 76 clients at risk of nursing home placement and Medicaid spend-down who were enrolled in the Virginia Community Living Program were analyzed. Two-step cluster analysis identified 4 groups of service users. Enabling resources (caregiver relationship to participant, participant living arrangement, and length of time caregiver provided assistance to participant) and disability type (physical, cognitive, traumatic brain injury, or other) differentiated the client groups. Groups differed on average service cost per day and likelihood of nursing home placement if services were not provided. Findings point to the value of having practitioners assist vulnerable clients in tailoring services to meet different care needs and the need for refining policies guiding home and community-based care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. [Development of an evaluation instrument for service quality in nursing homes].

    Science.gov (United States)

    Lee, Jia; Ji, Eun Sun

    2011-08-01

    The purposes of this study were to identify the factors influencing service quality in nursing homes, and to develop an evaluation instrument for service quality. A three-phase process was employed for the study. 1) The important factors to evaluate the service quality in nursing homes were identified through a literature review, panel discussion and focus group interview, 2) the evaluation instrument was developed, and 3) validity and reliability of the study instrument were tested by factor analysis, Pearson correlation coefficient, Cronbach's α and Cohen's Kappa. Factor analysis showed that the factors influencing service quality in nursing homes were healthcare, diet/assistance, therapy, environment and staff. To improve objectivity of the instrument, quantitative as well as qualitative evaluation approaches were adopted. The study instrument was developed with 30 items and showed acceptable construct validity. The criterion-related validity was a Pearson correlation coefficient of .85 in 151 care facilities. The internal consistency was Cronbach's α=.95. The instrument has acceptable validity and a high degree of reliability. Staff in nursing homes can continuously improve and manage their services using the results of the evaluation instrument.

  19. Contemporary trends and predictors of postacute service use and routine discharge home after stroke.

    Science.gov (United States)

    Prvu Bettger, Janet; McCoy, Lisa; Smith, Eric E; Fonarow, Gregg C; Schwamm, Lee H; Peterson, Eric D

    2015-02-23

    Returning home after the hospital is a primary aim for healthcare; however, additional postacute care (PAC) services are sometimes necessary for returning stroke patients to their pre-event status. Recent trends in hospital discharge disposition specifying PAC use have not been examined across age groups or health insurance types. We examined trends in discharge to inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), home with home health (HH), and home without services for 849 780 patients ≥18 years of age with ischemic or hemorrhagic stroke at 1687 hospitals participating in Get With The Guidelines-Stroke. Multivariable analysis was used to identify factors associated with discharge to any PAC (IRF, SNF, or HH) versus discharge home without services. From 2003 to 2011, there was a 2.1% increase (unadjusted P=0.001) in PAC use after a stroke hospitalization. Change was greatest in SNF use, an 8.3% decrease over the period. IRF and HH increased 6.9% and 3.6%, respectively. The 2 strongest clinical predictors of PAC use after acute care were patients not ambulating on the second day of their hospital stay (ambulation odds ratio [OR], 3.03; 95% confidence interval [CI], 2.86 to 3.23) and those who failed a dysphagia screen or had an order restricting oral intake (OR, 2.48; 95% CI, 2.37 to 2.59). Four in 10 stroke patients are discharged home without services. Although little has changed overall in PAC use since 2003, further research is needed to explain the shift in service use by type and its effect on outcomes. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

    Science.gov (United States)

    Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

    2017-11-01

    A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  1. Proposal of a service delivery integration index of home care for older persons: application in several European cities.

    NARCIS (Netherlands)

    Henrard, J.C.; Ankri, J.; Frijters, D.; Carpenter, I.; Topinkova, E.; Garms-Homolova, V.; Finne-Soveri, H.; Wergeland Sorbye, L.; Jonsson, P.V.; Ljunggren, G.; Schroll, M.; Wagner, C.; Bernabei, R.

    2006-01-01

    PURPOSE: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. THEORY: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure

  2. SOILS AND GEOENVIRONMENTS OF THE NATIONAL PARK OF VIRUÁ AND SURROUNDING, RORAIMA: INTEGRATED VISION OF THE LANDSCAPE AND ENVIRONMENTAL SERVICE

    Directory of Open Access Journals (Sweden)

    Bruno Araujo Furtado de Mendonça

    2013-06-01

    Full Text Available http://dx.doi.org/10.5902/198050989287The Viruá National Park (PARNA Viruá occupies 227.011ha, in the region of the low ‘Branco’ river, in Roraima state. This area includes an extensive mosaic of complex seasonally flooded forested and non-forested environments. The present work had as general objective to characterize the pedology aspects and the geo-environmental units of the Park and surroundings, in an integrated vision of the landscape and, additionally, estimate the carbon stocks in the soils and geo-environments. We described and collected 29 soil profiles in the main vegetation types of Campinaranas and Forests of PARNA Viruá and surroundings. The main soil classes are: Espodossolo Humilúvico, Neossolo Quartzarênico, Neossolo Flúvico, Neossolo Litólicos, Latossolo Vermelho-Amarelo, Latossolo Vermelho, Cambissolo Háplico, Cambissolo Flúvico, Gleissolo Háplico and Plintossolo Háplico. The soils present spatial distribution marked by abrupt limits and close association with the vegetation type. We identified three pedo-environments: (1 sandy soils of the Campinaranas; (2 soils associated with the inselbergs and adjacencies; and (3 alluvial soils. We mapped and described 18 geoenvironmental units in PARNA Viruá National Park. The main geo-environments are: i Sandy plains and Paleodunes with grassy and arborous Campinarana on ‘Neossolos Quartzarênicos hidromórficos’ and ‘Espodossolos’; and Floodplains and; ii Terraces with Igapó Forest on sandy hydromorphic soils, occupying 24.6% and 20.1% of the studied area, respectively. In terms of total soil carbon stocks, the geo-environments of the sandy complexes of Campinaranas and associations stand out, with 9450.9 Gg C. The great extension and representativeness of the sandy areas of Campinaranas characterize PARNA Viruá PArk as an important conservation unit for protection Amazonian sandy soil systems. The areas under the domain of ‘Espodossolos’ possess the

  3. The Overseas Service Veteran At Home Pilot: How Choice of Care May Affect Use of Nursing Home Beds and Waiting Lists. Brief Report

    Science.gov (United States)

    Pedlar, David; Walker, John

    2004-01-01

    In 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service…

  4. Prevalence of Different Combinations of Antiepileptic Drugs and CNS Drugs in Elderly Home Care Service and Nursing Home Patients in Norway.

    Science.gov (United States)

    Halvorsen, Kjell H; Johannessen Landmark, Cecilie; Granas, Anne Gerd

    2016-01-01

    Introduction. Antiepileptic drugs (AEDs) are used to treat different conditions in elderly patients and are among the drug classes most susceptible to be involved in drug-drug interactions (DDI). The aim of the study was to describe and compare use of AEDs between home care service and nursing home patients, as these patients are not included in nationwide databases of drug utilization. In the combined population, we investigate DDI of AEDs with other central nervous system- (CNS-) active drugs and DDIs involving AEDs in general. Materials and Methods. Point-prevalence study of Norwegian patients in home care services and nursing homes in 2009. At the patient level, we screened for different DDIs involving AEDs. Results. In total, 882 patients (7.8%) of 11,254 patients used AEDs and number of users did not differ between home care services and nursing homes (8.2% versus 7.7%). In the combined population, we identified 436 potential DDIs in 45% of the patients. Conclusions. In a large population of elderly, home care service and nursing home patients do not differ with respect to exposure of AEDs but use more AEDs as compared to the general population of similar age. The risk of DDIs with AEDs and other CNS-active drugs should be taken into consideration and individual clinical evaluations are assessed in this population.

  5. Service oriented network architecture for control and management of home appliances

    Science.gov (United States)

    Hayakawa, Hiroshi; Koita, Takahiro; Sato, Kenya

    2005-12-01

    Recent advances in multimedia network systems and mechatronics have led to the development of a new generation of applications that associate the use of various multimedia objects with the behavior of multiple robotic actors. The connection of audio and video devices through high speed multimedia networks is expected to make the system more convenient to use. For example, many home appliances, such as a video camera, a display monitor, a video recorder, an audio system and so on, are being equipped with a communication interface in the near future. Recently some platforms (i.e. UPnP1, HAVi2 and so on) are proposed for constructing home networks; however, there are some issues to be solved to realize various services by connecting different equipment via the pervasive peer-to-peer network. UPnP offers network connectivity of PCs of intelligent home appliances, practically, which means to require a PC in the network to control other devices. Meanwhile, HAVi has been developed for intelligent AV equipments with sophisticated functions using high CPU power and large memory. Considering the targets of home alliances are embedded systems, this situation raises issues of software and hardware complexity, cost, power consumption and so on. In this study, we have proposed and developed the service oriented network architecture for control and management of home appliances, named SONICA (Service Oriented Network Interoperability for Component Adaptation), to address these issues described before.

  6. Customer Intention toward Theme Park: The Mediating Role of Customer Attitude on The Impact of Service Quality and Experiential Marketing

    Directory of Open Access Journals (Sweden)

    Dwi Efrarin Purnamadita

    2012-09-01

    Full Text Available Dunia Fantasi (Dufan located in Taman Impian Jaya Ancol is one leading recreational unit with specific characteristics as a theme park. A research was done towards with service quality and implementation of experiential marketing applied in Dufan using path analysis. Experiential marketing was studied to have a direct effect, positive and significant impact on customer attitude variables. The basic objective of this research is to determine the effect of service quality and implementation of experiential marketing to customer attitude and its impact on customer intention of Dufan. Data collection was conducted through questionnaire given to Dufan visitors. From the results of data analysis we found that service quality has not significantly influenced customer’s attitude. The study revealed that the direct effect between experiential marketing and customer intention is 'strong’. As a subsequent finding, service quality has not given a significant effect on customer intention. However, experiential marketing was found having an indirect influence on customer intention mediated by attitude, in which the results of the study suggested that the indirect effect is 'strong'. Eventually, customer attitude has a direct positive and significant impact on customer intention variables. The direct influence of customer attitude to customer intention in Fantasy World,was 'strong'.

  7. Smart Homes for All: Collaborating Services in a for-All Architecture for Domotics

    Science.gov (United States)

    Catarci, Tiziana; Cincotti, Febo; de Leoni, Massimiliano; Mecella, Massimo; Santucci, Giuseppe

    Nowadays, control equipments such as automobiles, home appliances, communication, control and office machines, offer their functionalities in the form of services. Such service pervasivity is particularly evident in immersive realities, i.e., scenarios in which invisible embedded systems need to continuously interact with human users, in order to provide continuous sensed information and to react to service requests from the users themselves. The sm4all project, which will be presented in this paper, is investigating an innovative middleware platform for collaborating smart embedded services in immersive and person-centric environments, through the use of composability and semantic techniques.

  8. Exploring the Barriers of Home Care Services in Iran: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Heshmatolah Heydari

    2016-01-01

    Full Text Available With increasing chronic diseases, the use of home care is rising in the world. Home care in Iran has many challenges and to improve that, we should identify the challenges and barriers of home care. The aim of this study was to identify and explore the barriers of home care in Iran. This is a qualitative study with content analysis approach that was conducted in Iran in 2015. Fourteen key informants comprising health policymakers, faculty members, nurses, and physicians as well as patients and families engaged in home care purposefully participated in this study. Data was obtained using face-to-face semistructured interviews. A focus group discussion was also used to complete the findings. Graneheim and Lundman’s approach was used for analysis of data and Lincoln and Guba’s criteria were used to confirm the trustworthiness of study’s findings. The data were divided into three main categories and eight subcategories. Main categories included treatment-based approach in the healthcare system, cultural dimensions, and the lack of adequate infrastructure. A position for home care in the healthcare system, considering cultural dimensions in Iranian society and providing an appropriate infrastructure, can be beneficial to improve the situation of home care services in Iran.

  9. Does empowering resident families or nursing home employees in decision making improve service quality?

    Science.gov (United States)

    Hamann, Darla J

    2014-08-01

    This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.

  10. Modeling and Detecting Feature Interactions among Integrated Services of Home Network Systems

    Science.gov (United States)

    Igaki, Hiroshi; Nakamura, Masahide

    This paper presents a framework for formalizing and detecting feature interactions (FIs) in the emerging smart home domain. We first establish a model of home network system (HNS), where every networked appliance (or the HNS environment) is characterized as an object consisting of properties and methods. Then, every HNS service is defined as a sequence of method invocations of the appliances. Within the model, we next formalize two kinds of FIs: (a) appliance interactions and (b) environment interactions. An appliance interaction occurs when two method invocations conflict on the same appliance, whereas an environment interaction arises when two method invocations conflict indirectly via the environment. Finally, we propose offline and online methods that detect FIs before service deployment and during execution, respectively. Through a case study with seven practical services, it is shown that the proposed framework is generic enough to capture feature interactions in HNS integrated services. We also discuss several FI resolution schemes within the proposed framework.

  11. Care satisfaction among older people receiving public care and service at home or in special accommodation.

    Science.gov (United States)

    Karlsson, Staffan; Edberg, Anna-Karin; Jakobsson, Ulf; Hallberg, Ingalill R

    2013-02-01

    To explore care satisfaction in relation to place of living, health-related quality of life, functional dependency and health complaints among people 65 years or older, receiving public care and service. The concept public care and service concerns formal care from the municipality, including home help, home nursing care, rehabilitation and a special accommodation. To be able to provide care and service of high quality to older people, knowledge about factors influencing their experience of satisfaction with the care is essential. Cross-sectional, including comparison and correlation. One-hundred sixty-six people receiving public care and service from the municipality were interviewed regarding demography, functional ability, perceived health complaints and care. Health-related quality of life was measured with SF-12, and self-rated care satisfaction was measured with a questionnaire. Low self-rated care satisfaction was associated with dependency in Instrumental Activities of Daily Living, blindness, faeces incontinence and anxiety, while high self-rated care satisfaction was associated with dependency in Personal Activities of Daily Living. Those at home rated an overall higher care satisfaction and were more satisfied with care continuity and personal relations; they thought that the staff had more time and were more respectful and quiet, than the ratings by those in a special accommodation (equivalent to a nursing home). Care satisfaction and health-related quality of life among older people was more associated with functional impairment and health complaints than to whether care and service was received at home or in a special accommodation. An approach using intervention focused on functional ability and health complaints is important for development of improved care satisfaction for older people receiving public care and service. © 2013 Blackwell Publishing Ltd.

  12. Effects of Housing Costs and Home Sales on Local Government Revenues and Services

    OpenAIRE

    Allee, David J.

    1991-01-01

    The subtitle of this paper should be " How recession and federal devolution have caused local governments to cut services and raise property taxes --now, what should be done in response to the resulting clamor for local government consolidation?" Housing drives local government services. Home sales represent opportunities for more income and more costs. Intergovernmental competition for tax base and the role of state and federal aid to provide equity between jurisdictions are central to the q...

  13. Home Range of the Spur-Thighed Tortoise, Testudo graeca (Testudines, Testudinidae, in the National Park of El Kala, Algeria

    Directory of Open Access Journals (Sweden)

    Rouag R.

    2017-02-01

    Full Text Available Spur-thighed tortoise is a vulnerable species, the local declines of populations require an imperative need for conservation. Research on habitat use is essential for understanding population ecology. To investigate the home range and movement patterns we studied a population which occupies an enclosed area of 30 ha in northeastern Algeria. Studies of movement showed that home ranges were substantially smaller than in Spain. This difference was due to the high trophic availability with significant richness in plants which make part of the diet of the tortoise. The home range varied from 0.287 ha in males to 0.354 ha for females; there was no sexual difference. The males are the most active with a distance of 3.79 m/d. Females and juveniles are respectively about 2.25 m/d and 2.11 m/d. The distance moved each day do not vary significantly by sex and ages. Results from this study are important for establishing conservation strategies for this vulnerable species.

  14. Consuming Web Services on Android Mobile Platform for Finding Parking Lots

    OpenAIRE

    Isak Shabani; Besmir Sejdiu; Fatushe Jasharaj

    2015-01-01

    Many web applications over the last decade are built using Web services based on Simple Object Access Protocol (SOAP), because these Web services are the best choice for web applications and mobile applications in general. Researches and the results of them show how architectures and the systems primarily designed for use on desktop such as Web services calls with SOAP messaging, now are possible to be used on mobile platforms such as Android. The purpose of this paper is the study of Android...

  15. Home Economics--Food Service Catering. Kit No. 54. Instructor's Manual [and] Student Learning Activity Guide.

    Science.gov (United States)

    Lowery, Ann

    An instructor's manual and student activity guide on food service, catering are provided in this set of prevocational education materials which focuses on the vocational area of home economics. (This set of materials is one of ninety-two prevocational education sets arranged around a cluster of seven vocational offerings: agriculture, home…

  16. 76 FR 52377 - Consolidated Energy, Inc., Diamond Home Services, Inc., Goran Capital Inc., Kingsley Coach, Inc...

    Science.gov (United States)

    2011-08-22

    ... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Consolidated Energy, Inc., Diamond Home Services, Inc., Goran Capital Inc., Kingsley Coach, Inc. (The), Knockout Holdings, Inc., and Kuhlman Co... securities of Kingsley Coach, Inc. (The) because it has not filed any periodic reports since the period ended...

  17. Foster Youth Evaluate the Performance of Group Home Services in California

    Science.gov (United States)

    Green, Rex S.; Ellis, Peter T.

    2008-01-01

    In 2003 foster youth employed by a foster youth advocacy organization suggested that an evaluation of group home services to foster youth be conducted in Alameda County, California. This report presents the development and conduct of this evaluation study; how funding was obtained; and how foster youth were hired, trained, and employed to produce…

  18. Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

    DEFF Research Database (Denmark)

    Tufte, Pernille

    2013-01-01

    constitutes a challenge to care workers’ own sense and valuation of their work. The article is informed by two theoretical perspectives: standardization of care services and performance of care work in private homes. Empirically, the article examines how care workers perceive the relations between...

  19. Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation.

    Science.gov (United States)

    Wollscheid, Sabine; Eriksen, John; Hallvik, Jørgen

    2013-06-01

    This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered. © 2012 Nordic College of Caring Science.

  20. Compliance With Legal Age Restrictions on Adolescent Alcohol Sales for Alcohol Home Delivery Services (AHDS)

    NARCIS (Netherlands)

    van Hoof, Joris Jasper; van den Wildenberg, Esther; de Bruijn, Dorien

    2014-01-01

    Purpose: Alcohol availability is an important predictor of alcohol use in adolescents and its negative consequences. Within this study, we zoomed in on availability through alcohol home delivery services (AHDS) by measuring compliance with the legal age limit in this sector. Methods: Two methods

  1. Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.

    Science.gov (United States)

    Laguillo, Edgardo

    1988-01-01

    A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)

  2. Small and Home-Based Businesses: Measures of Success and the Contribution of Local Development Services

    Science.gov (United States)

    Brooks, Lara; Whitacre, Brian; Shideler, Dave; Muske, Glenn; Woods, Mike

    2012-01-01

    Small and home-based businesses have long been identified by Extension educators as an important component of economic development, particularly in rural areas. The services available to these businesses can take many forms, including management training, accessibility of local funding, providing incubation facilities, or setting up mentoring…

  3. [Cooperation between nursing homes and intellectual disability care services : State of affairs in Flanders].

    Science.gov (United States)

    Campens, J; Schiettecat, T; Vervliet, M; Van Heck, L; Lesseliers, J; Goethals, I; De Witte, N

    2017-10-01

    Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.

  4. Medicaid 1915(c) Home- and Community-Based Services Waivers for Children with Autism Spectrum Disorder

    Science.gov (United States)

    Velott, Diana L.; Agbese, Edeanya; Mandell, David; Stein, Bradley D.; Dick, Andrew W.; Yu, Hao; Leslie, Douglas L.

    2016-01-01

    This research aims to describe the characteristics of 1915(c) Home- and Community-Based Services waivers for children with autism spectrum disorder across states and over time. While increasingly popular, little is known about these Medicaid waivers. Understanding the characteristics of these programs is important to clinicians and policymakers in…

  5. 42 CFR 436.217 - Individuals receiving home and community-based services.

    Science.gov (United States)

    2010-10-01

    ... THE VIRGIN ISLANDS Options for Coverage as Categorically Needy Options for Coverage of Families and... receiving home and community-based services. The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for Medicaid...

  6. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  7. Threatened plant resources: distribution and ecosystem services in the world's high elevation park of the karakoram ranges

    International Nuclear Information System (INIS)

    Shedayi, A.; Xu, M.; Hussain, F.; Sadia, S.; Bano, S.

    2016-01-01

    This study aims to investigate diversity, distribution, status, ecosystem services and threats to the plant resources in the study area based on field survey and ethno ecological knowledge for effective conservation and sustainable ecosystem services. The present study was conducted in the world's high elevation Khunjerab National Park (KNP) of the Karakoram ranges in Pakistan bordering China. Tremendous ecosystem services are obtained from the park and considered the most important habitat for many plant biodiversity and wildlife species. Field surveys were conducted to collect plants in transect along the road side of seven valleys ranging from 3160m to 4934m altitudinal variation. The names and traditional uses were recorded from the local people of the area by semi structured questionnaires and direct interviews. The data was analyzed by excel spreadsheets, direct matrix ranking, and pair comparison tests. Asteraceae was the dominant family with 15% species followed by Chenopodiaceae 10%, Poaceae 8%, Papilionaceae and Rocaceae 7% each, Brasicaceae 6%. Plant resources contribute direct and indirect ecosystem services such as food, medicine, fuel, timber, thatching, water purification, mineral and soil retention, and most importantly as sink of global carbon stock especially in the high altitude peatlands. Herbs were the dominant species in the area with 89%. Fodder is the most common usage for plants, followed by medicine. Plants with percentages 27% and 39% found to be highly palatable and palatable respectively. Competition for food between wildlife and livestock was high recorded for 60% plants. Plants used to cure various diseases including stomachache, asthma, cancer and tuberculosis etc. Plant resources in KNP are unique and vary with climate and altitude. This floral wealth is under tremendous threats of global climate change and anthropogenic activities like overgrazing, increasing population, and a rapidly declining traditional knowledge for

  8. Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

    Science.gov (United States)

    Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

    2012-01-01

    Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

  9. Care and Service at Home for Persons With Dementia in Europe.

    Science.gov (United States)

    Bökberg, Christina; Ahlström, Gerd; Leino-Kilpi, Helena; Soto-Martin, Maria E; Cabrera, Esther; Verbeek, Hilde; Saks, Kai; Stephan, Astrid; Sutcliffe, Caroline; Karlsson, Staffan

    2015-09-01

    To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of "basic care and services" and "healthcare interventions," they were utilized by few in most countries. Furthermore, "specialized dementia care and services" were sparsely available and even more sparsely utilized in the participating countries. The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. © 2015 Sigma Theta Tau International.

  10. 76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2011-07-26

    ... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012 Correction In notice document 2011-18257 appearin...

  11. The Influence of Urinary Incontinence on Publicly Financed Home Care Services to Low-Income Elderly People.

    Science.gov (United States)

    Baker, Dorothy I.; Bice, Thomas W.

    1995-01-01

    A retrospective cohort design is used to estimate the effect of urinary incontinence (UI) on the public costs of home care services to elderly individuals. Multivariate analyses controlling for other individual, household, and supply characteristics demonstrate that those with UI generate significantly greater public costs for home care services.…

  12. Smart City Services over a Future Internet Platform Based on Internet of Things and Cloud: The Smart Parking Case

    Directory of Open Access Journals (Sweden)

    Jorge Lanza

    2016-09-01

    Full Text Available Enhancing the effectiveness of city services and assisting on a more sustainable development of cities are two of the crucial drivers of the smart city concept. This paper portrays a field trial that leverages an internet of things (IoT platform intended for bringing value to existing and future smart city infrastructures. The paper highlights how IoT creates the basis permitting integration of current vertical city services into an all-encompassing system, which opens new horizons for the progress of the effectiveness and sustainability of our cities. Additionally, the paper describes a field trial on provisioning of real time data about available parking places both indoor and outdoor. The trial has been carried out at Santander’s (Spain downtown area. The trial takes advantage of both available open data sets as well as of a large-scale IoT infrastructure. The trial is a showcase on how added-value services can be created on top of the proposed architecture.

  13. Supporting family carers providing end-of-life home care: a qualitative study on the impact of a hospice at home service.

    Science.gov (United States)

    Jack, Barbara A; O'Brien, Mary R; Scrutton, Joyce; Baldry, Catherine R; Groves, Karen E

    2015-01-01

    To explore bereaved family carers' perceptions and experiences of a hospice at home service. The increasing demand for the development of home-based end-of-life services is not confined to the western world; such services are also emerging in resource-poor countries where palliative care services are developing with limited inpatient facilities. Despite this growing trend, studies show a variety of interrelated factors, with an emphasis on the availability of informal carers and their ability to cope, which can influence whether terminally ill patients actually remain at home. A hospice at home service was developed to meet patients' and families' needs by providing individually tailored resources. A qualitative study. Data were collected by semi-structured, digitally recorded interviews from 20 family carers who had experienced the service. Interviews were transcribed verbatim and a thematic approach adopted for analysis. All participants reported a personal positive impact of the service. Family carers commented the service provided a valued presence, they felt in good hands and importantly it helped in supporting normal life. The impact of an individualised, targeted, hospice at home service using dedicated, palliative care trained, staff, is perceived positively by family carers and importantly, supportive of those with additional caring or employment commitments. The emergence of hospice at home services has resulted in more options for patients and their families, when the increased amount of care a family member has to provide in these circumstances needs to be adequately supported, with the provision of a flexible service tailored to individual needs and delivered by appropriately trained staff. © 2014 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  14. Health patterns of cardiac surgery clients using home health care nursing services.

    Science.gov (United States)

    Redeker, N S; Brassard, A B

    1996-12-01

    The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.

  15. Getting some insight into the home care nursing service in Croatia.

    Science.gov (United States)

    Kostanjšek, Diana; Nižetić, Vlatka Topolovec; Razum, Zeljko; Kovačić, Luka

    2014-12-01

    Croatia, as the other Western societies are facing with the increasing share of the population over 65 years and consequently with more care-dependant people. Community living and care, including home care, is stimulating not just because of efficiency of care but also because of the peopleis preferences that home is a place of emotional and physical associations, memories and comfort. The aim of the study was to see if there is lack or surplus of Home care nursing services within the health care system. Data from the Croatian Health Insurance Fond Data base were analysed. The results of this research indicated that the number of inhabitants per one home nurse and physiotherapist contracted by the Croatian Health Insurance Fond was below the defined Standard. The average number of inhabitants per one home care nurse contracted by the CHIF for 2013 was 3373.9 compared to 3500 defined by the Standard. There was found also the huge regional differences in their distributions. The average number of contracted home physiotherapists for the same year was 9805.2 in comparison to the Standard, which was setup at the level of 15000 inhabitants per one physiotherapist.

  16. Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

    Science.gov (United States)

    Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

    2018-04-01

    There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

  17. A Service-Oriented Framework for the Development of Home Robots

    Directory of Open Access Journals (Sweden)

    Tsung-Hsien Yang

    2013-02-01

    Full Text Available In recent years, researchers have been building home robots able to interact and work with people. Yet, because of the complicated and independent robot development environments, it is not always easy to share and reuse robot code created by different providers. In this work, we present an ontology-based framework that integrates service-oriented computing environments with the standard web interface to develop reusable robotic services. In addition to the service discovery, selection, and composition processes often performed by traditional web services, our work also includes an adaptive mechanism through which the user can iteratively modify composite robotic services to suit his or her needs. The proposed methodology has been implemented and evaluated, and the results show that our framework can be used to build robotic services successfully.

  18. 75 FR 26273 - Notice of Public Meeting and Teleconference for the National Park Service Alaska Region's...

    Science.gov (United States)

    2010-05-11

    ... Service (NPS) subsistence hunting program recommendations and other related subsistence management issues... Preserve, Copper Center, AK. The meeting may end early if all business is completed. For Further... Chair and Superintendent's Welcome and Introductions. 4. Administrative Announcements. 5. Review and...

  19. An configuration method of patient service cloud for the home patient with multi sensor network

    International Nuclear Information System (INIS)

    Noji, Tamotsu; Arino, Masashi; Saito, Mayuko; Horii, Minoru; Ogino, Tadashi; Suto, Yasuzo; Sasaki, Hitoshi; Mansei, Kouiti

    2010-01-01

    We are advancing the research of patient service cloud in the global medical collaboration network system based on 3D electronic referral letters. In this paper it proposes one configuration method of private cloud that aims at the home care patient's health care and independence support based on voice navigation system (VONAVS). We evaluate 3D image compression rate, try image compositing Cloud's configuration by the multi sensor network, and search for the configuration method of the remote image diagnosis. The proposed configuration method expands the possibility to the global medical collaboration network system for new large areas such as a telemedicine, an emergency care, and home medical care. (author)

  20. Experience of care home residents with Parkinson's disease: Reason for admission and service use.

    Science.gov (United States)

    Walker, Richard W; Palmer, Jessica; Stancliffe, Jonathan; Wood, Brian H; Hand, Annette; Gray, William K

    2014-10-01

    The care needs of people with Parkinson's disease (PD) are poorly understood. We aimed to investigate the factors that precipitate entry to institutional care, and on-going care needs once in care, within a representative cohort of community-dwelling people with PD. All people with idiopathic PD, Parkinson's plus syndromes and vascular parkinsonism under the care of the Northumbria Healthcare NHS Foundation Trust PD service who were living in care homes on 1 January 2013 were included. Disease severity (Hoehn and Yahr stage) and demographic data were collected. Admissions to hospital over the previous 2 years and in the year before institutional care admission were documented. A total of 90 patients (51 females) with a mean age of 81.3 years were included. During care home stay, the median number of emergency department attendances, the median number of hospital admissions and the median length of stay for those admitted per year were significantly lower than before care home admission. Both before care home admission and during care home stay, falls were the most common diagnoses in people attending emergency departments, with 32 of 65 (49.2%) admissions before and 34 of 59 (57.6%) admissions during care home stay having falls recorded as a cause of attendance. Hospital attendances and admissions were relatively common, even after institutional care home placement. Events precipitating admission, such as falls, might be preventable. PD nurse specialists could be an effective way to help train staff in homes where someone is known to have PD. © 2013 Japan Geriatrics Society.

  1. Specialist home-based nursing services for children with acute and chronic illnesses.

    Science.gov (United States)

    Parab, Chitra S; Cooper, Carolyn; Woolfenden, Susan; Piper, Susan M

    2013-06-15

    Specialist paediatric home-based nursing services have been proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay. This review is an update of our original review, which was published in 2006. To evaluate specialist home-based nursing services for children with acute and chronic illnesses. We searched the following databases in February 2012: the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012 Issue 2, Ovid MEDLINE, EMBASE, PsycINFO, CINAHL and Sociological Abstracts. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. No language restrictions were applied. Randomised controlled trials (RCTs) of children from birth to age 18 years with acute or chronic illnesses allocated to specialist home-based nursing services compared with conventional health care. Outcomes included utilisation of health care, physical and mental health, satisfaction, adverse health outcomes and costs. Two review authors extracted data from the studies independently and resolved any discrepancies by recourse to a third author. Meta-analysis was not appropriate because of the clinical diversity of the studies and the lack of common outcome measures. We screened 4226 titles to yield seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse. No significant differences were reported in health outcomes; two studies reported a reduction in the hospital stay with no difference in the hospital readmission rates. Three studies reported a reduction in parental anxiety and improvement in child behaviours was reported in three studies. Overall increased parental satisfaction was reported in three studies. Also, better parental coping and family functioning was reported in one study. By contrast, one study each reported no impact on parental burden of care or on functional status of

  2. Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study.

    Science.gov (United States)

    Wade, Victoria A; Taylor, Alan D; Kidd, Michael R; Carati, Colin

    2016-05-16

    This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of

  3. Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators.

    Science.gov (United States)

    Houle, Sherilyn; MacKeigan, Linda

    2017-01-01

    As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists' home-based services in Canada. To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care. A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed. Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare. Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing

  4. Home

    Science.gov (United States)

    AF Branding & Trademark Licensing Join the Air Force Home About Us The Air Force Symbol Display Resources Document Library TM Connect Search AF Branding and Trademark Licensing Program: important links Legal Documents 10 U.S.C. § 2260 15 U.S.C. § 167;167; 1114-1125 DODI 5535.12, DoD Branding and

  5. Home

    Science.gov (United States)

    intersect as Attack Wing leaders change roles The 112th COS postured as cyber shield for Pa. infrastructure 111th Attack Wing 111th Attack Wing 21st Century Guard Airmen Home News Photos Art Video Resources - The Balance Search 111th Attack Wing: COMMUNITY/ENVIRO May 16, 2018; Pa. Department of Health update

  6. Comparing consumer-directed and agency models for providing supportive services at home.

    Science.gov (United States)

    Benjamin, A E; Matthias, R; Franke, T M

    2000-04-01

    To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet

  7. The profitability of companies offering services to seniors: Comparative study of nursing homes and services at home

    Directory of Open Access Journals (Sweden)

    Teresa M. Monllau Jaques

    2013-09-01

    Full Text Available Purpose: We considered two objectives; on one hand, to analyze the effectiveness and efficiency of enterprises, the purpose of which is to provide services to the elderly. On the other hand, examine whether the enactment of law 39/2006, has meant a change in the profitability of the companies.Design/methodology/approach: We study the accounting behaviour of companies that have more than 250 employees. The period submits to study is over the years 2004 to 2011. The data has been obtained through the SABI and AMADEUS databases.The variables analyzed were the operating margin (OMR rate and the rate of rotation (TAR assets ratioFindings and Originality/value: The analysis of the evolution of OMR shows that in the subsectors analyzed, the Spanish companies are not profitable. The conclusion is not the same when the variable analyzed is TAR. It shows a change in the behaviour of the analyzed companies since 2007. This variation is statistically significant in the case of the OMR, but not so in the case of TAR.Originality/value: The subsectors analyzed have been little studied in Spain. Knowing the evolution of their behaviour will improve the competitiveness of enterprises.

  8. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  9. Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.

    Science.gov (United States)

    Bowblis, John R; Hyer, Kathryn

    2013-08-01

    To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

  10. Brokerage and SME Innovation: An Analysis of the Technology Transfer Service at Area Science Park, Italy

    Science.gov (United States)

    Cattapan, Paolo; Passarelli, Mariacarmela; Petrone, Michele

    2012-01-01

    This paper contributes to the literature on innovation brokerage by analysing the effects of brokerage activities on the innovation and growth of small and medium-sized enterprises (SMEs). The authors provide a detailed description of the Technology Transfer Service (TTS), credited as a European best-practice innovation broker, at Area Science…

  11. From service quality in organisations to self-determination at home.

    Science.gov (United States)

    Martínez-Tur, V; Moliner, C; Peñarroja, V; Gracia, E; Peiró, J M

    2015-10-01

    In our proposed model, family members' perceptions of service quality in organisations improve communication about self-determination. In turn, family perceptions of communication openness have a positive relationship with self-determination attitudes of family members. Finally, these attitudes predict self-determination behaviours of individuals with intellectual disability, as reported by family members. We tested this model with a sample of 625 family members (196 using 'day care services' and 429 using 'occupational services'). Multi-sample structural equation modelling (SEM) supported the model. Communication and attitudes fully mediated the link from service quality to self-determination behaviours. Improving family members' perceptions of service quality and opening channels of communication between professionals and family members are useful strategies to facilitate parents' positive attitudes and increase the frequency of self-determination behaviours at home. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  12. Pre-service Home Economics Teachers’ Attitudes on Selected Aspects of Practical Teaching

    Directory of Open Access Journals (Sweden)

    Francka Lovšin Kozina

    2016-09-01

    Full Text Available This paper presents the results of a study conducted among pre-service home economics teachers from the Faculty of Education of the University of Ljubljana with different levels of practical experience in teaching. The pre-service Home Economics teachers in the 3rd year of their studies had just completed their first class of teaching experience in contrast to the pre-service teachers from the 4th year of their faculty studies, who had conducted more teaching lessons. The results showed that the 4th-year pre-service teachers had fewer doubts and problems concerning the planning and conducting of a lesson. They also statistically significantly agreed that they are sufficiently prepared to teach than the 3rd-year pre-service teachers are. The results showed that the majority of the pre-service teachers agreed that the feedback from their colleagues was helpful for their professional development. The results suggest the importance of practical teaching experience in the context of professional development and the intention to continue a career in education. However, the results also revealed some critical points in the teacher’s development of competency. The results suggest problems related to the application of theoretical knowledge on the children’s development in practice and problems related to classroom management in specific situations.

  13. ROSA: Resource-Oriented Service Management Schemes for Web of Things in a Smart Home.

    Science.gov (United States)

    Liao, Chun-Feng; Chen, Peng-Yu

    2017-09-21

    A Pervasive-computing-enriched smart home environment, which contains many embedded and tiny intelligent devices and sensors coordinated by service management mechanisms, is capable of anticipating intentions of occupants and providing appropriate services accordingly. Although there are a wealth of research achievements in recent years, the degree of market acceptance is still low. The main reason is that most of the devices and services in such environments depend on particular platform or technology, making it hard to develop an application by composing the devices or services. Meanwhile, the concept of Web of Things (WoT) is becoming popular recently. Based on WoT, the developers can build applications based on popular web tools or technologies. Consequently, the objective of this paper is to propose a set of novel WoT-driven plug-and-play service management schemes for a smart home called Resource-Oriented Service Administration (ROSA). We have implemented an application prototype, and experiments are performed to show the effectiveness of the proposed approach. The results of this research can be a foundation for realizing the vision of "end user programmable smart environments".

  14. ROSA: Resource-Oriented Service Management Schemes for Web of Things in a Smart Home

    Directory of Open Access Journals (Sweden)

    Chun-Feng Liao

    2017-09-01

    Full Text Available A Pervasive-computing-enriched smart home environment, which contains many embedded and tiny intelligent devices and sensors coordinated by service management mechanisms, is capable of anticipating intentions of occupants and providing appropriate services accordingly. Although there are a wealth of research achievements in recent years, the degree of market acceptance is still low. The main reason is that most of the devices and services in such environments depend on particular platform or technology, making it hard to develop an application by composing the devices or services. Meanwhile, the concept of Web of Things (WoT is becoming popular recently. Based on WoT, the developers can build applications based on popular web tools or technologies. Consequently, the objective of this paper is to propose a set of novel WoT-driven plug-and-play service management schemes for a smart home called Resource-Oriented Service Administration (ROSA. We have implemented an application prototype, and experiments are performed to show the effectiveness of the proposed approach. The results of this research can be a foundation for realizing the vision of “end user programmable smart environments”.

  15. [Effects of Home Care Services Use by Older Adults on Family Caregiver Distress].

    Science.gov (United States)

    Kim, Jiyeon; Kim, Hongsoo

    2016-12-01

    The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

  16. Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care.

    Science.gov (United States)

    Park, Young Joo; Martin, Erika G

    2017-11-12

    We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. A cross-sectional study design of nursing homes within U.S. metropolitan areas. Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. © Health Research and Educational Trust.

  17. Ecological thresholds as a basis for defining management triggers for National Park Service vital signs: case studies for dryland ecosystems

    Science.gov (United States)

    Bowker, Matthew A.; Miller, Mark E.; Belote, R. Travis; Garman, Steven L.

    2013-01-01

    protection of resources within the range of desired conditions (Cook and others, 2010). The goal of conservation management for natural resources in the U.S. National Park System is to maintain native species and habitat unimpaired for the enjoyment of future generations. Achieving this goal requires, in part, early detection of system change and timely implementation of remediation. The recent National Park Service Inventory and Monitoring program (NPS I&M) was established to provide early warning of declining ecosystem conditions relative to a desired native or reference system (Fancy and others, 2009). To be an effective tool for resource protection, monitoring must be designed to alert managers of impending thresholds so that preventive actions can be taken. This requires an understanding of the ecosystem attributes and processes associated with threshold-type behavior; how these attributes and processes become degraded; and how risks of degradation vary among ecosystems and in relation to environmental factors such as soil properties, climatic conditions, and exposure to stressors. In general, the utility of the threshold concept for long-term monitoring depends on the ability of scientists and managers to detect, predict, and prevent the occurrence of threshold crossings associated with persistent, undesirable shifts among ecosystem states (Briske and others, 2006). Because of the scientific challenges associated with understanding these factors, the application of threshold concepts to monitoring designs has been very limited to date (Groffman and others, 2006). As a case in point, the monitoring efforts across the 32 NPS I&M networks were largely designed with the knowledge that they would not be used to their full potential until the development of a systematic method for understanding threshold dynamics and methods for estimating key attributes of threshold crossings. This report describes and demonstrates a generalized approach that we implemented to formalize

  18. Perancancangan Jaringan Fiber To The Home (FTTH Menggunakan Teknologi Gigabyte Passive Optical Network (GPON pada Mall Park23 Tuban

    Directory of Open Access Journals (Sweden)

    I Putu Gede Yudha Pratama

    2017-08-01

    Full Text Available Abstrak-Perancangan jaringan ini berpusat pada sebuah mall baru yang akan dibangun pada daerah Tuban, Bali. Yang dimana mall berada pada pada luas tanah 6,981 m2. Perancangan ini menggunakan sistem IndiHome (100% fiber dengan menggunakan GPON (Gigabyte Passive Optical Network sebagai teknologinya. Perancangan jaringan ini, dimulai dengan perhitungan demand dan menghitung kebutuhan traffik tiap calon tenant yang akan dibagi menjadi 3 kategori jenis tenant. Dilanjutkan dengan proses merancang struktur jaringan yang dimulai dari penyambungan kabel pada closure sebanyak 48 core hingga sampai pada ONT (Optical Network Termination. Hasil analisis dengan menggunakan parameter Power Link Budget diperoleh total redaman untuk uplink dan downlink masing-masing sebesar 23,84 dB dan 23,574 dB. Margin Daya didapat sebesar 4,16 dBm. Sedangkan, Rise Time Budget diperoleh sebesar 0,25 ns untuk uplink dan 0,22 ns untuk downlink. Nilai tersebut masih dibawah standard maksimum rise time yaitu sebesar 0,5833 ns.

  19. Predictors of suicidal ideation in older individuals receiving home-care services.

    Science.gov (United States)

    Park, Jong-Il; Han, Myeong-Il; Kim, Myung Sig; Yoon, Myeong-Sook; Ko, Sung-Hee; Cho, Hye-Chung; Chung, Young-Chul

    2014-04-01

    Despite the importance of tending to older individuals who are vulnerable to suicide, little is known about suicidal ideation in the portion of this population receiving home-care services in Asian countries. The objective of this cross-sectional study was to examine predictors of suicidal ideation in older individuals using home-care service. Participants were randomly selected from the individuals 50 years old and over using home-care services across Jeollabuk-do Province, Korea. A total of 697 subjects participated in this study. Each participant completed the short version of the Geriatric Depression Scale, the Scale for Suicidal Ideation, the Multidimensional Scale of Perceived Social Support, and the World Health Organization Disability Assessment Schedule II. Hierarchical regression analyses revealed that depression, perceived social support, and disability were significant predictors of suicidal ideation, whereas the roles of subjective health status and fish consumption remained ambiguous in this regard. In terms of social support, we also found that less perceived social support from family members was related to higher levels of suicidal ideation. The associations between various categories of disability and suicidal ideation disappeared after controlling for depression. Our investigation of the mediating effect of depression on the relationship between disability and suicidal ideation revealed that depression was either a complete (disability related to cognition, self-care, getting along with others, and life activities) or partial (disability related to participation) mediator. Preventive strategies focusing on depression, social support, and disability should be emphasized during encounters with older people receiving home-care services. Copyright © 2013 John Wiley & Sons, Ltd.

  20. Discrepancies in assessing home care workers' working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels.

    Science.gov (United States)

    Andersen, Gunn Robstad; Westgaard, Rolf H

    2015-07-25

    The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers' working conditions. The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders' appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels). Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular. It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy

  1. Developing services to support parents caring for a technology-dependent child at home.

    Science.gov (United States)

    Kirk, S; Glendinning, C

    2004-05-01

    A group of children with complex health care needs have emerged as a result of medical advances and government policies emphasizing the community as the arena for care. Some of these children remain dependent on the medical technology that enabled them to survive and require care of a complex and intensive nature to be carried out by their parents at home. To explore the experiences of families caring at home for a technology-dependent child; to examine their needs for practical and other support; and to examine how far services are currently meeting these needs. Methods In-depth interviews were conducted with the parents of 24 technology-dependent children and with 44 health, social care and other professionals. Services in the community were not sufficiently developed to support this group of families. Major problems were identified in the purchasing and provision of both short-term care/home support services and specialist equipment/therapies in the community. Service provision could be poorly planned and co-ordinated at an operational level and few families had a designated key worker. Parents felt that professionals did not always recognize either the emotional costs entailed in providing care of this nature or their expertise in caregiving. Information-giving to parents was often described as poor and participants reported that hospital professionals failed to negotiate the transfer of caregiving responsibility to parents. Services need to work in partnership with families and with each other at both strategic and operational levels, to develop integrated and co-ordinated services that can meet the needs of this group of families.

  2. 36 CFR 7.25 - Hawaii Volcanoes National Park.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Hawaii Volcanoes National Park. 7.25 Section 7.25 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR SPECIAL REGULATIONS, AREAS OF THE NATIONAL PARK SYSTEM § 7.25 Hawaii Volcanoes National Park. (a...

  3. Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services.

    Science.gov (United States)

    Solis, Guillermina R; Champion, Jane Dimmitt

    2017-03-01

    Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person's quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

  4. Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

    Science.gov (United States)

    Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto

    2016-11-01

    The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

  5. Occupational Therapy in Medicaid Home and Community-Based Services Waivers.

    Science.gov (United States)

    Friedman, Carli; VanPuymbrouck, Laura

    Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. Comparisons across states strengthen the profession's ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. Copyright © 2018 by the American Occupational Therapy Association, Inc.

  6. Occupational Therapy in Medicaid Home and Community-Based Services Waivers

    Science.gov (United States)

    VanPuymbrouck, Laura

    2018-01-01

    OBJECTIVE. Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. METHOD. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. RESULTS. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. CONCLUSION. Comparisons across states strengthen the profession’s ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. PMID:29426389

  7. Utilizing Social Network Services for Enhanced Communication with Elderly Living at Home

    DEFF Research Database (Denmark)

    Wagner, Stefan

    2009-01-01

    This paper discusses whether social network services, like Facebook and Twitter, may be used by elderly living in their own homes to enhance communication with their relatives and friends. It introduces a prototype solution based on the iRobot Roomba 560, iRobot, USA, robot vacuum cleaner, which...... has been enhanced with Facebook and Twitter communication capabilities. The paper points out a number of other relevant applications where the use of social network services may provide better communication for ambient assisted living solutions and intelligent environments....

  8. Reasons patients leave their nearest healthcare service to attend Karen Park Clinic, Pretoria North

    Directory of Open Access Journals (Sweden)

    Agnes T. Masango- Makgobela

    2013-10-01

    Conclusion: The majority of patients who had attended their nearest clinic were adamant that they would not return. It is necessary to reduce waiting times, thus reducing long queues. This can be achieved by having adequate, satisfied healthcare providers to render a quality service and by organising training for management. Patients can thus be redirected to their nearest clinic and the health centre’s capacity can be increased by procuring adequate drugs. There is a need to follow up on patients’ complaints about staff attitudes.

  9. Proposal of a service delivery integration index of home care for older persons: application in several European cities

    Directory of Open Access Journals (Sweden)

    Jean-Claude Henrard

    2006-07-01

    Full Text Available Purpose: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method: Items considered as part of both dimensions according to an expert consensus (face validity were extracted from a standardised questionnaire used in “Aged in Home care” (AdHoc study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results: Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion: The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity.

  10. 78 FR 59953 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service...

    Science.gov (United States)

    2013-09-30

    ... Reservation, Arizona; San Carlos Apache Tribe of the San Carlos Reservation, Arizona; Tohono O'odham Nation of... notice has occurred. ADDRESSES: Bob Love, Superintendent, Tumacacori National Historical Park, P.O. Box..., Superintendent, Tumacacori National Historical Park, P.O. Box 8067, Tumacacori, AZ 85640, telephone (520) 398...

  11. 78 FR 59967 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service...

    Science.gov (United States)

    2013-09-30

    ... Carlos Apache Tribe of the San Carlos Reservation, Arizona; Tohono O'odham Nation of Arizona; Tonto... correction notice has occurred. ADDRESSES: Bob Love, Superintendent, Tumacacori National Historical Park, P.O... National Historical Park, P.O. Box 8067, Tumacacori, AZ 85640, telephone (520) 398-2341 Ext. 52, email bob...

  12. Barriers in access to home care services among ethnic minority and Dutch elderly--a qualitative study.

    Science.gov (United States)

    Suurmond, Jeanine; Rosenmöller, Doenja L; El Mesbahi, Hakima; Lamkaddem, Majda; Essink-Bot, Marie-Louise

    2016-02-01

    Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly. Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly. Qualitative semi-structured group interviews and individual interviews. The Netherlands. Seven group interviews (n=50) followed by individual interviews (n=5) were conducted, in the preferred language of the participants. Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage. This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care. In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Chen Ya-Mei

    2012-08-01

    Full Text Available Abstract Background As Home-and Community-Based Services (HCBS, such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. Methods The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1 Community-Community-Community (CCC: Resided in community during the entire study period; (2 Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3; (3 Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3; (4 Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.. Results Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other

  14. Smart Home and Smart City Solutions enabled by 5G, IoT, AAI and CoT Services

    DEFF Research Database (Denmark)

    Skouby, Knud Erik; Lynggaard, Per

    2014-01-01

    Future 5G technologies are expected to connect the world from the largest megacities to the smallest internet of things in an always online fashion. Such a connected hierarchy must combine the smart cities, the smart homes, and the internet of things into one large coherent infrastructure...... such as interconnected internet of things, smart homes with artificial intelligence, and a platform for new combined smart home and smart city services based on big-data....

  15. Home and community care services: a major opportunity for preventive health care

    Directory of Open Access Journals (Sweden)

    Lujic Sanja

    2010-05-01

    Full Text Available Abstract Background In Australia, the Home and Community Care (HACC program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results 4,978 (4.8% participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis

  16. Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites.

    Science.gov (United States)

    Johnston, Bridget; Patterson, Anne; Bird, Lydia; Wilson, Eleanor; Almack, Kathryn; Mathews, Gillian; Seymour, Jane

    2018-02-23

    The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014-2016) included: Quantitative outcome measures - Palliative Performance Scale [PPS] and Palliative Prognostic Index [PPI] (n = 2711); Integrated Palliative Outcome Scales [IPOS] (n = 1157); Carers Support Needs Assessment Tool [CSNAT] (n = 241); Views of Informal Carers -Evaluation of Services [VOICES-SF] (n = 102); a custom-designed Service Data Tool [SDT] that gathered prospective data from each site (n = 88). Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The

  17. Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

    Science.gov (United States)

    Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U

    2017-03-01

    As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  18. Factors associated with emergency services use in Taiwanese advanced cancer patients receiving palliative home care services during out-of-hours periods: a retrospective medical record study.

    Science.gov (United States)

    Kao, Yee-Hsin; Liu, Yao-Ting; Koo, Malcolm; Chiang, Jui-Kun

    2018-03-12

    For patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan. This case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care. Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care. Patients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.

  19. Socioeconomic Differences in and Predictors of Home-Based Palliative Care Health Service Use in Ontario, Canada.

    Science.gov (United States)

    Cai, Jiaoli; Guerriere, Denise N; Zhao, Hongzhong; Coyte, Peter C

    2017-07-18

    The use of health services may vary across people with different socioeconomic statuses, and may be determined by many factors. The purposes of this study were (i) to examine the socioeconomic differences in the propensity and intensity of use for three main home-based health services, that is, home-based palliative care physician visits, nurse visits and personal support worker (PSW) hours; and (ii) to explore the determinants of the use of home-based palliative care services. A prospective cohort study was employed. A total of 181 caregivers were interviewed biweekly over the course of the palliative care trajectory, yielding a total of 994 interviews. The propensity and intensity of health service use were examined using logistic regression and negative binomial regression, respectively. The results demonstrated that both the propensity and intensity of home-based nurse and PSW visits fell with socioeconomic status. The use of home-based palliative care services was not concentrated in high socioeconomic status groups. The common predictors of health service use in the three service categories were patient age, the Palliative Performance Scale (PPS) score and place of death. These findings may assist health service planners in the appropriate allocation of resources and service packages to meet the complex needs of palliative care populations.

  20. IoT-Based Image Recognition System for Smart Home-Delivered Meal Services

    Directory of Open Access Journals (Sweden)

    Hsiao-Ting Tseng

    2017-07-01

    Full Text Available Population ageing is an important global issue. The Taiwanese government has used various Internet of Things (IoT applications in the “10-year long-term care program 2.0”. It is expected that the efficiency and effectiveness of long-term care services will be improved through IoT support. Home-delivered meal services for the elderly are important for home-based long-term care services. To ensure that the right meals are delivered to the right recipient at the right time, the runners need to take a picture of the meal recipient when the meal is delivered. This study uses the IoT-based image recognition system to design an integrated service to improve the management of image recognition. The core technology of this IoT-based image recognition system is statistical histogram-based k-means clustering for image segmentation. However, this method is time-consuming. Therefore, we proposed using the statistical histogram to obtain a probability density function of pixels of a figure and segmenting these with weighting for the same intensity. This aims to increase the computational performance and achieve the same results as k-means clustering. We combined histogram and k-means clustering in order to overcome the high computational cost for k-means clustering. The results indicate that the proposed method is significantly faster than k-means clustering by more than 10 times.

  1. Assessment of status of patients receiving palliative home care and services provided in a rural area-Kerala, India

    Directory of Open Access Journals (Sweden)

    Jayakrishnan Thayyil

    2012-01-01

    Conclusions: The service could address most of the medical, psychosocial, and supportive needs of the patients and reduce their pain and symptoms. The interface between institutional-based care and home care needs more exploration and prospective studies.

  2. Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

    Science.gov (United States)

    Setiawan, Muhammad Arif; Muhammad, Fuad

    2018-02-01

    Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

  3. Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

    Directory of Open Access Journals (Sweden)

    Setiawan Muhammad Arif

    2018-01-01

    Full Text Available Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

  4. Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes.

    Science.gov (United States)

    Roberts, Amy Restorick; Bowblis, John R

    2017-02-01

    Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.

  5. Resident complaints about the nursing home food service: relationship to cognitive status.

    Science.gov (United States)

    Simmons, Sandra F; Cleeton, Patrick; Porchak, Tracy

    2009-05-01

    Most nursing home (NH) residents are not interviewed about their satisfaction with the food service due to cognitive impairment. The purpose of this study was to determine the proportion of NH residents able to complete a structured interview to assess food complaints when no cognitive status criteria were used to exclude residents from interview. Eighty-nine percent of 163 residents were able and willing to complete the interview, and 65% expressed complaints about the NH food service. Residents who expressed complaints ate less of their meals, had less cognitive impairment, and had more depressive symptoms than those who did not. This study shows that the majority of NH residents are able to reliably answer questions about their satisfaction with the food service, regardless of cognitive status, and the presence of complaints is related to poor meal intake and depressive symptoms.

  6. Applications Based on Service-Oriented Architecture (SOA) in the Field of Home Healthcare.

    Science.gov (United States)

    Avila, Karen; Sanmartin, Paul; Jabba, Daladier; Jimeno, Miguel

    2017-07-25

    This article makes a literature review of applications developed in the health industry which are focused on patient care from home and implement a service-oriented (SOA) design in architecture. Throughout this work, the applicability of the concept of Internet of Things (IoT) in the field of telemedicine and health care in general is evaluated. It also performs an introduction to the concept of SOA and its main features, making a small emphasis on safety aspects. As a central theme, the description of different solutions that can be found in the health industry is developed, especially those whose goal is health care at home; the main component of these solutions are body sensor networks. Finally, an analysis of the literature from the perspectives of functionalities, security implementation and semantic interoperability is made to have a better understanding of what has been done and which are probable research paths to be studied in the future.

  7. An assisted-living home architecture with integrated healthcare services for elderly people.

    Science.gov (United States)

    Marsh, Andy; Biniaris, Christos; Vergados, Dimitrios; Eppler, Arnold; Kavvadias, Christoforos; Bigalke, Olaf; Robert, Eric; Jerabek, Boro; Alevizos, Alevizos; Caragiozidis, Michael

    2008-01-01

    Since the population of elderly people grows absolutely and in relation to the overall population in the world, the improvement of the quality of life of elderly people at home is of a great importance. This can be achieved through the development of generic technologies for managing their domestic ambient environment consisting of medical sensors, entertainment equipment, home automation systems and white goods, increasing their autonomy and safety. In this context, the provision intelligent interactive healthcare services will improve their daily life and allowing at the same time the continuous monitoring of their health and their effective treatment. This work is supported by the INHOME Project EU IST-045061-STP, http://www.ist-inhome.eu.

  8. Survey on demand of the aged people for college volunteers in home nursing care service

    Directory of Open Access Journals (Sweden)

    Tian Meng

    2017-01-01

    Full Text Available Objects: To study the demand of the aged community residents for college volunteers in home nursing care service and its influence factors. Methods: Questionnaires on the aged residents’ expectation and requirements for college volunteers in home nursing care was prepared on basis of studies of reference books, study materials and pre-investigation, and then the questionnaires was completed by means of convenient sampling of 200 aged residents. Results The demand and expectation of the elderly for college volunteers in health care and spiritual comfort was strong. The old people who have more children, living alone and often feel lonely are more likely to need college volunteers. Conclusions: Volunteers should be arranged reasonably according to the needs of the aged people, and priority should be given to those who have more children, living alone and often feel lonely.

  9. Incidence and seasonality of falls amongst old people receiving home help services in a municipality in northern Sweden.

    Science.gov (United States)

    Vikman, Irene; Nordlund, Anders; Näslund, Annika; Nyberg, Lars

    2011-04-01

    Falls among old people is a well-documented phenomenon; however, falls among people living in the community and receiving home help services have been under-researched. The aim of this study was to investigate the incidence, including possible seasonal variation, circumstances and injuries related to falls among community living home help receivers, and to investigate whether fall incidence is associated with the type and amount of home help services received. Prospective cohort study. All 614 persons aged 65 and over who were living in a particular northern Swedish community and receiving municipality home help were included. Data on age, sex and home help service use were collected from home help service records, and falls were reported by staff on report forms specifically designed for the study. Results. A total number of 264 falls were recorded among 122 participants. The overall fall incidence was 626 per 1,000 PY, and incidence rate ratios were significantly correlated to the total amount of services used (pfalls reported as resulting in injury was 33%. The monthly fall incidence was significantly associated to daylight photoperiod, however it was not associated to temperature. Fall incidence among home help receivers aged 65 and over seems correlated to the amount of services they receive. This is probably explained by the fact that impairments connected to ADL limitations and home help needs also are connected to an increased risk of falls. This implies that fall prevention should be considered when planning home help care for old people with ADL limitations. Further research on the connection between daylight photoperiod and fall incidence in populations at different latitudes is needed.

  10. Benefits of a telepsychiatry consultation service for rural nursing home residents.

    Science.gov (United States)

    Rabinowitz, Terry; Murphy, Katharine M; Amour, Judith L; Ricci, Michael A; Caputo, Michael P; Newhouse, Paul A

    2010-01-01

    Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

  11. Provision and perceived quality of mental health services for older care home residents in England: a national survey.

    Science.gov (United States)

    Stewart, Karen; Hargreaves, Claire; Jasper, Rowan; Challis, David; Tucker, Sue; Wilberforce, Mark

    2018-02-01

    This study examined the nature, extent and perceived quality of the support provided by community mental health teams for older people (CMHTsOP) to care home residents. A postal survey was sent to all CMHTsOP in England. Information was collected about teams' staffing and their involvement in case finding, assessment, medication reviews, care planning and training as well as team managers' rating of the perceived quality of the service they provided for care home residents. Data were analysed using chi-squared tests of association and ordinal regression. Responses were received from 225 (54%) CMHTsOP. Only 18 per cent of these teams contained staff with allocated time for care home work. Services for care home residents varied considerably between teams. Two-fifths of teams provided formal training to care home staff. Team managers were more likely to perceive the quality of their service to care homes as good if they had a systematic process in place for reviewing antipsychotic drugs or routine mental health reviews, including contact with a GP. The findings suggested that more evidence is needed on the best approach for supporting care home residents with mental health needs. Areas to consider are the potential benefits of training to care home staff and regular mental health reviews, utilising links between GPs and CMHTsOP. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  12. A review of the present state and future policy alternatives for home visit nursing services in Korea.

    Science.gov (United States)

    Lim, Ji Young; Noh, Wonjung; Kim, Eunjoo; Choi, Kyung Won

    2014-01-01

    The aim of this study was to describe the current state of home visit nursing services in the Korean context and to suggest future policy directions. First, the three home visit nursing services that have developed in Korea are compared using the analytic framework provided by Gilbert and Terrell in 2012. The framework is based on four dimensions of social welfare: users, services, source of funds, and service delivery process. Second, we perform a strength, weakness, opportunity, and threat analysis to suggest comprehensive and constructive home visit nursing service policies for the future. Specifically, we advocate the creation of an organization that steers the central government to operate an integrated management organization to distribute services and reduce redundancy for preventing the waste of both medical and state financial resources. This study also recommends the development of educational programs to improve the quality of services and service evaluation criteria for the objective assessment of those services. These policy guidelines may prove useful both for Korea and for other countries that intend to prepare or revise their home visit nursing service systems. © 2014 Wiley Periodicals, Inc.

  13. A Consumer Health Information System to Assist Patients Select Quality Home Health Services

    Directory of Open Access Journals (Sweden)

    Dimitrios Zikos

    2017-11-01

    Full Text Available Patients evaluate the quality of home health agencies (HHAs using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p < 0.001: governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p < 0.001. The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.

  14. A Semantic Approach with Decision Support for Safety Service in Smart Home Management.

    Science.gov (United States)

    Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

    2016-08-03

    Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate.

  15. A Semantic Approach with Decision Support for Safety Service in Smart Home Management

    Directory of Open Access Journals (Sweden)

    Xiaoci Huang

    2016-08-01

    Full Text Available Research on smart homes (SHs has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate.

  16. Synthesis of thirty years of surface water quality and aquatic biota data in Shenandoah National Park: Collaboration between the US Geological Survey and the National Park Service

    Science.gov (United States)

    Rice, Karen C.; Jastram, John D.; Wofford, John E.B.; Schaberl, James P.

    2014-01-01

    The eastern United States has been the recipient of acidic atmospheric deposition (hereinafter, “acid rain”) for many decades. Deleterious effects of acid rain on natural resources have been well documented for surface water (e.g., Likens et al. 1996; Stoddard et al. 2001), soils (Bailey et al. 2005), forest health (Long et al. 2009), and habitat suitability for stream biota (Baker et al. 1993). Shenandoah National Park (SNP) is located in northern and central Virginia and consists of a long, narrow strip of land straddling the Blue Ridge Mountains (Figure 1). The park’s elevated topography and location downwind of the Ohio River valley, where many acidic emissions to the atmosphere are generated (NSTC 2005), have made it a target for acid rain. Characterizing the link between air quality and water quality as related to acid rain, contaminants, soil conditions, and forest health is a high priority for research and monitoring in SNP. The US Geological Survey (USGS) and SNP have had a long history of collaboration on documenting acid rain effects on the park’s natural resources, starting in 1985 and continuing to the present (Lynch and Dise 1985; Rice et al. 2001, 2004, 2005, 2007; Deviney et al. 2006, 2012; Jastram et al. 2013).

  17. Vulnerability of National Park Service beaches to inundation during a direct hurricane landfall: Fire Island National Seashore

    Science.gov (United States)

    Stockdon, Hilary F.; Thompson, David M.

    2007-01-01

    Waves and storm surge associated with strong tropical storms are part of the natural process of barrier-island evolution and can cause extensive morphologic changes in coastal parks, leading to reduced visitor accessibility and enjoyment. Even at Fire Island National Seashore, a barrier-island coastal park in New York where extratropical storms (northeasters) dominate storm activity, the beaches are vulnerable to the powerful, sand-moving forces of hurricanes. The vulnerability of park beaches to inundation, and associated extreme coastal change, during a direct hurricane landfall can be assessed by comparing the elevations of storm-induced mean-water levels (storm surge) to the elevations of the crest of the sand dune that defines the beach system. Maps detailing the inundation potential for Category 1-4 hurricanes can be used by park managers to determine the relative vulnerability of various barrier-island parks and to assess which areas of a particular park are more susceptible to inundation and extreme coastal changes.

  18. Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial.

    Science.gov (United States)

    King, Anna I I; Parsons, Matthew; Robinson, Elizabeth; Jörgensen, Diane

    2012-07-01

    Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face-to-face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health-related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well-being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI -0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P home care service may be of benefit to older people, and improves home care service efficacy. © 2011 Blackwell Publishing Ltd.

  19. Shift work to balance everyday life - a salutogenic nursing perspective in home help service in Sweden

    OpenAIRE

    Agosti, Madelaine T?rnquist; Andersson, Ingemar; Ejlertsson, G?ran; Janl?v, Ann-Christin

    2015-01-01

    Background: Nurses in Sweden have a high absence due to illness and many retire before the age of sixty. Factors at work as well as in private life may contribute to health problems. To maintain a healthy work–force there is a need for actions on work-life balance in a salutogenic perspective. The aim of this study was to explore perceptions of resources in everyday life to balance work and private life among nurses in home help service. Methods: Thirteen semi-structured individual interviews...

  20. Experiences of community-dwelling older adults with the use of telecare in home care services

    DEFF Research Database (Denmark)

    Karlsen, Cecilie; Ludvigsen, Mette Spliid; Moe, Carl Erik

    2017-01-01

    BACKGROUND: The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults...... both published and unpublished studies in English, Norwegian, Swedish and Danish, from 2005 to 2017. METHODOLOGICAL QUALITY: Methodological quality of the included studies was assessed independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA...

  1. Capacity and readiness for quality improvement among home and community-based service providers.

    Science.gov (United States)

    Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

    2016-01-01

    The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

  2. Hybrid-Aware Model for Senior Wellness Service in Smart Home.

    Science.gov (United States)

    Jung, Yuchae

    2017-05-22

    Smart home technology with situation-awareness is important for seniors to improve safety and security. With the development of context-aware computing, wearable sensor technology, and ubiquitous computing, it is easier for seniors to manage their health problem in smart home environment. For monitoring senior activity in smart home, wearable, and motion sensors-such as respiration rate (RR), electrocardiography (ECG), body temperature, and blood pressure (BP)-were used for monitoring movements of seniors. For context-awareness, environmental sensors-such as gas, fire, smoke, dust, temperature, and light sensors-were used for senior location data collection. Based on senior activity, senior health status can be classified into positive and negative. Based on senior location and time, senior safety is classified into safe and emergency. In this paper, we propose a hybrid inspection service middleware for monitoring elderly health risk based on senior activity and location. This hybrid-aware model for the detection of abnormal status of seniors has four steps as follows: (1) data collection from biosensors and environmental sensors; (2) monitoring senior location and time of stay in each location using environmental sensors; (3) monitoring senior activity using biometric data; finally, (4) expectation-maximization based decision-making step recommending proper treatment based on a senior health risk ratio.

  3. Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter".

    Science.gov (United States)

    Guterman, Neil B; Bellamy, Jennifer L; Banman, Aaron

    2018-02-01

    Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being. Copyright © 2017. Published by Elsevier Ltd.

  4. Fiber-to-the-home: bringing the services the end-user

    Science.gov (United States)

    van den Hoven, G. N.; Pluk, E. G. C.

    2006-07-01

    The ever increasing bandwidth demand will put large pressure on classical broadband communication networks. Optical fiber, with its high bandwidth, offers a solution to this emerging problem. Fiber-to-the-home (FTTH) can provide end-users with virtually unlimited bandwidth, creating the opportunity to receive any service they like. FTTH networks consist of a passive network, active equipment and a top-layer which brings the services to the end-user. Companies and organisations who are deploying FTTH networks are not the traditional telecom and cable operators, but utility companies, housing corporations and local communities. The FTTH network deployed in Nuenen is a good example showing the strength of FTTH. In the future, bandwidth demand will increase even more. Intelligent solutions, such as flexible bandwidth, can have large added value for future FTTH networks.

  5. Salivary alpha amylase in on-call from home fire and emergency service personnel

    Directory of Open Access Journals (Sweden)

    Sarah J Hall

    2017-10-01

    Full Text Available The effect of working on-call from home on the sympatho-adrenal medullary system activity is currently unknown. This study had two aims, Aim 1: examine salivary alpha amylase awakening response (AAR and diurnal salivary alpha amylase (sAA profile in fire and emergency service workers who operate on-call from home following a night on-call with a call (NIGHT-CALL, a night on-call without a call (NO-CALL and an off-call night (OFF-CALL, and Aim 2: explore whether there was an anticipatory effect of working on-call from home (ON compared to when there was an off-call (OFF on the diurnal sAA profile. Participants wore activity monitors, completed sleep and work diaries and collected seven saliva samples a day for one week. AAR area under the curve with respect to ground (AUCG, AAR area under the curve with respect to increase (AUCI, AAR reactivity, diurnal sAA slope, diurnal sAA AUCG and mean 12-h sAA concentrations were calculated. Separate generalised estimating equation models were constructed for each variable of interest for each aim. For Aim 1, there were no differences between NIGHT-CALL or NO-CALL and OFF-CALL for any response variable. For Aim 2, there was no difference between any response variable of interest when ON the following night compared to when OFF the following night (n = 14. These findings suggest that there is no effect of working on-call from home on sAA, but should be interpreted with caution, as overnight data were not collected. Future research, using overnight heart rate monitoring, could help confirm these findings.

  6. Hunger at Home: A Higher Education Service Learning Course of Appraisal and Action in Community Food Security

    Science.gov (United States)

    Ross, Nancy J.

    2011-01-01

    Service learning and civic engagement are playing an increasingly larger role in higher education. Unity College's Hunger at Home course could serve as a model for service learning in disciplines such as nutrition, sociology, and food and agriculture. The class worked with local partners to get a better understanding of hunger in the area, recent…

  7. Context-Aware Middleware Support for the Nomadic Mobile Services on Multi-homed Handheld Mobile Devices

    NARCIS (Netherlands)

    Pawar, Pravin; van Beijnum, Bert-Jan; Peddemors, Arjan; van Halteren, Aart

    2007-01-01

    Nowadays, a variety ofhandheld mobile devices are capable of connecting to the Internet using multiple network interfaces. This is referred to as multi-homing. In addition to this, enriched computation resources allow them to host nomadic mobile services and provide these services to the clients

  8. Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

    Science.gov (United States)

    Li, S A; Jack, S M; Gonzalez, A; Duku, E; MacMillan, H L

    2015-01-01

    Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

  9. Effect of the economic crisis on the use of health and home care services among Spanish COPD patients.

    Science.gov (United States)

    de Miguel-Diez, Javier; Lopez-de-Andres, Ana; Herandez-Barrera, Valentin; Jimenez-Trujillo, Isabel; Puente-Maestu, Luis; Cerezo-Lajas, Alicia; Jimenez-Garcia, Rodrigo

    2018-01-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death worldwide. Consequently, COPD patients are frequent users of health and social resources. Therefore, they are highly vulnerable to decreases in investment in healthcare services. We aimed to describe the utilization of health and home care services among Spanish COPD patients during the economic crisis to identify factors independently associated with changes in the utilization of these services and to study the time trends from 2009 to 2014. We used data from the European Health Interview Surveys for Spain (EHSS) conducted between 2009/2010 (n=22,188) and 2014 (n=22,842). We included responses from adults with COPD aged 40 years or over. Dependent variables included self-reported hospitalizations during the previous year, general practitioner (GP) visits during the last 4 weeks, other health care services used during the previous year (nursing, rehabilitation, and psychological services), and home care services use during the previous year. Independent variables included demographic and socioeconomic characteristics, health status variables, and lifestyles. We identified 1,328 and 1,008 COPD patients from EHSS 2009 and EHSS 2014, respectively. We observed a significant increase in non-GP services use (30.6% in 2009 vs 39.11% in 2014; p home care services use over time. Multivariable models showed that associated factors with a higher use included any chronic comorbidity and worse self-rated health. Physical activity was a strong predictor of fewer hospitalizations and less home care service use. Female sex was associated with significantly fewer hospitalizations (OR 0.72; 95% CI 0.58-0.89). We found an increase in the use of non-GP services (nursing, rehabilitation, and psychological) but not in other health and home care services. The only differences in hospitalizations were observed according to sex. Therefore, the effect of the economic crisis, if any, seems to have been of

  10. [Menus offered in long-term care homes: quality of meal service and nutritional analysis].

    Science.gov (United States)

    Rodríguez Rejón, Ana Isabel; Ruiz López, María Dolores; Malafarina, Vincenzo; Puerta, Antonio; Zuñiga, Antonia; Artacho, Reyes

    2017-06-05

    Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient deficiencies are considered to be the main causes. To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain). Cross-sectional study. A validated "quality of meals and meal service" set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings. Important deficiencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fiber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil, legumes, or nuts. It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes.

  11. Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

    Directory of Open Access Journals (Sweden)

    Pernille Tufte

    2013-05-01

    Full Text Available Reflecting on the temporal conditions of home care work, care workers are fairly critical, stressing that time frames are inflexible and time is limited and occasionally insufficient, altogether constituting a time pressure in work performance. Besides from the immediate consequences of time scarcity in the daily work performance, care workers relate the issue of time to a more fundamental discussion of what the performance of care does and should entail. The purpose of the article is to examine care workers’ perceptions of the temporal conditions of care work, investigating how time pressure constitutes a challenge to care workers’ own sense and valuation of their work. The article is informed by two theoretical perspectives: standardization of care services and performance of care work in private homes. Empirically, the article examines how care workers perceive the relations between the temporal framing and the possibilities to perform care work. Methodologically, the article is based on qualitative data, collected through focus group interviews and participant observation, and analyzed within the perspective of reflexive interpretation, using grounded theory method and hermeneutic approaches of analysis. A central focus of analysis is the concept of “additional care services.” The use of the concept reflects different understandings of care. Relying on the logic of standardization, managers articulate additional services as definite items, which could (and should be left out of the performance of care work. Care workers do, however, not accept this notion. Relying on their experience of work, they perceive additional services as an ambiguous concept, which recognizes the multiple character of care work. Conclusions are that time scarcity constitutes a pressure on work performance as a whole, reducing care workers’ flexibility, challenging their authority, but still keeping them in a position of responsibility. Ultimately, the

  12. Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

    Science.gov (United States)

    Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

    2017-09-04

    Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Bibliometric analysis of scientific production indexed in MEDLINE, about hospital based home care services

    Directory of Open Access Journals (Sweden)

    Javier Sanz-Valero

    2017-01-01

    Full Text Available Objective: A thematic and bibliometric analysis was done for the available scientific production about the home care services based in the hospital. Methods: Bibliometric analysis. Data was obtained from MEDLINE database using MeSH “Home Care Services, Hospital-Based” as Major Topic. Search date: July 2016. The study sample was calculated by estimating population parameters for an infinite population and the selection was a simple random without replacement. Results: A total of 386 references were analysed. The number of original articles was of 204 (52,85%, identifying 243 institutions, with an index of cooperation of 3,75±1,16 authors/article. English was the predominant language in 279 (72,28% articles. The obsolescence was of 13 years according to the Burton-Kebler Index and the Price Index was of 14,40%. Bradford nucleon was constituted by 23 journals. The thematic classification determines a relevance of 70.73%. Conclusions: There was a high obsolescence and an anglophone orientation. Also, there was a weak relation between institutions and corporation index. Over the time there was an improvement of the access to the primary source, in line with the Open Access initiative. The production was collected in a high number of journals (in a very dispersed form. The thematic classification meets the studied issue.

  14. The Patient’s Perspective of in-Home Telerehabilitation Physiotherapy Services Following Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    the Telage Researchers

    2013-08-01

    Full Text Available This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1 improving access to services with reduced need for transportation; (2 developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3 complementing telerehabilitation with in-person visits; (4 providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5 perceived ease-of-use of telerehabilitation equipment; and (6 feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.

  15. Shift work to balance everyday life - a salutogenic nursing perspective in home help service in Sweden.

    Science.gov (United States)

    Agosti, Madelaine Törnquist; Andersson, Ingemar; Ejlertsson, Göran; Janlöv, Ann-Christin

    2015-01-01

    Nurses in Sweden have a high absence due to illness and many retire before the age of sixty. Factors at work as well as in private life may contribute to health problems. To maintain a healthy work-force there is a need for actions on work-life balance in a salutogenic perspective. The aim of this study was to explore perceptions of resources in everyday life to balance work and private life among nurses in home help service. Thirteen semi-structured individual interviews and two focus group interviews were conducted with home help service nurses in Sweden. A qualitative content analysis was used for the analyses. In the analyses, six themes of perceptions of recourses in everyday life emerged; (i) Reflecting on life. (ii) Being healthy and taking care of yourself. (iii) Having a meaningful job and a supportive work climate. (iv) Working shifts and part time. (v) Having a family and a supporting network. (vi) Making your home your castle. The result points out the complexity of work-life balance and support that the need for nurses to balance everyday life differs during different phases and transitions in life. In this salutogenic study, the result differs from studies with a pathogenic approach. Shift work and part time work were seen as two resources that contributed to flexibility and a prerequisite to work-life balance. To have time and energy for both private life and work was seen as essential. To reflect on and discuss life gave inner strength to set boundaries and to prioritize both in private life and in work life. Managers in nursing contexts have a great challenge to maintain and strengthen resources which enhance the work-life balance and health of nurses. Salutogenic research is needed to gain an understanding of resources that enhance work-life balance and health in nursing contexts.

  16. HIA 2016 DOE Zero Energy Ready Home Case Study: United Way of Long Island, United Veterans, Beacon House, Deer Park, NY

    Energy Technology Data Exchange (ETDEWEB)

    Pacific Northwest National Laboratory

    2016-09-01

    Case study of a DOE 2016 Housing Innovation Award winning affordable home in the mixed-humid climate that met the DOE Zero Energy Ready Home criteria and achieved a HERS 32 without PV or HERS 9 with PV.

  17. Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions.

    Science.gov (United States)

    Kralik, Debbie; Anderson, Barbara

    2008-11-01

    To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions. Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions. The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007. The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18·7%) and three non-cancer clients (7·1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time. Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions. There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision

  18. Perceptions of telecare training needs in home healthcare services: a focus group study.

    Science.gov (United States)

    Guise, Veslemøy; Wiig, Siri

    2017-02-23

    The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals' perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients' perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills

  19. Hotspotting: Development of an Interprofessional Education and Service Learning Program for Care Management in Home Care Patients.

    Science.gov (United States)

    Zomorodi, Meg; Odom, Trish; Askew, Naomi C; Leonard, Christina R; Sanders, Kimberly A; Thompson, Daniel

    2018-03-28

    The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.

  20. Fall Risk and Its Associated Factors among Older Adults without Home-Help Services in a Swedish Municipality.

    Science.gov (United States)

    Hammarlund, Catharina Sjödahl; Hagell, Peter; Westergren, Albert

    2016-01-01

    During preventive home visits, the purpose of this study was to identify the prevalence of fall risk and any associated factors. Participants (n = 1471) were cognitively sound community-dwelling older adults (≥ 70 years) without home-help service, living in a Swedish municipality. The Downton Fall Risk Index and nine single items were used. Tiredness/fatigue, age ≥ 80, inability to walk 1 hr, inability to climb stairs and worrying were significantly associated with fall risk. Preventive home visits incorporating fall-risk screening proved valuable, providing information for interventions aimed at preventing falls, maintaining independence, and facilitating health among community dwelling participants.

  1. Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes.

    Science.gov (United States)

    Luk, James K H; Chan, W K; Ng, W C; Chiu, Patrick K C; Ho, Celina; Chan, T C; Chan, Felix H W

    2013-12-01

    To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment. Cohort longitudinal study. Residential care homes for the elderly in Hong Kong West. Residents of such homes aged 65 years or more with advanced cognitive impairment. In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004). Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.

  2. Using NASA Earth Observations to Assist the National Park Service in Assessing Snow Cover Distribution and Persistence Changes in the Sky Islands

    Science.gov (United States)

    Bayat, F.; Barrow, C., III; Gonsoroski, E.; Dutta, S.; Lynn, T.; Harville, K.; Spruce, J.

    2017-12-01

    Saguaro National Park in southeastern Arizona occupies one of several unique mountain ranges known collectively as the Sky Islands or the Madrean Archipelago. The Sky Islands are biodiversity hotspots and host different ecosystems, ranging from arid deserts to temperate forests. Snowmelt provides a source of water during the dry season for various flora and fauna inhabiting the region. Climate change and its effect on snow cover is of growing concern by resource managers in this location. Currently, the National Park Service (NPS) monitors water presence via stream gauges, but a synoptic record of snow presence does not exist due to the remote and rugged topography of the region. As a result, it is difficult to study how climate change has affected water resources in the Sky Islands and what effect this has on wildlife and vegetation. This project used NASA Earth observations (e.g., Landsat data) and GIS technology to help the NPS in understanding the role of snow cover in the Sky Islands. Historical snow cover maps were compiled using a combination of snow detection indices to provide spatio-temporal information on snow presence and phenology. With a more complete understanding of snow cover trends in the park, the NPS can further analyze snow cover impacts to improve future land management decisions.

  3. Use of Home- and Community-Based Services in Taiwan's National 10-Year Long-Term Care Plan.

    Science.gov (United States)

    Yu, Hsiao-Wei; Tu, Yu-Kang; Kuo, Po-Hsiu; Chen, Ya-Mei

    2018-05-01

    We aimed to understand the relationships between care recipients' profiles and home- and community-based services (HCBS use patterns. Data were from the 2010 to 2013 Long-Term Care Service Management System in Taiwan ( N = 78,205). We used latent class analysis and multinomial logistic regression analyses. Three HCBS use patterns were found. Care recipients who lived alone, lived in less urbanized areas, and had instrumental activities of daily living disabilities were more likely to be in the home-based personal care group. Those in the home-based personal and medical care group were more likely than others to have a primary caregiver. Care recipients who had poorer abilities at basic activities of daily living and cognitive function, better household income, and lived in a more urbanized area were more likely to be in the non-personal care multiple services group. The findings suggest that policymakers alleviate barriers to accessing various patterns of HCBS should be encouraged.

  4. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

    Science.gov (United States)

    Gomes, Barbara; Calanzani, Natalia; Curiale, Vito; McCrone, Paul; Higginson, Irene J

    2013-01-01

    Background Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. Objectives 1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness. Search methods We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). Main results We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive

  5. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial.

    Science.gov (United States)

    Burton, Elissa; Lewin, Gill; Clemson, Lindy; Boldy, Duncan

    2013-01-01

    Restorative home care services are short-term and aimed at maximizing a person's ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults. A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention) or the structured exercise program currently being used in the service (control). Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability. There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program. Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes.

  6. Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003

    DEFF Research Database (Denmark)

    Mikkelsen, Bent Egberg; Beck, Anne Marie; Lassen, Anne Dahl

    2007-01-01

    in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food...... are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. Conclusion...

  7. Valuing Attributes of Home Palliative Care With Service Users: A Pilot Discrete Choice Experiment.

    Science.gov (United States)

    Gomes, Barbara; de Brito, Maja; Sarmento, Vera P; Yi, Deokhee; Soares, Duarte; Fernandes, Jacinta; Fonseca, Bruno; Gonçalves, Edna; Ferreira, Pedro L; Higginson, Irene J

    2017-12-01

    Discrete choice experiment (DCE) is a quantitative method that helps determine which service attributes are most valued by people and consequently improve their well-being. The objective of this study was to test a new DCE on home palliative care (HPC). Cross-sectional survey using the DCE method with adult patients and their family caregivers, users of three HPC services in Portugal. Service attributes were based on a Cochrane review, a meta-ethnography, and the few existing DCEs on HPC: 1) team's availability, 2) support for family caregivers, 3) homecare support, 4) information and planning, and 5) waiting time. The experimental design consisted in three blocks of eight choice sets where participants chose between two service alternatives that combined different levels of each attribute. We piloted the DCE using cognitive interviewing. Interviews were analyzed for difficulties using Tourangeau's model of information processing. The DCE was conducted with 21 participants of 37 eligible (10 patients with median Palliative Performance Scale score = 45, 11 caregivers). Most participants found the DCE easy (median 2 from 1 to 5), although two patients did not finish the exercise. Key difficulties related to comprehension (e.g., waiting time sometimes understood as response time for visit instead of time from referral to care start) and judgment (e.g., indecision due to similar service alternatives). The DCE method is feasible and acceptable but not all patients are able to participate. In the main study phase, we will give more attention to the explanation of the waiting time attribute. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  8. Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003.

    Science.gov (United States)

    Mikkelsen, B E; Beck, A M; Lassen, A

    2007-01-01

    Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes. The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress. A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels. Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might

  9. A Framework for Smart Home Services with Secure and QoS-aware Communications

    Directory of Open Access Journals (Sweden)

    Markus Hager

    2013-01-01

    Full Text Available The scenario of smart home services will be discussed with regard to two important aspects: the quality of service problem for the in-house communication and the need for a security scheme for the whole system. We focus on an installation with smart computers in each flat interconnected using a switched Ethernet network. These smart devices are responsible for performing local services, user control and operate as a gateway for the different types of sensor and actor networks installed at each flat. We propose a QoS scheme to prevent congestion situation for the Ethernet network which is applicable to currently available cost-sensitive hardware. Furthermore, the whole system, all communication channels, user data and the access to the framework are secured by our proposed security architecture. Finally, we will present the latest improvements on Ethernet network standards, the ongoing work on this topics and our next steps for future work.

  10. Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports

    Science.gov (United States)

    Newquist, Deborah D.; DeLiema, Marguerite; Wilber, Kathleen H.

    2016-01-01

    Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research. PMID:26062611

  11. Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports.

    Science.gov (United States)

    Newquist, Deborah D; DeLiema, Marguerite; Wilber, Kathleen H

    2015-10-01

    Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research. © The Author(s) 2015.

  12. Park It!

    Science.gov (United States)

    Sartorius, Tara Cady

    2010-01-01

    Many artists visit national parks to draw, paint and take photographs of some of the most amazing scenery on earth. Raw nature is one of the greatest inspirations to an artist, and artists can be credited for helping inspire the government to create the National Park System. This article features Thomas Moran (1837-1926), one of the artists who…

  13. Elderly people and ulcer caused by pressure at home care service

    Directory of Open Access Journals (Sweden)

    Ana Débora Alcantara Coêlho

    2012-09-01

    Full Text Available This research aimed at estimating the prevalence of pressure ulcers in a home care service. Cross-sectional study carried out in July/August 2009 with 194 bedridden aged patients. For data collection, the Braden Scale and an instrument consisting of demographics, clinical data, and preventive measures for pressure ulcers were applied. Data was analyzed using SPSS16.0 and presented as descriptive statistics. From the total sample, 69.6% (n = 135 were female; 68% (n = 132 ≥ 80 years old; 33% (n=64 were Alzheimer patients, and 26.3% (n = 51 had sequels of stroke; 31.4% (n = 61 had pressure ulcers, from which 54.1% (n = 33 were developed in the hospital. A prevalence of 31.4% and moderate risk (13.2% for pressure ulcers was identified. It is recommended longitudinal study for evaluating the relationship between the Braden Scale indicators and the development of pressure ulcers.

  14. Parks & benefits

    DEFF Research Database (Denmark)

    Brandt, Jesper; Christensen, Andreas Aagaard; Holmes, Esbern

    2011-01-01

    conservation. Increasing visitor flows and cuts in staff resources has put focus on the management of visitor carrying capacities and their relation to landscape structure and zoning. At the same time park authorities face falling public appropriations and receding focus on their conservation functions...... compared to recreation and settlement. The constant priority of the balancing of nature protection and economic utilization gives rise to various experience with land use and visitor management relevant for sustainable development also outside the parks. In European nature parks the handling of visitor...... carrying capacities related to Natura2000-sites and their included habitat type areas is a priority theme for the sustainable management of nature parks. A comparative analysis of conditions and initiatives related to visitor carrying capacities in 8 nature parks in the Baltic region has been carried out...

  15. "Between the devil and the deep blue sea": the beliefs of caregivers of people with dementia regarding the use of in-home respite services.

    Science.gov (United States)

    Phillipson, Lyn; Jones, Sandra C

    2011-04-01

    This article details results from qualitative research with caregivers in regard to the beliefs they associate with the use of in-home respite services. Outcomes are perceived by caregivers in relation to care recipient personal safety and the avoidance of negative consequences through the provision of supervision in the caregiver's absence. Use of in-home services challenges normative beliefs for some caregivers, particularly for spousal caregivers who feel it is their role to provide assistance that is needed in the home. Likewise, perceived inflexibility and the inability of in-home services to provide responsive and personalized care make the use of in-home services difficult and may inform control beliefs. Implications are discussed in relation to community care pathways and the promotion and development of in-home respite services to better target caregiver beliefs and respond to caregiver perceived needs.

  16. Live-In Versus Live-Out Home Care in Israel: Satisfaction With Services and Caregivers' Outcomes.

    Science.gov (United States)

    Ayalon, Liat; Green, Ohad

    2015-08-01

    The present study provides a preliminary examination of the relationship between the type of home care services (live-in vs. live-out; i.e., round the clock vs. several hours per week), the caregiver's satisfaction with services, and the caregiver's burden, distress, well-being, and subjective health status within the conceptual framework of caregiving outcomes proposed by Yates and colleagues (Yates, M. E., Tennstedt, S., & Chang, B. H. [1999]. Contributors to and mediators of psychological well-being for informal caregivers. Journal of Gerontology: Psychological Sciences, 54, P12 -P22. doi:10.1093/geronb/54B.1.P12). A random stratified sample of family caregivers of older adults more than the age of 70 who receive live-in (442) or live-out (244) home care services through the financial assistance of the National Insurance institute of Israel was selected. A path analysis was conducted. Satisfaction with services was higher among caregivers under the live-in home care arrangement and positively related to well-being. Among caregivers, live-in home care was directly associated with higher levels of subjective health and indirectly associated with better well-being via satisfaction with services. The present study emphasizes the potential benefits of live-in home care services for caregivers of older adults who suffer from high levels of impairment and the importance of assessing satisfaction with services as a predictor of caregivers' outcomes. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Burton E

    2013-12-01

    Full Text Available Elissa Burton,1,2 Gill Lewin,1,2 Lindy Clemson,3 Duncan Boldy41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain, Perth, WA, Australia; 3Health and Work Research Unit, The University of Sydney, Sydney, NSW, Australia; 4School of Nursing and Midwifery, Curtin University, Perth, WA, AustraliaBackground: Restorative home care services are short-term and aimed at maximizing a person’s ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults.Methods: A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention or the structured exercise program currently being used in the service (control. Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability.Results: There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program.Conclusion: Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes

  18. [Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study].

    Science.gov (United States)

    Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P

    2015-04-01

    The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

  19. Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial.

    Science.gov (United States)

    Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M

    2018-02-01

    To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.

  20. Accessible Internet-of-Things and Internet-of-Content Services for All in the Home or on the Move

    Directory of Open Access Journals (Sweden)

    Dimitris Tektonidis

    2012-10-01

    Full Text Available Public authorities and national healthcare service providers across the European Union and beyond are increasingly under pressure to deliver better services with diminishing resources. Users, quite rightly, demand a high standard of service and increasingly also convenience focused on the needs of the users rather than how the services are organised to deliver them. Users, on the whole, also prefer to be supported in their homes, and be free to move as much as possible. While users without impairments and generally well provided for, there are increasingly also users who have special needs, including the aged and those with a range of physical and mental disabilities who are unable to make effective use of such services from their homes due to the lack of proactive and accessible services. The idea we promote in the chapter is to provide better support to users with disabilities and impairments from the comfort of their home by means of providing them with a set of scalable services which can be either offered for free or purchased through some central form of a marketplace repository.

  1. Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study.

    Science.gov (United States)

    Dhiliwal, Sunil R; Muckaden, Maryann

    2015-01-01

    Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.

  2. Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms.

    Science.gov (United States)

    Cheng, Lu; Zhu, Mu; Poss, Jeffrey W; Hirdes, John P; Glenny, Christine; Stolee, Paul

    2015-10-09

    Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment. We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada. Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not. Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.

  3. Zone-Aware Service Platform: A New Concept of Context-Aware Networking and Communications for Smart-Home Sustainability

    Directory of Open Access Journals (Sweden)

    Jinsung Byun

    2018-01-01

    Full Text Available Recent advances in networking and communications removed the restrictions of time and space in information services. Context-aware service systems can support the predefined services in accordance with user requests regardless of time and space. However, due to their architectural limitations, the recent systems are not so flexible to provide device-independent services by multiple service providers. Recently, researchers have focused on a new service paradigm characterized by high mobility, service continuity, and green characteristics. In line with these efforts, improved context-aware service platforms have been suggested to make the platform possible to manage the contexts to provide the adaptive services for multi-user and locations. However, this platform can only support limited continuity and mobility. In other words, the existing system cannot support seamless service provision among different service providers with respect to the changes of mobility, situation, device, and network. Furthermore, the existing context-aware service platform is significant reliance on always-on infrastructure, which leads to great amounts of energy consumption inevitably. Therefore, we subsequently propose a new concept of context-aware networking and communications, namely a zone-aware service platform. The proposed platform autonomously reconfigures the infrastructure and maintains a service session interacting with the middleware to support cost- and energy-efficient pervasive services for smart-home sustainability.

  4. Home visiting programs for HIV-affected families: a comparison of service quality between volunteer-driven and paraprofessional models.

    Science.gov (United States)

    Kidman, Rachel; Nice, Johanna; Taylor, Tory; Thurman, Tonya R

    2014-10-02

    Home visiting is a popular component of programs for HIV-affected children in sub-Saharan Africa, but its implementation varies widely. While some home visitors are lay volunteers, other programs invest in more highly trained paraprofessional staff. This paper describes a study investigating whether additional investment in paraprofessional staffing translated into higher quality service delivery in one program context. Beneficiary children and caregivers at sites in KwaZulu-Natal, South Africa were interviewed after 2 years of program enrollment and asked to report about their experiences with home visiting. Analysis focused on intervention exposure, including visit intensity, duration and the kinds of emotional, informational and tangible support provided. Few beneficiaries reported receiving home visits in program models primarily driven by lay volunteers; when visits did occur, they were shorter and more infrequent. Paraprofessional-driven programs not only provided significantly more home visits, but also provided greater interaction with the child, communication on a larger variety of topics, and more tangible support to caregivers. These results suggest that programs that invest in compensation and extensive training for home visitors are better able to serve and retain beneficiaries, and they support a move toward establishing a professional workforce of home visitors to support vulnerable children and families in South Africa.

  5. A descriptive retrospective study of time consumption in home care services: how do employees use their working time?

    Science.gov (United States)

    Holm, Solrun G; Angelsen, Ragnhild O

    2014-09-26

    Home care services in Norway are provided for free, and municipalities are responsible for their provision to all those in need of them, in accordance with the Act on Municipal Health and Care Services. The costs of home care services are increasing. Many municipalities are now working to find the best cost-effective solutions to ensure that home care services are of sufficient quality but still affordable. This paper describes how nurses and health workers spend their working time, with a hypothesis that driving time and time required to document details of the care given are underestimated in weekly planning schedules. This article sets out a descriptive retrospective study of day-schedules and driving routes for staff working in home care services. Data were analyzed using GIS. The driving time was between 18% and 26% of working time in municipality A, and between 21% and 23% in municipality B. Visiting time varied between 44% and 62% in municipality A, and 40% and 56% in municipality B. Other tasks, including the legally-required documentation of the care given, varied between 19% and 32% in municipality A and 21% and 38% in municipality B. Overall, 22% of the driving routes in municipality A, and 14% in municipality B, took more time than expected. In municipality A, 22% of the day-schedules underestimated overtime; this figure was 14% in municipality B. In home care services, time taken for driving and to write statutory documentation seems to have been underestimated. Better planning and organization of driving routes would reduce driving time and allow more time for other necessary work.

  6. Recommendations service for chronic disease patient in multimodel sensors home environment.

    Science.gov (United States)

    Hussain, Maqbool; Ali, Taqdir; Khan, Wajahat Ali; Afzal, Muhammad; Lee, Sungyoung; Latif, Khalid

    2015-03-01

    With advanced technologies in hand, there exist potential applications and services built around monitoring activities of daily living (ADL) of elderly people at nursing homes. Most of the elderly people in these facilities are suffering from different chronic diseases such as dementia. Existing technologies are mainly focusing on non-medication interventions and monitoring of ADL for addressing loss of autonomy or well-being. Monitoring and managing ADL related to cognitive behaviors for non-medication intervention are very effective in improving dementia patients' conditions. However, cognitive functions of patients can be improved if appropriate recommendations of medications are delivered at a particular time. Previously we developed the Secured Wireless Sensor Network Integrated Cloud Computing for Ubiquitous-Life Care (SC(3)). SC(3) services were limited to monitoring ADL of elderly people with Alzheimer's disease and providing non-medication recommendations to the patient. In this article, we propose a system called the Smart Clinical Decision Support System (CDSS) as an integral part of the SC(3) platform. Using the Smart CDSS, patients are provided with access to medication recommendations of expert physicians. Physicians are provided with an interface to create clinical knowledge for medication recommendations and to observe the patient's condition. The clinical knowledge created by physicians as the knowledge base of the Smart CDSS produces recommendations to the caregiver for medications based on each patient's symptoms.

  7. Smart parking barrier

    KAUST Repository

    Alharbi, Abdulrazaq M.

    2016-01-01

    positioning of the movable parking barrier, and a parking controller configured to initiate movement of the parking barrier, via the barrier drive. The movable parking barrier can be positioned between a first position that restricts access to the parking

  8. Location Planning Problem of Service Centers for Sustainable Home Healthcare: Evidence from the Empirical Analysis of Shanghai

    Directory of Open Access Journals (Sweden)

    Gang Du

    2015-11-01

    Full Text Available It is of theoretical and practical significance to understand what factors influence the sustainable development of home healthcare services in China. Based on a face-to-face survey, we find that the location planning, which is decisive for the improvement of patient satisfaction, can effectively reduce the risks, as well as the costs of redundant construction and re-construction of service centers for home healthcare and, thus, helps ensure the sustainability of health and the environment. The purposes of this paper are to investigate the existing problem of home healthcare in Shanghai and to find the optimum location planning scheme under several realistic constraints. By considering differentiated services provided by the medical staff at different levels and the degrees of patient satisfaction, a mixed integer programming model is built to minimize the total medical cost. The IBM ILOGCPLEX is used to solve the above model. Finally, a case study of Putuo district in Shanghai is conducted to validate the proposed model and methodology. Results indicate that the model used in this paper can effectively reduce the total medical cost and enhance the medical sustainability, and therefore, the results of the model can be used as a reference for decision makers on the location planning problem of home healthcare services in China.

  9. Hard Times: The Effects of Financial Strain on Home Care Services Use and Participant Outcomes in Michigan

    Science.gov (United States)

    D'Souza, Jennifer C.; James, Mary L.; Szafara, Kristina L.; Fries, Brant E.

    2009-01-01

    Purpose: When government funding for long-term care is reduced, participant outcomes may be adversely affected. We investigated the effect of program resources on individuals enrolled in the Michigan Home- and Community-Based Services (HCBS) waiver program for elderly and disabled adults. Design and Methods: Using dates of major policy and budget…

  10. 76 FR 41032 - Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and...

    Science.gov (United States)

    2011-07-12

    ... documentation must also describe how the health status of the recipient at the time of the face-to-face... [CMS 2348-P] RIN 0938-AQ36 Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy... document the existence of a face-to-face encounter (including through the use of telehealth) with the...

  11. Give Water a Hand. Home Site Action Guide. Organizing Water Conservation and Pollution Prevention Service Projects in Your Community.

    Science.gov (United States)

    Wisconsin Univ., Madison. Coll. of Agricultural and Life Sciences.

    Students grades 4-8 can use this guide to explore the topics of water and water conservation within the home while conducting an environmental community service project. Youth groups, led by a group leader, work with local experts from business, government, or environmental organizations to complete the project. Nine activity sections involve…

  12. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

    Directory of Open Access Journals (Sweden)

    Barbara Gomes

    Full Text Available BACKGROUND: Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. OBJECTIVES: 1. to quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarize the current evidence on cost-effectiveness. METHODS: Search methods: We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria: We included randomised controlled trials (RCTs, controlled clinical trials (CCTs, controlled before and after studies (CBAs and interrupted time series (ITSs evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis: One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs for the primary outcome (death at home. MAIN RESULTS: We identified 23 studies (16 RCTs, 6 of high quality, including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure

  13. Parking management : strategies, evaluation and planning

    International Nuclear Information System (INIS)

    Litman, T.A.

    2006-01-01

    Parking facilities are a major cost to society. Current planning practices are based on the assumption that parking should be abundant and provided free, with costs borne indirectly. This report examined parking management strategies related to integrated parking plans. Problems with current parking planning practices were reviewed. The costs of parking facilities were examined, as well as the savings that can accrue from improved management techniques. Strategies included shared parking; remote parking and shuttle services; walking and cycling improvements; improved enforcement and control; and increasing the capacity of existing parking facilities. Parking pricing methods, financial incentives and parking tax reforms were reviewed. Issues concerning user information and marketing were examined. Overflow parking plans were evaluated. Three illustrative examples of parking management programs were outlined, along with details of implementation, planning and evaluation procedures. It was concluded that cost-effective parking management programs can often reduce parking requirements by 20 to 40 per cent compared with conventional planning requirements, in addition to providing economic, social and environmental benefits. 32 refs., 7 tabs., 3 figs

  14. Park Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Parks Districts layer is part of a dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature classes for...

  15. When the clinic becomes a home. Successful VCT and ART services in a stressful environment.

    Science.gov (United States)

    Dapaah, Jonathan Mensah; Spronk, Rachel

    2016-12-01

    With the upscaling of antiretroviral therapy (ART) in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call 'home'. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country's highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013). 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA). The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their 'therapy management group' [Janzen, J. M. (1987). Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1), 68-84]. The clients have thus created a fictive family within the clinic - made up of health workers (as 'parents'), the clients themselves (as 'children') and the peer educators (as 'aunts' and 'uncles'). In the face of persistent stigma associated with HIV infection in Ghana, the use of the

  16. Quality of working life and workload in home help services: a review of the literature and a proposal for a research model.

    NARCIS (Netherlands)

    Arts, S.E.J.; Kerkstra, A.; Zee, J. van der; Huyer Abu-Saad, H.

    2001-01-01

    In this literature review, several models for quality of working life and workload appropriate for home help services are presented. The aim was to develop a model for assessing the psychological and physical outcomes of working in home help services. Although the models described in this review

  17. Using benchmarking to assist the improvement of service quality in home support services for older people-IN TOUCH (Integrated Networks Towards Optimising Understanding of Community Health).

    Science.gov (United States)

    Jacobs, Stephen P; Parsons, Matthew; Rouse, Paul; Parsons, John; Gunderson-Reid, Michelle

    2018-04-01

    Service providers and funders need ways to work together to improve services. Identifying critical performance variables provides a mechanism by which funders can understand what they are purchasing without getting caught up in restrictive service specifications that restrict the ability of service providers to meet the needs of the clients. An implementation pathway and benchmarking programme called IN TOUCH provided contracted providers of home support and funders with a consistent methodology to follow when developing and implementing new restorative approaches for service delivery. Data from performance measurement was used to triangulate the personal and social worlds of the stakeholders enabling them to develop a shared understanding of what is working and what is not. The initial implementation of IN TOUCH involved five District Health Boards. The recursive dialogue encouraged by the IN TOUCH programme supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Investigation on nursing service satisfaction of the elderly living in nursing home and influencing factors--Taking Zhengzhou City as an example

    Directory of Open Access Journals (Sweden)

    Xing Wenhui

    2016-01-01

    Full Text Available Objective: Investigate the status quo of the elderly living in the nursing home and their satisfaction and needs of nursing services, and analyze the service needs of the elderly living in the nursing home of Zhengzhou City. Methods: Randomly select 312 elderly people from 84 nursing homes for questionnaire survey and in-depth interview. Results: More than 60% of the respondents show their satisfaction on the current life in the nursing home. Sex, occupation, physical condition, dietary level, accommodation level, service level and health care conditions of the nursing home have a significant impact on the satisfaction of the elderly. Conclusion: With the growth of the aging of population, improving the level of service for the elderly and improve the service facilities is an essential way to improve the satisfaction and urgent needs of the elderly.

  19. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

    Science.gov (United States)

    Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

    2017-01-01

    Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs

  20. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

    Directory of Open Access Journals (Sweden)

    Heidi H. Ewen

    2017-03-01

    Full Text Available Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%, homemaker services (19%, and transportation services (18%. More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and

  1. Green spaces are not all the same for the provision of air purification and climate regulation services: The case of urban parks.

    Science.gov (United States)

    Vieira, Joana; Matos, Paula; Mexia, Teresa; Silva, Patrícia; Lopes, Nuno; Freitas, Catarina; Correia, Otília; Santos-Reis, Margarida; Branquinho, Cristina; Pinho, Pedro

    2018-01-01

    The growing human population concentrated in urban areas lead to the increase of road traffic and artificial areas, consequently enhancing air pollution and urban heat island effects, among others. These environmental changes affect citizen's health, causing a high number of premature deaths, with considerable social and economic costs. Nature-based solutions are essential to ameliorate those impacts in urban areas. While the mere presence of urban green spaces is pointed as an overarching solution, the relative importance of specific vegetation structure, composition and management to improve the ecosystem services of air purification and climate regulation are overlooked. This avoids the establishment of optimized planning and management procedures for urban green spaces with high spatial resolution and detail. Our aim was to understand the relative contribution of vegetation structure, composition and management for the provision of ecosystem services of air purification and climate regulation in urban green spaces, in particular the case of urban parks. This work was done in a large urban park with different types of vegetation surrounded by urban areas. As indicators of microclimatic effects and of air pollution levels we selected different metrics: lichen diversity and pollutants accumulation in lichens. Among lichen diversity, functional traits related to nutrient and water requirements were used as surrogates of the capacity of vegetation to filter air pollution and to regulate climate, and provide air purification and climate regulation ecosystem services, respectively. This was also obtained with very high spatial resolution which allows detailed spatial planning for optimization of ecosystem services. We found that vegetation type characterized by a more complex structure (trees, shrubs and herbaceous layers) and by the absence of management (pruning, irrigation and fertilization) had a higher capacity to provide the ecosystems services of air

  2. Home-based music therapy--a systematic overview of settings and conditions for an innovative service in healthcare.

    Science.gov (United States)

    Schmid, Wolfgang; Ostermann, Thomas

    2010-10-14

    Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT) programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from music therapists, patients and their

  3. 36 CFR 3.9 - May I operate my personal watercraft (PWC) in park waters?

    Science.gov (United States)

    2010-07-01

    ... watercraft (PWC) in park waters? 3.9 Section 3.9 Parks, Forests, and Public Property NATIONAL PARK SERVICE...) in park waters? (a) A person may operate a PWC only in park areas where authorized by special... on park waters is subject to the following conditions: (1) No person may operate a PWC unless each...

  4. [An Integrative Review of Home Care Service for Pregnant Women, Mothers, Infants, and Toddlers in Vulnerable Group].

    Science.gov (United States)

    Kim, Dasom; Lee, Insook

    2017-10-01

    This study was intended to integrate the evidence of home care service intervention for mothers and children in vulnerable groups through an integrative literature review. We searched the MEDLINE (PubMED), EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, DBpia databases. The quality of the articles was assessed by one doctoral researcher and verified by one professor of community health nursing who had participated in the systematic review of literature. A framework was developed to identify the intervention patterns in the selected papers and categorize various elements. The extracted intervention elements were grouped into potential themes, which were verified by assessors on whether they clearly reflected the interventions in the papers. Among 878 searched papers, we selected 16 papers after excluding literature that does not satisfy the selection criteria and quality evaluation. The intervention elements of 16 selected papers were categorized into six themes. The extracted intervention elements were divided into the themes of Patient-specific/Situation-specific care planning and intervention, Emphasis on self care competency, Intense home visit by developmental milestone, Reinforcing and modeling mother-child attachment, Communication and interaction across the intervention, Linkage with community resource and multidisciplinary approach. As a result of the analysis of proper interventions of home care services for mothers and children in vulnerable groups, it was found that it is necessary to consider indispensable intervention elements that can standardize the quality of home care services, and conduct studies on developing intervention programs based on the elements. © 2017 Korean Society of Nursing Science

  5. Occupational accidents among nursing professionals in a home care service in the state of São Paulo

    OpenAIRE

    Jéssica Fernanda Corrêa Cordeiro; Amanda Pavinsk Alves; Emília Maria Paulina Campos Chayamiti; Diego Oliveira Miranda; Elucir Gir; Silvia Rita Marin da Silva Canini

    2016-01-01

    This is a cross-sectional study whose objective is to identify and describe accidents with biological material as told by nursing professionals in a home care service in a city in the state of São Paulo. Of the 30 subjects who provided that service in the data collection period, 28 agreed to participate and 12 (42.8%) claimed to have suffered at least one accident with biological material while carrying out professional procedures for that service. Most of the exposures were percutaneous (91....

  6. Evaluation of aggression in Australian after-hours doctor home-visit services.

    Science.gov (United States)

    Ifediora, Chris O

    2018-04-01

    Minimizing the risks and distress arising from aggression in after-hours house call (AHHC) services will help improve service quality in the industry. Unfortunately, no national study has ever evaluated this in Australian AHHCs. Apart from reducing this gap, findings from this work will have global relevance given the rising popularity of the AHHC industry worldwide. A survey of all 300 doctors employed by the National Home Doctor Service, Australia's largest AHHC service provider. A validated electronic questionnaire was used to examine the doctors' experiences over a 12-month period. There were 168 valid responses (56% response rate). Aggression prevalence was 47.1%, and just over half (51.8%) of the cases came from the patients. "Verbal aggression" was the commonest (48.3%). Others are "threats" (26.6%), "vexatious complaints" (13.3%), "property damage" (4.2%), "physical violence" (4.2%), "sexual harassment" (2.8%), and "stalking" (0.7%). Majority of the respondents were concerned (90.2%) and apprehensive (75.2%) regarding the risks. Doctors who have experienced aggression were more likely to express apprehension (OR = 3.99; CI = 1.54-10.31; P = 0.004), while those that have attained Postgraduate Fellowships (Vocationally Registered) were less likely to report experiences of aggression (OR = 0.28; CI = 0.09-0.84; P = 0.02). Even though a higher proportion of females were concerned (92.3% vs 89.6%) and apprehensive (82.1% vs 73.6%) compared with males, these differences were not statistically significant (Fisher's Exact Tests: P = 1.000 and 0.469, respectively). Aggression in Australian AHHC affects nearly 1-in-2 practitioners, with high levels of concern and apprehension being expressed. Concerned companies should do more to ensure that their doctors attain PG fellowships, as this is linked to lower reports of aggression. Where possible, family and friends need to be involved in patient care, as nearly half of the reported aggressions come from

  7. People diagnosed with dementia in Sweden: What type of home care services and housing are they granted? A cross-sectional study.

    Science.gov (United States)

    Odzakovic, Elzana; Hydén, Lars-Christer; Festin, Karin; Kullberg, Agneta

    2018-02-01

    This study aims to examine what types of home care services and housing are granted to people with a dementia diagnosis and how these types are associated with socio-demographic factors (sex, age, marital status, native or foreign born, and regional area). A cross-sectional study of all people diagnosed with dementia in three Swedish counties was conducted from the medical records in 2012. Logistic regression analysis was carried out to investigate associations between home care services and housing and socio-demographic variables. In total, 17,405 people had a dementia diagnosis, and the majority were women, aged 80+ years, and unmarried. Some 72% were living in ordinary housing and 28% lived in special housing. Of those who lived in ordinary housing, 50% did not receive any home care service. Not receiving any type of home care services was less common for older people and was also associated with being married and living in rural municipalities. The most common home care services granted were home help and personal care. Special housing was more common for older people, unmarried persons, and those living in rural municipalities. Most people with a dementia diagnosis were living in ordinary housing, and, surprisingly, half of those did not receive any type of home care service. This knowledge is essential for making the living conditions and needs of people living with dementia more visible and to provide good home care services for people with dementia and their families.

  8. Automated Car Park Management System

    Science.gov (United States)

    Fabros, J. P.; Tabañag, D.; Espra, A.; Gerasta, O. J.

    2015-06-01

    This study aims to develop a prototype for an Automated Car Park Management System that will increase the quality of service of parking lots through the integration of a smart system that assists motorist in finding vacant parking lot. The research was based on implementing an operating system and a monitoring system for parking system without the use of manpower. This will include Parking Guidance and Information System concept which will efficiently assist motorists and ensures the safety of the vehicles and the valuables inside the vehicle. For monitoring, Optical Character Recognition was employed to monitor and put into list all the cars entering the parking area. All parking events in this system are visible via MATLAB GUI which contain time-in, time-out, time consumed information and also the lot number where the car parks. To put into reality, this system has a payment method, and it comes via a coin slot operation to control the exit gate. The Automated Car Park Management System was successfully built by utilizing microcontrollers specifically one PIC18f4550 and two PIC16F84s and one PIC16F628A.

  9. The Impact of Fear of Falling on Functional Independence Among Older Adults Receiving Home Health Services

    Directory of Open Access Journals (Sweden)

    Katherine A. Lawson OTR, LMSSW, PhD

    2014-07-01

    Full Text Available Background: Falls are the fifth leading cause of death for adults aged 65 years and older. Several intrinsic and extrinsic fall risk factors have been identified, butthere is less understanding of the impact of a fear of falling on falls. Seventy percent of recent fallers and 40% percent of non-fallers report a fear of falling. Therefore, the purpose of this study was to examine the correlation between a fear of falling and a history of falls, as well as the impact on the functional independence of community-dwelling older adults receiving home health services. Methods: The participants completed the Falls Efficacy Scale, the Modified Timed Up and Go Test, self- reported fear of falling, and the KATZ ADL-staircase. The participants were primarily Hispanic females. Results: There was not a significant correlation between a fear of falling and a history of falls. Only participants' age, gender, and the number of medical diagnoses were predictive of past falls. There was a moderate correlation between impaired functional mobility and dependence with activities of daily living (ADL. Additionally, a fear of falling was associated with dependence to perform ADLs as measured objectively. Conclusion: Future studies need to examine the effectiveness of interventions that include dual-task challenges during therapeutic interventions and ADL retraining to reduce fall risk among older adults.

  10. Service quality, satisfaction, and behavioral intention in home delivered meals program

    Science.gov (United States)

    Joung, Hyun-Woo; Yuan, Jingxue Jessica; Huffman, Lynn

    2011-01-01

    This study was conducted to evaluate recipients' perception of service quality, satisfaction, and behavioral intention in home delivered meals program in the US. Out of 398 questionnaires, 265 (66.6%) were collected, and 209 questionnaires (52.5%) were used for the statistical analysis. A Confirmatory Factor Analysis (CFA) with a maximum likelihood was first conducted to estimate the measurement model by verifying the underlying structure of constructs. The level of internal consistency in each construct was acceptable, with Cronbach's alpha estimates ranging from 0.7 to 0.94. All of the composite reliabilities of the constructs were over the cutoff value of 0.50, ensuring adequate internal consistency of multiple items for each construct. As a second step, a Meals-On-Wheels (MOW) recipient perception model was estimated. The model's fit as indicated by these indexes was satisfactory and path coefficients were analyzed. Two paths between (1) volunteer issues and behavioral intention and (2) responsiveness and behavioral intention were not significant. The path for predicting a positive relationship between food quality and satisfaction was supported. The results show that having high food quality may create recipient satisfaction. The findings suggest that food quality and responsiveness are significant predictors of positive satisfaction. Moreover, satisfied recipients have positive behavioral intention toward MOW programs. PMID:21556231

  11. Service quality, satisfaction, and behavioral intention in home delivered meals program.

    Science.gov (United States)

    Joung, Hyun-Woo; Kim, Hak-Seon; Yuan, Jingxue Jessica; Huffman, Lynn

    2011-04-01

    This study was conducted to evaluate recipients' perception of service quality, satisfaction, and behavioral intention in home delivered meals program in the US. Out of 398 questionnaires, 265 (66.6%) were collected, and 209 questionnaires (52.5%) were used for the statistical analysis. A Confirmatory Factor Analysis (CFA) with a maximum likelihood was first conducted to estimate the measurement model by verifying the underlying structure of constructs. The level of internal consistency in each construct was acceptable, with Cronbach's alpha estimates ranging from 0.7 to 0.94. All of the composite reliabilities of the constructs were over the cutoff value of 0.50, ensuring adequate internal consistency of multiple items for each construct. As a second step, a Meals-On-Wheels (MOW) recipient perception model was estimated. The model's fit as indicated by these indexes was satisfactory and path coefficients were analyzed. Two paths between (1) volunteer issues and behavioral intention and (2) responsiveness and behavioral intention were not significant. The path for predicting a positive relationship between food quality and satisfaction was supported. The results show that having high food quality may create recipient satisfaction. The findings suggest that food quality and responsiveness are significant predictors of positive satisfaction. Moreover, satisfied recipients have positive behavioral intention toward MOW programs.

  12. Changes in commitment to change among leaders in home help services.

    Science.gov (United States)

    Westerberg, Kristina; Tafvelin, Susanne

    2015-07-06

    The purpose of the this study was to explore the development of commitment to change among leaders in the home help services during organizational change and to study this development in relation to workload and stress. During organizational change initiatives, commitment to change among leaders is important to ensure the implementation of the change. However, little is known of development of commitment of change over time. The study used a qualitative design with semi-structured interviews with ten leaders by the time an organizational change initiative was launched and follow-up one year later. Thematic content analysis was used to analyze the interviews. Commitment to change is not static, but seems to develop over time and during organizational change. At the first interview, leaders had a varied pattern reflecting different dimensions of commitment to change. One year later, the differences between leaders' commitment to change was less obvious. Differences in commitment to change had no apparent relationship with workload or stress. The data were collected from one organization, and the number of participants were small which could affect the results on workload and stress in relation to commitment to change. It is important to support leaders during organizational change initiatives to maintain their commitment. One way to accomplish this is to use management team meetings to monitor how leaders perceive their situation. Qualitative, longitudinal and leader studies on commitment to change are all unusual, and taken together, this study shows new aspects of commitment.

  13. A Study on the Relationship between Customer Satisfaction and Employee Service Delivery at Sutera Sanctuary Lodges’s Front Office Department at Kinabalu Park, Kundasang, Sabah, Malaysia

    Directory of Open Access Journals (Sweden)

    Alaska Adrian Kalasa

    2014-01-01

    Full Text Available The purpose of this study is focused on the customer service delivery by staff of front office department of Sutera Sanctuary Lodges, at Kinabalu Park, Kundasang, and Sabah, Malaysia. It will look into the attitude, skills and knowledge of the staff on customer service delivery and its effect on customer satisfaction. There are gaps that were identified from the findings; the front line staff has English language issues. The low rating for knowledge and skills in their work area are a concern. As a three (3 Orchid rated lodges operation the standard and quality should not be compromised. There is a positive relationship of customer satisfaction and employee service delivery. Rating of poor service delivery has been noted in the survey in anticipating guests need with 1% below expectation, Speed and efficiency of check-in process with 1% rated below expectation, welcoming and greeting with 11% below expectation. This includes courtesy, helpfulness of staff and grooming all rated 4% in below expectation.

  14. Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain.

    Science.gov (United States)

    Aiken, Abigail R A; Guthrie, Katherine A; Schellekens, Marlies; Trussell, James; Gomperts, Rebecca

    2018-02-01

    To examine reasons for seeking abortion services outside the formal healthcare system in Great Britain, where abortion is legally available. We conducted a mixed-methods study among women resident in England, Scotland, and Wales who requested at-home medication abortion through online telemedicine initiative Women on Web (WoW) between November 22, 2016, and March 22, 2017. We examined the demographics and circumstances of all women requesting early medication abortion and conducted a content analysis of a sample of their anonymized emails to the service to explore their reasons for seeking help. Over a 4-month period, 519 women contacted WoW seeking medication abortion. These women were diverse with respect to age, parity, and circumstance. One hundred eighty women reported 209 reasons for seeking abortion outside the formal healthcare setting. Among all reasons, 49% were access barriers, including long waiting times, distance to clinic, work or childcare commitments, lack of eligibility for free NHS services, and prior negative experiences of abortion care; 30% were privacy concerns, including lack of confidentiality of services, perceived or experienced stigma, and preferring the privacy and comfort of using pills at home; and 18% were controlling circumstances, including partner violence and partner/family control. Despite the presence of abortion services in Great Britain, a diverse group of women still experiences logistical and personal barriers to accessing care through the formal healthcare system, or prefer the privacy of conducting their abortions in their own homes. Health services commissioning bodies could address existing barriers if supported by policy frameworks. The presence of multiple barriers to accessing abortion care in Great Britain highlights the need for future guidelines to recommend a more woman-centered approach to service provision. Reducing the number of clinic visits and designing services to meet the needs of those living in

  15. Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.

    Science.gov (United States)

    Becker, Stan; Taulo, Frank O; Hindin, Michelle J; Chipeta, Effie K; Loll, Dana; Tsui, Amy

    2014-12-20

    HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors. This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences. 89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p emotional closeness to partner (p contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.

  16. Heterogeneous Parking Market Subject to Parking Rationing

    Directory of Open Access Journals (Sweden)

    Saeed Asadi Bagloee

    2015-01-01

    Full Text Available Different types of drivers and parking spaces delineate a heterogeneous parking market for which the literature has yet to provide a model applicable to the real world. The main obstacle is computational complexities of considering various parking restrictions along with traffic congestion on the road network. In this study, the heterogeneity aspects are considered within a Logit parking choice model. A mathematical programming problem was introduced to explicitly consider parking capacities and parking rationing constraints. The parking rationing is defined as any arrangement to reserve parking space for some specific demand such as parking permit, private parking, VIP parking, and different parking durations. Introduction of parking rationing in the presence of other constraints is a unique factor in this study which makes the model more realistic. The algorithm was tested on a central business district case study. The results prove that the algorithm is able to converge rapidly. Among the algorithm’s output are shadow prices of the parking capacity and parking rationing constraints. The shadow prices contain important information which is key to addressing a variety of parking issues, such as the location of parking shortages, identification of fair parking charges, viability of parking permits, and the size of reserved parking.

  17. ParkIndex

    DEFF Research Database (Denmark)

    Kaczynski, Andrew T; Schipperijn, Jasper; Hipp, J Aaron

    2016-01-01

    using ArcGIS 9.3 and the Community Park Audit Tool. Four park summary variables - distance to nearest park, and the number of parks, amount of park space, and average park quality index within 1 mile were analyzed in relation to park use using logistic regression. Coefficients for significant park......, planners, and citizens to evaluate the potential for park use for a given area. Data used for developing ParkIndex were collected in 2010 in Kansas City, Missouri (KCMO). Adult study participants (n=891) reported whether they used a park within the past month, and all parks in KCMO were mapped and audited...

  18. The Labor-saving Kitchen: Sources for Designs of the Architects’ Small Home Service Bureau

    Directory of Open Access Journals (Sweden)

    Lisa M. Tucker

    2014-12-01

    Full Text Available The history of the kitchen has received much attention from designers and design historians. Since the writings of Catharine Beecher, designers, household engineers, and others have written about the importance of the kitchen as the center of the home. This research traces the impact of the writings of theorists such as Frederick Taylor, Georgie Boynton Child, Helen Binkerd Young, and Christine Frederick on the designs produced by the architects in the first quarter of the 20th century.  Frederick’s work took the concept of an efficient kitchen to a new level applying movement studies and introducing new ideas to the kitchen layout and arrangement.  In a properly laid out and equipped kitchen, steps were saved by placing kitchen cabinets, ovens and stoves, refrigerators and sinks where they were needed in the sequence of food preparation and delivery to dining table as well as clean up after the meal.  In her books, she also provided advice on a variety of considerations, such as appliances and accessories, lighting and ventilation; materials, finishes and color; and appliances and equipment.  In 1919 a group of architects dedicated to improving the housing stock in the United States through good design banded together to form the Architects’ Small House Service Bureau (ASHSB.  Their first plan book, How to Plan Finance and Build your Home published in 1921, also encouraged labor-saving kitchen design and provided advice on kitchen design. The research reported here assesses how the influence of Frederick and Boyton’s advice as reflected in the work of and interpreted by Helen Binkerd Young is demonstrated in the kitchen designs of the ASHSB’s first plan book. A plan content analysis instrument, developed using Frederick’s writings and edited to include other variables from Young and Child, is used to analyze the 99 kitchens and two essays in the ASHSB’s plan book.  The plans and accompanying comments evidence enthusiasm for

  19. A City Parking Integration System Combined with Cloud Computing Technologies and Smart Mobile Devices

    Science.gov (United States)

    Yeh, Her-Tyan; Chen, Bing-Chang; Wang, Bo-Xun

    2016-01-01

    The current study applied cloud computing technology and smart mobile devices combined with a streaming server for parking lots to plan a city parking integration system. It is also equipped with a parking search system, parking navigation system, parking reservation service, and car retrieval service. With this system, users can quickly find…

  20. Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents' Involvement in Home Visiting Services.

    Science.gov (United States)

    McKelvey, Lorraine M; Fitzgerald, Shalese; Conners Edge, Nicola A; Whiteside-Mansell, Leanne

    2018-05-28

    Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent-child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (B = .1, SE = .03, p < .001) months, such that there was a stronger positive association for depressed parents. The main effects of child development focused content and retention at 6 (B = .07, SE = .01, p < .001) and 12 (B = .08, SE = .01, p < .001) months were positive, while effects of case management focused content at 6 (B = - .06, SE = .01, p < .001) and 12 (B = - .07, SE = .01, p < .001) months were negative. Conclusions Families were more likely to be retained when home visitors focused on child development and parent-child interaction, but less likely with more case management focus. Parents with positive depression screens were more likely to remain in services with more time spent focused on supporting parent-child interactions.

  1. A case of community-based fall prevention: Survey of organization and content of minor home help services in Swedish municipalities.

    Science.gov (United States)

    Bernfort, Lars; Eckard, Nathalie; Husberg, Magnus; Alwin, Jenny

    2014-11-01

    The aim of this study was to survey minor home help services provided by Swedish municipalities with the main purpose to prevent fall injuries. If minor home help services were presented on the homepage of a municipality, an initial telephone contact was taken. Thereafter a questionnaire was administered, including questions about target groups, aim with the services, tasks included, costs and restrictions for users, budget, and experienced gains with the services. Municipalities not providing minor home help services were asked about the reason therefore and if the municipality had previously provided the services Results: The questionnaire response rate was 92%. In 191 of Sweden's 290 municipalities services were provided by, or in cooperation with, the municipality. Reasons for not providing the services were mainly financial and lack of demand. Services were more often provided in larger cities and in municipalities located in populous regions. In some municipalities services were performed by persons with functional disabilities or unemployed persons. Both providers and users expressed satisfaction with the services aspects expressed were that services lead to greater sense of safety and social gains the effect of the services in terms of fall prevention is yet to be proved with only a small fall-preventive effect services are probably cost-effective improved quality of life, sense of safety, and being able to offer meaningful work to otherwise unemployed persons are important aspects that might in themselves motivate the provision of minor home help services. © 2014 the Nordic Societies of Public Health.

  2. Maryon Park

    OpenAIRE

    Bertoli, Giasco

    2018-01-01

    Tiré du site Internet de Onestar Press: "Maryon Park is the place Michelangelo Antonioni chose, in 1966, to shoot the scenes that would become cult images from his film "Blow Up", and deservedly so. The park is located in Charlton, southeast of London, a place that's hardly changed since Antonioni shot there. I first went there to shoot a series of photos on March 7 and 8, 2007. I returned again on March 7, 2014. I called the series “Maryon Park”. I used a medium format, six by seven inch col...

  3. Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study.

    Science.gov (United States)

    Keogh, B; Callaghan, P; Higgins, A

    2015-11-01

    What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms. Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the

  4. Measurement of special access to home visit nursing services among Japanese disabled elderly people: using GIS and claim data.

    Science.gov (United States)

    Naruse, Takashi; Matsumoto, Hiroshige; Fujisaki-Sakai, Mahiro; Nagata, Satoko

    2017-05-30

    Home care service demands are increasing in Japan; this necessitates improved service allocation. This study examined the relationship between home visit nursing (HVN) service use and the proportion of elderly people living within 10 min' travel of HVN agencies. The population of elderly people living within reach of HVN agencies for each of 17 municipalities in one low-density prefecture was calculated using public data and geographic information systems. Multilevel logistic analysis for 2641 elderly people was conducted using medical and long-term care insurance claims data from October 2010 to examine the association between the proportion of elderly people reachable by HVNs and service usage in 13 municipalities. Municipality variables included HVN agency allocation appropriateness. Individual variables included HVN usage and demographic variables. The reachable proportion of the elderly population ranged from 0.0 to 90.2% in the examined municipalities. The reachable proportion of the elderly population was significantly positively correlated with HVN use (odds ratio: 1.938; confidence interval: 1.265-2.967). Residents living in municipalities with a lower reachable proportion of the elderly population are less likely to use HVN services. Public health interventions should increase the reachable proportion of the elderly population in order to improve HVN service use.

  5. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia.

    Science.gov (United States)

    Mihic, Marko M; Todorovic, Marija Lj; Obradovic, Vladimir Lj; Mitrovic, Zorica M

    2016-01-01

    Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.

  6. Linking Structure, Process, and Outcome to Improve Group Home Services for Foster Youth in California

    Science.gov (United States)

    Green, Rex S.; Ellis, Peter T.

    2007-01-01

    The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service…

  7. Utilisation of home-based physician, nurse and personal support worker services within a palliative care programme in Ontario, Canada: trends over 2005-2015.

    Science.gov (United States)

    Sun, Zhuolu; Laporte, Audrey; Guerriere, Denise N; Coyte, Peter C

    2017-05-01

    With health system restructuring in Canada and a general preference by care recipients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. A multidisciplinary team of health professionals is the most common delivery model for home-based palliative care in Canada. However, little is known about the changing temporal trends in the propensity and intensity of home-based palliative care. The purpose of this study was to assess the propensity to use home-based palliative care services, and once used, the intensity of that use for three main service categories: physician visits, nurse visits and care by personal support workers (PSWs) over the last decade. Three prospective cohort data sets were used to track changes in service use over the period 2005 to 2015. Service use for each category was assessed using a two-part model, and a Heckit regression was performed to assess the presence of selectivity bias. Service propensity was modelled using multivariate logistic regression analysis and service intensity was modelled using log-transformed ordinary least squares regression analysis. Both the propensity and intensity to use home-based physician visits and PSWs increased over the last decade, while service propensity and the intensity of nurse visits decreased. Meanwhile, there was a general tendency for service propensity and intensity to increase as the end of life approached. These findings demonstrate temporal changes towards increased use of home-based palliative care, and a shift to substitute care away from nursing to less expensive forms of care, specifically PSWs. These findings may provide a general idea of the types of services that are used more intensely and require more resources from multidisciplinary teams, as increased use of home-based palliative care has placed dramatic pressures on the budgets of local home and community care organisations. © 2016 John Wiley & Sons Ltd.

  8. Incidence and seasonality of falls amongst old people receiving home help services in a municipality in northern Sweden

    OpenAIRE

    Vikman, Irene; Nordlund, Anders; Näslund, Annika; Nyberg, Lars

    2011-01-01

    Artikkelen omhandler en studie hvor hensikten var å undersøke forekomst, inkludert variasjoner ad sesonger, omstendigheter og skader relatert til fall hos eldre som bor hjemme og mottar hjemmesykepleie, samt undersøke om det er en sammenheng mellom fall og type/omfang hjelp fra hjemmesykepleien. Objectives: falls among old people is a well-documented phenomenon; however, falls among people living in the community and receiving home help services have been under-researched. The aim of this ...

  9. Evaluating the Implementation of Home-Based Videoconferencing for Providing Mental Health Services.

    Science.gov (United States)

    Interian, Alejandro; King, Arlene R; St Hill, Lauren M; Robinson, Claire H; Damschroder, Laura J

    2018-01-01

    The Veterans Health Administration (VHA) has recently implemented video-to-home (V2H) telehealth as part of a strategy to improve access to mental health treatment. Implementation research of this modality is needed, given that V2H telehealth transforms the traditional face-to-face delivery of mental health services. To address this need, V2H implementation was evaluated by examining barriers and facilitators that were associated with level of staff V2H experience and factors that differentiated facilities with various levels of V2H performance. Semistructured interviews with VHA personnel (N=33) from three facilities were conducted. The facilities were selected by overall number of mental health V2H visits during fiscal year (FY) 2015 as well as by growth in number of visits from FY 2014 through FY 2015. Factors influencing implementation were identified through qualitative analyses that contrasted responses by groups of participants with three different levels of V2H experience (no experience, limited experience, most experience) as well as three facilities that differed in V2H productivity (high visit count, high visit growth, and low visit count and low visit growth). Providers seemed to encounter different barriers and facilitators depending on their level of experience with V2H. Site-level analyses illustrated the importance of logistical support, especially for providers who are newly adopting the technology. Other factors that differentiated the facilities were also identified and described. Key factors related to implementation of V2H telehealth pertained to provider buy-in and logistical support. Facility-level strategies that address these factors may enhance provider progression from nonuse to sustained use.

  10. Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

    Science.gov (United States)

    Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

    2018-04-06

    Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

  11. The Swedish municipal food distribution service to the elderly living at home as experienced by the recipient's relatives.

    Science.gov (United States)

    Pajalic, Zada

    2013-07-23

    The municipal Food distribution service (FD) to the elderly living at home is a part of the public social and care service in Sweden, The objective of this service is to ensure proper food intake for persons who are unable to do their own shopping, and prepare their own meals. The foremost reasons for the need of the FD service are in situations where there are illness related physical or psychological limitations.This means that the Swedish welfare system takes on the responsibility for its citizens when they have a legal social related need of care. Further, according to the Swedish social legislation, children or other relatives have no legal obligations to take care of their parents or elderly disabled relatives. This also means that the children or relatives of elderly people requiring social support have no legal right to be involved in the evaluation procedure of need assessment or the outcome of any social and care services granted by the Swedish social welfare system. The aim of the present study was to gain insight into how the relatives of elderly people living at home in Sweden experience the municipal service of ready-made meals distributed daily. The data was collected using in-depth interviews with relatives of elderly persons who use the municipal food distribution (FD) service (n=8). The transcribed interview material was analysed using the grounded theory method. The findings of this study revealed that the relatives of the municipal FD service recipients advocate for a food preparation service in the home of the recipient rather than the distribution of ready-made meals from a central kitchen. The results also revealed that the participating relatives felt frustrated by the legal limitations that make it impossible for them to influence the municipal FD service. The findings in this study also indicate that relatives should be considered as a resource in this matter and could actively participate, and have a positive influence on the quality of

  12. Pattern of disability among persons who availed half-way home-care services for psychosocial rehabilitation

    Directory of Open Access Journals (Sweden)

    M Ranganathan

    2012-01-01

    Full Text Available Background: There is dearth of studies related to pattern of disability among persons who availed psychosocial rehabilitation services in India. We studied the pattern of disability among persons who availed half-way home-care services for psychosocial rehabilitation. Materials and Methods: Out of 130 case files of discharged patients, 50 files were randomly selected for data collection. Indian Disability Evaluation and Assessment Schedule was used to assess the pattern of disability in the sample. Results: The study revealed that only one-third (35% of the residents had disability in self-care, 41% in communication and understanding and 47% in interpersonal relationship. Overall, majority (76% of the respondents had moderate level of psychiatric disability at the time of discharge from half-way home. There was no significant relationship between gender and type of psychiatric illness with the level of disability. The overall disability correlated positively with the duration of illness (rs=0.39. Conclusion: Three-fourth of the residents who availed half-way home-care services had moderate level of disability.

  13. Occupational accidents among nursing professionals in a home care service in the state of São Paulo

    Directory of Open Access Journals (Sweden)

    Jéssica Fernanda Corrêa Cordeiro

    2016-10-01

    Full Text Available This is a cross-sectional study whose objective is to identify and describe accidents with biological material as told by nursing professionals in a home care service in a city in the state of São Paulo. Of the 30 subjects who provided that service in the data collection period, 28 agreed to participate and 12 (42.8% claimed to have suffered at least one accident with biological material while carrying out professional procedures for that service. Most of the exposures were percutaneous (91.7% and blood was the most often involved fluid (75%. Regarding procedures, 75% of the individuals were administering drugs when the accident happened and 50% admitted that they were recapping hollow needles. The current study enabled the identification of situations described by the professionals and which led to the occurrence of accidents with biological material during home care. These findings can support preventive measures and guide future studies that involve this type of accident at homes.

  14. Predictors of hospital stay and home care services use: a population-based, retrospective cohort study in stage IV gastric cancer.

    Science.gov (United States)

    Mahar, Alyson L; Coburn, Natalie G; Viola, Raymond; Johnson, Ana P

    2015-02-01

    Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis. To examine disease, patient and healthcare system predictors of hospital stay, and home care services use in metastatic gastric cancer patients. This is a population-based, retrospective cohort study. Chart review and administrative data were linked, using a 26-month time horizon to collect health services data. All patients diagnosed with metastatic gastric cancer in the province of Ontario between 2005 and 2008 were included in the study (n = 1433). Age, comorbidity, tumor location, and burden of metastatic disease were identified as predictors of hospital stay and receipt of home care services. Individuals who received home care services spent fewer days in hospital than individuals who did not (relative risk: 0.44; 95% confidence interval: 0.38-0.51). Patients who interacted with a high-volume oncology specialist had shorter cumulative hospital stay (relative risk: 0.62; 95% confidence interval: 0.54-0.71) and were less likely to receive home care services (relative risk: 0.80; 95% confidence interval: 0.72-0.88) than those who did not. Examining how differences in hospital stay and home care services use impact clinical outcomes and how policies may reduce costs to the healthcare system is necessary. © The Author(s) 2014.

  15. Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services

    Directory of Open Access Journals (Sweden)

    Sandberg L

    2018-05-01

    first language and SDCS factor 5 (lack of recognition and stagnated organizational climate. Conclusion: The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study. Keywords: aging-in-place, home care services, work situation, language, organization, stress

  16. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia

    Directory of Open Access Journals (Sweden)

    Mihic MM

    2016-01-01

    Full Text Available Marko M Mihic, Marija Lj Todorovic, Vladimir Lj Obradovic, Zorica M Mitrovic Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia Background: Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner.Purpose: This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment.Methods: This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method.Results: The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%.Conclusion: This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner. Keywords: home care, social investment, human resources, economic analysis, elderly

  17. Parking guidance - modelling, simulation and impact assessment

    NARCIS (Netherlands)

    Jonkers, E.; Noort, M. van; Veen, J.L. van der

    2011-01-01

    Intelligent parking services that help drivers with reservation of a parking spot, navigation and automated payment have reached the deployment phase. These services may provide significant benefits to drivers and municipalities. Drivers may experience an increase in comfort and lower and more

  18. Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

    Science.gov (United States)

    Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

    2017-11-01

    The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

  19. Long-duration drought variability and impacts on ecosystem services: A case study from Glacier National Park, Montana

    Science.gov (United States)

    Pederson, Gregory T.; Gray, Stephen T.; Fagre, Daniel B.; Graumlich, Lisa J.

    2006-01-01

    Instrumental climate records suggest that summer precipitation and winter snowpack in Glacier National Park (Glacier NP), Montana, vary significantly over decadal to multidecadal time scales. Because instrumental records for the region are limited to the twentieth century, knowledge of the range of variability associated with these moisture anomalies and their impacts on ecosystems and physical processes are limited. The authors developed a reconstruction of summer (June–August) moisture variability spanning a.d. 1540–2000 from a multispecies network of tree-ring chronologies in Glacier NP. Decadal-scale drought and pluvial regimes were defined as any event lasting 10 yr or greater, and the significance of each potential regime was assessed using intervention analysis. Intervention analysis prevents single intervening years of average or opposing moisture conditions from ending what was otherwise a sustained moisture regime. The reconstruction shows numerous decadal-scale shifts between persistent drought and wet events prior to the instrumental period (before a.d. 1900). Notable wet events include a series of three long-duration, high-magnitude pluvial regimes spanning the end of the Little Ice Age (a.d. 1770–1840). Though the late-nineteenth century was marked by a series of >10 yr droughts, the single most severe dry event occurred in the early-twentieth century (a.d. 1917–41). These decadal-scale dry and wet events, in conjunction with periods of high and low snowpack, have served as a driver of ecosystem processes such as forest fires and glacial dynamics in the Glacier NP region.

  20. Home Monitoring and Personal Health Management Services in a Regional Health Telematics Network

    National Research Council Canada - National Science Library

    Traganitis, A

    2001-01-01

    ...), the R&D issues involved in the design, development and implementation of a modular and configurable Home Care Platform that supports different health and social care domains, and the results of the clinical...

  1. Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare

    Directory of Open Access Journals (Sweden)

    Ostermann Thomas

    2010-10-01

    Full Text Available Abstract Background Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. Methods The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. Results A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8, were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. Conclusions We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely

  2. Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare

    Science.gov (United States)

    2010-01-01

    Background Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT) programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. Methods The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. Results A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. Conclusions We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from

  3. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

    Science.gov (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

    2018-02-01

    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  4. Swallowing Function and Nutritional Status in Japanese Elderly People Receiving Home-care Services: A 1-year Longitudinal Study.

    Science.gov (United States)

    Okabe, Y; Furuta, M; Akifusa, S; Takeuchi, K; Adachi, M; Kinoshita, T; Kikutani, T; Nakamura, S; Yamashita, Y

    2016-01-01

    Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care. Prospective observational cohort study with 1-year follow-up. Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012. One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving home-care services because of physical disabilities, without malnutrition. Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model. Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65-16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition. Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.

  5. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

    Science.gov (United States)

    Riolfi, Mirko; Buja, Alessandra; Zanardo, Chiara; Marangon, Chiara Francesca; Manno, Pietro; Baldo, Vincenzo

    2014-05-01

    It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Retrospective cohort study. We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

  6. When the clinic becomes a home. Successful VCT and ART services in a stressful environment

    Directory of Open Access Journals (Sweden)

    Jonathan Mensah Dapaah

    2016-01-01

    Full Text Available With the upscaling of antiretroviral therapy (ART in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call ‘home’. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country’s highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013. 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA. The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their ‘therapy management group’ [Janzen, J. M. (1987. Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1, 68–84]. The clients have thus created a fictive family within the clinic – made up of health workers (as ‘parents’, the clients themselves (as ‘children’ and the peer educators (as ‘aunts’ and ‘uncles’. In the face of persistent stigma associated with

  7. Nursing care needs and services utilised by home-dwelling elderly with complex health problems: observational study.

    Science.gov (United States)

    Næss, Gro; Kirkevold, Marit; Hammer, Wenche; Straand, Jørund; Wyller, Torgeir Bruun

    2017-09-12

    In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met. In this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the "Timed Up-and-Go" test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant. Of 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in home-dwelling patients. For this group, resources for home nursing

  8. "It's Changed Everything": Voices of Veterans in the Veteran-Directed Home and Community Based Services Program.

    Science.gov (United States)

    Mahoney, Ellen K; Milliken, Aimee; Mahoney, Kevin J; Edwards-Orr, Merle; Willis, Danny G

    2018-04-05

    The purpose of this study was to understand the value and impact of the Veteran-Directed Home and Community Based Services program (VD-HCBS) on Veterans' lives in their own voices. Focus groups and individual interviews by telephone were conducted to elicit participant perspectives on what was most meaningful, and what difference VD-HCBS made in their lives. Transcripts were analyzed using content analysis. The sample included 21 Veterans, with a mean age of 66±14, enrolled in VD-HCBS an average of 20.8 months. All were at risk of institutional placement based on their level of disability. Five major categories captured the information provided by participants: What a Difference Choice Makes; I'm a Person!; It's a Home-Saver; Coming Back to Life; and Keeping Me Healthy & Safe. Participants described the program as life changing. This study is the first time that Veterans themselves have identified the ways in which VD-HCBS impacted their lives, uncovering the mechanisms underlying positive outcomes. These categories revealed new ways of understanding VD-HCBS as an innovative approach to meeting the person-centered needs of Veterans wishing to remain at home, while experiencing quality care and leading meaningful lives, areas identified as priorities for improving long term services and supports.

  9. The importance of understanding epidemiology in order to inform financial decisions: a lesson from the Scottish Home Oxygen Service.

    Science.gov (United States)

    Wood, R; Grant, I; Bain, M

    2012-11-01

    To ensure that decisions on the future planning of the Scottish Home Oxygen Service reflect population needs by examining the epidemiology of the main conditions that require home oxygen therapy and trends in their management. Analysis of routinely available vital event and health service data supplemented by published literature. Use of linked data to provide person-based analyses. Consideration of trends in key risk factors, disease incidence, prevalence and mortality for chronic neonatal lung disease, cystic fibrosis, chronic interstitial lung disease in adults and chronic obstructive pulmonary disease. Examination of trends in management of these conditions including hospital admissions, length of stay and re-admissions. The prevalence of all the conditions studied has increased in Scotland over recent years due to a combination of increased incidence, increased survival, more active case finding and demographic changes. There have been changes in management with trends towards shorter hospital stays. The clinical need for home oxygen therapy is likely to continue to increase over the next 10-20 years. It will encompass all age groups and a complex range of conditions. Public health needs to be proactive in providing relevant needs assessment information to ensure that planning within financial constraints is appropriately informed on population needs. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  10. Robotic Services at Home: An Initialization System Based on Robots' Information and User Preferences in Unknown Environments

    Directory of Open Access Journals (Sweden)

    Nor Nur Safwati Mohd

    2014-07-01

    Full Text Available One important issue in robotic services is the construction of the robotic system in the actual environment. In other words, robots must perform environment sensing or have information on real objects, such as location and 3D dimensions, in order to live together with humans. It is crucial to have a mechanism to create an actual robotic system (intelligent space such that there is no initialization framework for the objects in the environment, or we have to perform SLAM and object recognition as well as mapping to generate a useful environmental database. In intelligent space research, normally the objects are attached to various sensors in order to extract the necessary information. However, that approach will highly depend on sensor accuracy and the robotic system will be burdened if there are too many sensors in an environment. Therefore, in this paper we present a system in which a robot can obtain information about an object and even create the furniture layout map for an unknown environment. Our approach is intended to improve home-based robotic services by taking into account the user or individual preferences for the Intelligent Space (IS. With this information, we can create an informational map of the home-based environment for the realization of robot assistance of humans in their daily activities at home, especially for disabled people. The result shows the system design and development in our approach by using model-based system engineering.

  11. Experiences of community-dwelling older adults with the use of telecare in home care services: a qualitative systematic review.

    Science.gov (United States)

    Karlsen, Cecilie; Ludvigsen, Mette Spliid; Moe, Carl Erik; Haraldstad, Kristin; Thygesen, Elin

    2017-12-01

    The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults' experiences with the actual use of telecare. The aim of this review was to identify and synthesize the best available qualitative evidence of community-dwelling older adults' experience with the use of telecare in home care services. This review considered studies that focused on qualitative data, examining older adults' experiences with the use of active and passive technology devices, such as personal alarms and sensor technology, in the context of home care services. This review systematically searched the databases Scopus, CINAHL, PsycINFO, and SveMed+ to find both published and unpublished studies in English, Norwegian, Swedish and Danish, from 2005 to 2017. Methodological quality of the included studies was assessed independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative data were extracted from papers included in the review using the standardized Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and involved aggregation and synthesis of findings. A total of 118 findings from 11 studies were aggregated into 20 categories. The categories generated seven synthesized findings: 1) Aging in place is desired; however, it may also be related to feeling isolated and lonely. 2) Telecare contributes to safety, security, and aging in place. 3) Privacy is not seen as a problem by most older adults because the technology is intended to help them live safely in their own home. 4) Some telecare devices have side effects, especially new technology. Some devices do not work outside

  12. Nutritional status, dietary habits and social and health profile of home meal service users for elderly of Vitoria-Gasteiz

    Directory of Open Access Journals (Sweden)

    Fernando Gómez-Busto

    2014-09-01

    Full Text Available Introduction: The home meals service (HMS is a little-developed resource in the Basque Country, and is dependent on social services. The aim of this study is to establish the nutritional status, eating habits and main social and healthcare characteristics of the users of this service.Material and Methods: A descriptive and transversal study carried out in 2 phases: (a phase 1: an assessment of nutritional status and eating habits using an abbreviated version of the Mini Nutritional Assessment and a questionnaire on food consumption. (b phase 2: the assessment of the dependency risk at home and quality of life related to health by means of Barber and EuroQoL-5D questionnaires.Results: Eighty users (35 men, 45 women fulfilled the criteria for inclusion; average age: 83.62 years (± 5.53. Nutritional status: the prevalence of malnutrition was 11% and that of risk of malnutrition 39%. Eating habits: the meal provided guaranteed a minimal provision of legumes, pasta, rice or potatoes (once or twice a week, fish (once or twice a week, and meat (three or four times a week. In spite of this, the frequency of consumption of vegetables, fish, rice, eggs or meat was less than recommended in over 70% of the group. Social and healthcare profile: 127 users (60 men, 67 women took part; average age: 83.82 years (± 6.17. Barber’s questionnaire: living alone: 48%; housebound through illness: 20%. Poor hearing: 44%; poor sight: 34%; although: 30% needed help, 95% were receiving support. EuroQoL-5D: Serious problems reported: 4.7% had difficulties with mobility; 7.9% with personal care; 23.6% had problems with carrying out daily activities; 15% reported pain or discomfort; 3.9% anxiety/depression. Perceived health status: 32.3% considered their health to be good or very good, 34,6% fair, and 33% bad or very bad.Conclusions: The group studied consists of a vulnerable people, with social and health problems and more malnutrition than the older population living at

  13. 38 CFR 17.166 - Dental services for hospital or nursing home patients and domiciled members.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Dental services for... Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.166 Dental services for... domiciliary care pursuant to the provisions of §§ 17.46 and 17.47, will be furnished such dental services as...

  14. Smart parking barrier

    KAUST Repository

    Alharbi, Abdulrazaq M.

    2016-05-06

    Various methods and systems are provided for smart parking barriers. In one example, among others, a smart parking barrier system includes a movable parking barrier located at one end of a parking space, a barrier drive configured to control positioning of the movable parking barrier, and a parking controller configured to initiate movement of the parking barrier, via the barrier drive. The movable parking barrier can be positioned between a first position that restricts access to the parking space and a second position that allows access to the parking space. The parking controller can initiate movement of the movable parking barrier in response to a positive identification of an individual allowed to use the parking space. The parking controller can identify the individual through, e.g., a RFID tag, a mobile device (e.g., a remote control, smartphone, tablet, etc.), an access card, biometric information, or other appropriate identifier.

  15. Midwives' experiences of referring obese women to either a community or home-based antenatal weight management service: Implications for service providers and midwifery practice.

    Science.gov (United States)

    Atkinson, Lou; French, David P; Ménage, Diane; Olander, Ellinor K

    2017-06-01

    a variety of services to support women to undertake weight management behaviours during pregnancy have recently been implemented as a means to reduce the risks to mother and infant. In the UK, midwives lead the care of the majority of pregnant women and are seen as the ideal source of referral into antenatal services. However, midwives have reported concerns regarding raising the topic of weight with obese women and negative referral experiences have been cited as a reason not to engage with a service. This study explored midwives' experiences of referring women to one of two antenatal weight management services. qualitative, cross-sectional interview and focus group study, with data analysed thematically. midwifery teams in the West Midlands, England. midwives responsible for referring to either a home-based, one to one service (N=12), or a community-based, group service (N=11). four themes emerged from the data. Participants generally had a positive View of the service, but their Information needs were not fully met, as they wanted more detail about the service and feedback regarding the women they had referred. Approaches to referral differed, with some participants referring all women who met the eligibility criteria, and some offering women a choice to be referred or not. Occasionally the topic was not raised at all when a negative reception was anticipated. Reasons for poor uptake of the services included pragmatic barriers, and their perception of women's lack of interest in weight management. midwives' differing views on choice and gaining agreement to refer means referral practices vary, which could increase the risk that obese women have inequitable access to weight management services. However, midwives' confidence in the services on offer may be increased with more detailed information about the service and feedback on referrals, which would additionally act as prompts to refer. weight management services need to improve communication with their

  16. Midwifery Provision of Home Birth Services: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-01-01

    The number of women in the United States choosing to give birth at home has risen substantially in the past decade, creating an increased need for understanding of the evidence regarding the provision of midwifery care to women and families considering this option. The safety of home birth has been evaluated in observational studies in several industrialized nations, including the United States. Most studies find that women who are essentially healthy at term with a singleton fetus and give birth at home have positive outcomes and a lower rate of interventions during labor. Although some studies have found increased neonatal morbidity and mortality in newborns born at home when compared to newborns born in a hospital, the absolute numbers reported in both birth sites are very low. The purpose of this clinical bulletin is to review the evidence on provision of care to women and families who plan to give birth at home, including roles and responsibilities, shared decision making, informed consent, and ongoing assessment for birth site selection. © 2015 by the American College of Nurse-Midwives.

  17. Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.

    Science.gov (United States)

    Mahoney, Kevin J; Simon-Rusinowitz, Lori; Simone, Kristin; Zgoda, Karen

    2006-01-01

    The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.

  18. 78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

    Science.gov (United States)

    2013-07-26

    ...This notice announces the annual adjustments to the national average payment rates for meals and snacks served in child care centers, outside-school-hours care centers, at-risk afterschool care centers, and adult day care centers; the food service payment rates for meals and snacks served in day care homes; and the administrative reimbursement rates for sponsoring organizations of day care homes, to reflect changes in the Consumer Price Index. Further adjustments are made to these rates to reflect the higher costs of providing meals in the States of Alaska and Hawaii. The adjustments contained in this notice are made on an annual basis each July, as required by the laws and regulations governing the Child and Adult Care Food Program.

  19. NPDES Permit for Mesa Verde National Park Wastewater Treatment Facility in Colorado

    Science.gov (United States)

    Under NPDES permit number CO-0034398, the United States Department of the Interior, National Park Service, Mesa Verde National Park is authorized to discharge from the Mesa Verde National Park wastewater treatment plant, in Montezuma County, Colo.

  20. Kaloko-Honokohau National Historical Park Air Tour Management Plan planning and NEPA scoping document

    Science.gov (United States)

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Kaloko-Honokohau Historic Park pursuant to the National Parks Air Tour Management ...

  1. Kalaupapa National Historic Park Air Tour Management Plan planning and NEPA scoping study

    Science.gov (United States)

    2005-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Kalaupapa Historic Park pursuant to the National Parks Air Tour Management Act of ...

  2. Hawaii Volcanoes National Park Air Tour Management Plan: Planning and NEPA Scoping Document

    Science.gov (United States)

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of Air Tour Management Plans (ATMPs) for Haleakala National Park, Hawaii Volcanoes National Park, Puukohola Heiau National H...

  3. Modeling Ecosystem Services for Park Trees: Sensitivity of i-Tree Eco Simulations to Light Exposure and Tree Species Classification

    Directory of Open Access Journals (Sweden)

    Rocco Pace

    2018-02-01

    Full Text Available Ecosystem modeling can help decision making regarding planting of urban trees for climate change mitigation and air pollution reduction. Algorithms and models that link the properties of plant functional types, species groups, or single species to their impact on specific ecosystem services have been developed. However, these models require a considerable effort for initialization that is inherently related to uncertainties originating from the high diversity of plant species in urban areas. We therefore suggest a new automated method to be used with the i-Tree Eco model to derive light competition for individual trees and investigate the importance of this property. Since competition depends also on the species, which is difficult to determine from increasingly used remote sensing methodologies, we also investigate the impact of uncertain tree species classification on the ecosystem services by comparing a species-specific inventory determined by field observation with a genus-specific categorization and a model initialization for the dominant deciduous and evergreen species only. Our results show how the simulation of competition affects the determination of carbon sequestration, leaf area, and related ecosystem services and that the proposed method provides a tool for improving estimations. Misclassifications of tree species can lead to large deviations in estimates of ecosystem impacts, particularly concerning biogenic volatile compound emissions. In our test case, monoterpene emissions almost doubled and isoprene emissions decreased to less than 10% when species were estimated to belong only to either two groups instead of being determined by species or genus. It is discussed that this uncertainty of emission estimates propagates further uncertainty in the estimation of potential ozone formation. Overall, we show the importance of using an individual light competition approach and explicitly parameterizing all ecosystem functions at the

  4. Effects and meanings of a person-centred and health-promoting intervention in home care services - a study protocol of a non-randomised controlled trial.

    Science.gov (United States)

    Bölenius, Karin; Lämås, Kristina; Sandman, Per-Olof; Edvardsson, David

    2017-02-16

    The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people. NCT02846246 .

  5. Pre-school nutrition-related behaviours at home and early childhood education services: findings from the Growing Up in New Zealand longitudinal study.

    Science.gov (United States)

    Gerritsen, Sarah; Anderson, Sarah E; Morton, Susan Mb; Wall, Clare R

    2018-05-01

    Pre-school nutrition-related behaviours influence diet and development of lifelong eating habits. We examined the prevalence and congruence of recommended nutrition-related behaviours (RNB) in home and early childhood education (ECE) services, exploring differences by child and ECE characteristics. Telephone interviews with mothers. Online survey of ECE managers/head teachers. New Zealand. Children (n 1181) aged 45 months in the Growing Up in New Zealand longitudinal study. A mean 5·3 of 8 RNB were followed at home, with statistical differences by gender and ethnic group, but not socio-economic position. ECE services followed a mean 4·8 of 8 RNB, with differences by type of service and health-promotion programme participation. No congruence between adherence at home and in ECE services was found; half of children with high adherence at home attended a service with low adherence. A greater proportion of children in deprived communities attended a service with high adherence, compared with children living in the least deprived communities (20 and 12 %, respectively). Children, across all socio-economic positions, may not experience RNB at home. ECE settings provide an opportunity to improve or support behaviours learned at home. Targeting of health-promotion programmes in high-deprivation areas has resulted in higher adherence to RNB at these ECE services. The lack of congruence between home and ECE behaviours suggests health-promotion messages may not be effectively communicated to parents/family. Greater support is required across the ECE sector to adhere to RNB and promote wider change that can reach into homes.

  6. Fall risk factors in community-dwelling elderly who receive Medicaid-supported home- and community-based care services.

    Science.gov (United States)

    Yamashita, Takashi; Jeon, Haesang; Bailer, A John; Nelson, Ian M; Mehdizadeh, Shahla

    2011-06-01

    This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Data were collected from enrollees of Ohio's Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.

  7. 78 FR 53478 - Proposed Information Collection; United States Park Police Personal History Statement

    Science.gov (United States)

    2013-08-29

    ...] Proposed Information Collection; United States Park Police Personal History Statement AGENCY: National Park... about this IC, contact Major Scott Fear, United States Park Police, 1100 Ohio Drive SW., Washington, DC... INFORMATION: I. Abstract The United States Park Police (USPP) is a unit of the National Park Service...

  8. An exploration of chronic pain patients perceptions of home telerehabilitation services

    NARCIS (Netherlands)

    Cranen, Karlijn; Cranen, Karlijn; Drossaert, Constance H.C.; Brinkman, Evelien S.; Braakman-Jansen, Louise Marie Antoinette; IJzerman, Maarten Joost; Vollenbroek-Hutten, Miriam Marie Rosé

    2011-01-01

    Objectives  To explore patients’ perceptions regarding prospective telerehabilitation services and the factors that facilitate or impede patients’ intentions to use these services. Design  Using semi-structured interviews, patients reflected on the pros and cons of various scenarios of prospective

  9. Occupational Home Economics Education Series. Catering Services. Competency Based Teaching Module.

    Science.gov (United States)

    Lowe, Phyllis; And Others

    This module, one of ten competency based modules developed for vocational home economics teachers, is based on a job cluster in the catering industry. It is designed for use with a variety of levels of learners (secondary, postsecondary, adult) in both school and non-school educational settings. Focusing on two levels of employment, food caterer…

  10. An optimization approach for communal home meal delivery service : A case study

    NARCIS (Netherlands)

    Bräysy, Olli; Nakari, Pentti; Dullaert, Wout; Neittaanmäki, Pekka

    2009-01-01

    This paper is the first to discuss the communal home meal delivery problem. The problem can be modelled as a multiple travelling salesman problem with time windows, that is closely related to the well-studied vehicle routing problem with time windows. Experimental results are reported for a

  11. Service Approaches to Young People with Complex Needs Leaving Out-of-Home Care

    Science.gov (United States)

    Malvaso, Catia; Delfabbro, Paul; Hackett, Louisa; Mills, Hayley

    2016-01-01

    Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of…

  12. An Integrated Patient Information and In-Home Health Monitoring System Using Smartphones and Web Services.

    Science.gov (United States)

    Sorwar, Golam; Ali, Mortuza; Islam, Md Kamrul; Miah, Mohammad Selim

    2016-01-01

    Modern healthcare systems are undergoing a paradigm shift from in-hospital care to in-home monitoring, leveraging the emerging technologies in the area of bio-sensing, wireless communication, mobile computing, and artificial intelligence. In-home monitoring promises to significantly reduce healthcare spending by preventing unnecessary hospital admissions and visits to healthcare professionals. Most of the in-home monitoring systems, proposed in the literature, focus on monitoring a set of specific vital signs. However, from the perspective of caregivers it is infeasible to maintain a collection of specialized monitoring systems. In this paper, we view the problem of in-home monitoring from the perspective of caregivers and present a framework that supports various monitoring capabilities while making the complexity transparent to the end users. The essential idea of the framework is to define a 'general purpose architecture' where the system specifies a particular protocol for communication and makes it public. Then any bio-sensing system can communicate with the system as long as it conforms to the protocol. We then argue that as the system grows in terms of number of patients and bio-sensing systems, artificial intelligence technologies need to be employed for patients' risk assessment, prioritization, and recommendation. Finally, we present an initial prototype of the system designed according to the proposed framework.

  13. DOE Zero Energy Ready Home Case Study: Ithaca Neighborhood Housing Services, Ithaca, New York

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-10-01

    Eleven new townhomes comply with EPA's airPLUS criteria and use EPA WaterSense-qualifying features. Foundation walls are insulated on the exterior with XPS insulation. Non-shared walls use wall panels that were produced offsite. This builder was awarded a 2013 Housing Innovation Award in the affordable home category.

  14. Performance Analysis of Nomadic Mobile Services on Multi-homed Handheld Devices

    NARCIS (Netherlands)

    Pawar, P.; van Beijnum, Bernhard J.F.; van Sinderen, Marten J.; Aggarwal, Akshai; De Clercq, Frederic

    2007-01-01

    Compared to their predecessors, the current generation handheld mobile devices possess higher processing power, increased memory and new multi-homing capabilities. These features combined with the widespread acceptance and use of these devices result in a situation where mobile devices are no longer

  15. Utilisation of formal and informal care and services at home among persons with dementia: a cross-sectional study.

    Science.gov (United States)

    Bökberg, Christina; Ahlström, Gerd; Karlsson, Staffan

    2017-09-04

    The progression of dementia disease implies increasing needs for both informal and formal care and services but also risk of institutionalisation. To better adjust care and services in the phase preceding institutionalisation it is important to find out whether utilisation of formal and informal care and services is determined by increased needs and by who meets the needs. The aim was to compare persons with dementia (65+) with different levels of cognitive impairment, regarding utilisation of formal and informal care and service at home. The participants consisted of 177 persons with dementia ≥65 years old and at risk of nursing home admission, divided into groups according to their cognitive function. Structured interviews were conducted based on questionnaires about type and amount of formal and informal care utilised, as well as questions regarding cognitive impairment, dependency in activities of daily living (ADLs) and neuropsychiatric symptoms. To analyse the data, descriptive and comparative statistics were used. The findings revealed that the group with severe dementia used significantly more help with ADLs and supervision in terms of time (number of hours and days) provided by the informal caregiver, compared with the group with moderate dementia. Utilisation of formal care and services was highest in the group with the most severe cognitive impairments (Standardized Mini-Mental State Examination score of <9). The group with severe dementia were more dependent in ADLs and had more neuropsychiatric symptoms (hallucinations and motor disturbances). They were younger and more often cohabitated with the informal caregiver, compared with the group with moderate dementia. This study shows that in the phase preceding institutionalisation the ADL and supervision needs due to progression of dementia appear to tend to be met first and foremost by the informal caregivers. © 2017 Nordic College of Caring Science.

  16. Effect of the economic crisis on the use of health and home care services among elderly Spanish diabetes patients.

    Science.gov (United States)

    Lopez-de-Andres, Ana; de Miguel-Diez, Javier; Hernandez-Barrera, Valentin; Jiménez-Trujillo, Isabel; Martinez-Huedo, Maria-Angeles; Del Barrio, José Luis; Jimenez-Garcia, Rodrigo

    2018-03-27

    To describe the utilization of health and home care services among older people (≥65 years) with diabetes during the economic crisis; to identify the factors associated with changes in the utilization of these services; and to study the time trends (2009-2014). We used the European Health Interview Surveys for Spain (EEHSS) for 2009/10 and 2014. The dependent variables included self-reported hospitalizations; general practitioner (GP) visits; 'other healthcare services' (OHS) used; and home care services (HCS) used. We identified 6026 and 6020 diabetic patients (EEHSS2009 and EEHSS2014, respectively). A significant decrease in the number of GP visits (OR 0.94; 95% CI 0.91-0.98) and the use of HCS (OR 0.95; 95% CI 0.91-0.99) was found; however, we found an increase in the use of OHS (OR 1.06; 95% CI 1.02-1.10). Multivariate models showed that factors associated with an increased use included chronic conditions, worse self-rated health, pain and mental disorders. Physical activity was a strong predictor of lower hospitalizations and HCS use. Female gender was associated with significantly lower hospitalizations and a higher use of OHC and HCS. We found a decrease in the number of GP visits and the use of HCS among elderly diabetic adults; however, we also observed an increase in the use of OHS, which may partly explain this decrease in the figures. Significant differences in the use of health services were found according to gender. The effect of the economic crisis, if any, seems to have had a small magnitude. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

    Science.gov (United States)

    Varney, Jane; Weiland, Tracey J; Jelinek, George

    2014-06-01

    Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

  18. Patient predictors and utilization of health services within a medical home for homeless persons.

    Science.gov (United States)

    Jones, Audrey L; Thomas, Roxanne; Hedayati, Daniel O; Saba, Shaddy K; Conley, James; Gordon, Adam J

    2018-02-07

    The Veterans Health Administration (VHA) established a patient-centered medical home model of care for veterans experiencing homelessness called a Homeless Patient Aligned Care Team (HPACT) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of the HPACT model, this study compares the number and type of health care visits in the 12 months before and after enrollment in HPACT at one VHA facility, and explores patient characteristics associated with increases and decreases in visits. Chart reviews of VHA medical records were conducted for all patients enrolled in an HPACT in Pittsburgh, Pennsylvania, between May 2012 and December 2013 (N = 179). Multivariable mixed-effect logistic regressions estimated differences in having any visit in the 0-6 months and 7-12 months before and after HPACT enrollment, and multinomial logistic regressions predicted increases or decreases versus no change in number of visits over 12 months. Compared with 0-6 months prior to HPACT, patients were more likely to visit primary care in the 0-6 months (adjusted odds ratio [aOR] = 4.91, 95% confidence interval [CI] = 2.94-8.20) and 7-12 months (aOR = 2.30, 95% CI = 1.42-3.72) following HPACT. Patients were less likely to visit the emergency department (ED) or to be hospitalized in the 0-6 months (aOR = 0.57, 95% CI = 0.34-0.94; and aOR = 0.55, 95% CI = 0.25-0.76) and 7-12 months (aOR = 0.43, 95% CI = 0.33-0.91; and aOR = 0.45, 95% CI = 0.26-0.80) following HPACT. Patients were less likely to visit mental health (aOR = 0.35, 95% CI = 0.20-0.60) and addiction specialists (aOR = 0.39, 95% CI = 0.18-0.84) in the 7-12 months following HPACT. Overall, 59% of patients had increases in primary care visits following HPACT. Female patients and those with self-housing were less likely to have increases versus no change in primary care visits (adjusted relative risk ratio [aRRR] = 0.15, 95% CI = 0.03-0.74; and aRRR = 0.35, 95% CI = 0

  19. Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

    Science.gov (United States)

    Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

    2017-01-01

    A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

  20. 75 FR 27574 - United States Park Police; 60-Day Notice of Intention To Request Clearance of Collection of...

    Science.gov (United States)

    2010-05-17

    ... DEPARTMENT OF THE INTERIOR National Park Service United States Park Police; 60-Day Notice of... States Park Police, National Park Service, Interior. ACTION: Notice and request for comments. SUMMARY... Keeping Requirements, the United States Park Police (USPP) invites public comments on an extension of a...

  1. [Oral and dental health and oral and dental support of home patients--role of dental hygienist in the home service nursing station].

    Science.gov (United States)

    Hayashi, T; Kimura, M; Tamura, N; Hirata, S; Yabunaka, T; Kamimura, Y

    1999-12-01

    Home patients have few chances for going out, so communication with their family means a lot. Talking and eating are particular pleasures. Therefore, oral and dental health and oral and dental support are very important for home patients. A dental hygienist from our clinic visits and offers oral and dental health (oral care) and oral and dental support (oral rehabilitation) to home patients as part of a care plan with home care nurses. Moreover, as general conditions are closely related with oral function, maintaining oral and dental health and regular oral and dental support are very important in order to improve the quality of life (QOL) of home patients.

  2. K-means cluster analysis of rehabilitation service users in the Home Health Care System of Ontario: examining the heterogeneity of a complex geriatric population.

    Science.gov (United States)

    Armstrong, Joshua J; Zhu, Mu; Hirdes, John P; Stolee, Paul

    2012-12-01

    To examine the heterogeneity of home care clients who use rehabilitation services by using the K-means algorithm to identify previously unknown patterns of clinical characteristics. Observational study of secondary data. Home care system. Assessment information was collected on 150,253 home care clients using the provincially mandated Resident Assessment Instrument-Home Care (RAI-HC) data system. Not applicable. Assessment information from every long-stay (>60 d) home care client that entered the home care system between 2005 and 2008 and used rehabilitation services within 3 months of their initial assessment was analyzed. The K-means clustering algorithm was applied using 37 variables from the RAI-HC assessment. The K-means cluster analysis resulted in the identification of 7 relatively homogeneous subgroups that differed on characteristics such as age, sex, cognition, and functional impairment. Client profiles were created to illustrate the diversity of this geriatric population. The K-means algorithm provided a useful way to segment a heterogeneous rehabilitation client population into more homogeneous subgroups. This analysis provides an enhanced understanding of client characteristics and needs, and could enable more appropriate targeting of rehabilitation services for home care clients. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. How IoT, AAI Can Contribute to Smart Home and Smart Cities Services - the Role of Innovation

    DEFF Research Database (Denmark)

    Skouby, Knud Erik; Lynggaard, Per; Windekilde, Iwona Maria

    between ICT based infrastructure and innovation. The theory of innovation will be used to explain the phenomenon by which the technological and service innovation transforms existing cities into smart cities. We will demonstrate the innovative use of distributed IoT, CoT, AAI to solve problems in the area...... non-static concepts that evolve over time. To address these challenges the latest information and communication technology (ICT) including its available services is needed. ICT offers a concept that fuels sustainable economic development and a high quality of life together with a wise management...... of natural resources. A valuable smart city ICT infrastructure must be able to integrate the smart homes into a coherent smart city concept. Vitale elements in this concept are Internet of Things (IoT), Clouds of Things (CoT), and Artificial Intelligence (AI). The integration of a smart city, its embedded...

  4. Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training.

    Science.gov (United States)

    Maddox, Christina; Pontin, David

    2013-06-01

    UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.

  5. Child, Caregiver, and Family Characteristics Associated with Emergency Department Use by Children Who Remain at Home after a Child Protective Services Investigation

    Science.gov (United States)

    Schneiderman, Janet U.; Hurlburt, Michael S.; Leslie, Laurel K.; Zhang, Jinjin; Horwitz, Sarah McCue

    2012-01-01

    Objectives: To examine emergency department (ED) use among children involved with child protective services (CPS) in the US but who remain at home, and to determine if ED use is related to child, caregiver and family characteristics as well as receipt of CPS services. Method: We analyzed data on 4,001 children in the National Survey of Child and…

  6. Time-limited home-care reablement services for maintaining and improving the functional independence of older adults.

    Science.gov (United States)

    Cochrane, Andy; Furlong, Mairead; McGilloway, Sinead; Molloy, David W; Stevenson, Michael; Donnelly, Michael

    2016-10-11

    Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years).We are very uncertain as to

  7. Exploring the link between products and services in low-income markets—Evidence from solar home systems

    International Nuclear Information System (INIS)

    Friebe, Christian A.; Flotow, Paschen von; Täube, Florian A.

    2013-01-01

    One of the key challenges of energy access in emerging markets and developing countries is how to reach households and communities that are unlikely to get a grid connection in the long term or those that are connected to the grid but suffer from regular blackouts or low voltage. By surveying entrepreneurs selling Solar Home Systems (SHSs) on a commercial basis in emerging and developing countries, this study is one of the first attempts to quantify the key elements of four potential Product Service Systems (PSSs): Cash, Credit, Leasing and Fee-for-Service. Whereas the Fee-for-Service approach was found to be suitable only under certain conditions, all PSSs share two key elements for successful market deployment: one or more years of maintenance, and customer support in financing these customers' new asset. Moreover, it appears that private sector companies are in principle able to deliver SHSs to households with incomes greater than USD 1000 per year. The implications for policy makers and development aid agencies are, first, to include maintenance services into public programmes or public–private partnerships and, second, to explicitly consider financial risks for entrepreneurs (e.g., customer commitment and repayment conditions). - Highlights: ► Explorative quantitative study among entrepreneurs across different low-income markets. ► Specific combinations of product and service are identified and evaluated. ► Cash, Credit and Leasing can be feasible from a private sector point of view. ► Fee-for-Service is very challenging for the private sector without any policy support. ► Combining the SHS with services such as finance and maintenance is key to success.

  8. Eldercare at Home: Choosing a Nursing Home

    Science.gov (United States)

    ... required, these services can be provided by a separate home health agency as directed by a doctor or ... complaints made by or on behalf of nursing home residents and work to resolve the problems. If they are unable ...

  9. 'If they're helping me then how can I be independent?' The perceptions and experience of users of home-care re-ablement services.

    Science.gov (United States)

    Wilde, Alison; Glendinning, Caroline

    2012-11-01

    Home-care re-ablement is a short-term, intensive service that helps people to (re-) establish their capacity and confidence in performing basic personal care and domestic tasks at home, thereby reducing needs for longer term help. Home-care re-ablement is an increasingly common feature of English adult social care services; there are similar service developments in Australia and New Zealand. This paper presents evidence from semi-structured interviews conducted in early 2010 with 34 service users and 10 carers from five established re-ablement services in England. The interviews formed part of a larger, mixed-methods study into the immediate and longer term impacts and cost-effectiveness of home-care re-ablement services. There was clear evidence that interviewees felt that they had benefitted from re-ablement services; most service users and their families valued the intervention. However, the interviews also identified potential barriers to optimal independence for some service users, particularly those with progressive conditions, sensory impairments, specific cultural needs, or who lived alone. The beneficial impacts of re-ablement could also be reduced if users failed to understand the aims of the service, or if the service failed to provide support with activities or outcomes that were particularly important to the service user or carer. Putting the lived experiences of people receiving re-ablement at the centre of analysis, this paper concludes that re-ablement services have the potential for enhanced effectiveness, particularly if there is more understanding of users' own priorities and concepts of independence. © 2012 Blackwell Publishing Ltd.

  10. 45 CFR 3.23 - Parking.

    Science.gov (United States)

    2010-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CONDUCT OF PERSONS AND TRAFFIC ON THE NATIONAL INSTITUTES OF HEALTH FEDERAL ENCLAVE Traffic Regulations § 3.23 Parking. (a) A person may not stand (vehicle... sign, crosswalk, or traffic control signal; (5) In a double-parked position; (6) At a curb painted...

  11. 77 FR 19690 - Notice of Inventory Completion: California Department of Parks and Recreation, Sacramento, CA

    Science.gov (United States)

    2012-04-02

    ...: California Department of Parks and Recreation, Sacramento, CA AGENCY: National Park Service, Interior. ACTION... Department of Parks and Recreation, 1416 9th Street, Room 902, Sacramento, CA 95814, telephone (916) 653-8893... located in San Diego County, CA. This notice is published as part of the National Park Service's...

  12. 77 FR 19689 - Notice of Inventory Completion: California Department of Parks and Recreation, Sacramento, CA

    Science.gov (United States)

    2012-04-02

    ...: California Department of Parks and Recreation, Sacramento, CA AGENCY: National Park Service, Interior. ACTION... Department of Parks and Recreation, 1416 9th Street, Room 902, Sacramento, CA 95814, telephone (916) 653-8893... located in San Diego County, CA. This notice is published as part of the National Park Service's...

  13. 77 FR 64544 - Minor Boundary Revision at Chickamauga and Chattanooga National Military Park

    Science.gov (United States)

    2012-10-22

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-SER-CHCH-10687; 5220-726] Minor Boundary Revision at Chickamauga and Chattanooga National Military Park AGENCY: National Park Service, Interior.... 460l- 9(c)(1)(ii), the boundary of Chickamauga and Chattanooga National Military Park is modified to...

  14. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support

    Directory of Open Access Journals (Sweden)

    Dianne Goeman

    2016-01-01

    Full Text Available Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS. Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients’ diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

  15. Sally Park Nursing Home, Sally Park Close, Firhouse, Dublin 24.

    LENUS (Irish Health Repository)

    Coyne, Imelda

    2013-01-01

    Children\\'s rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting shared decision-making (SDM) for children with cancer.

  16. A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services

    Directory of Open Access Journals (Sweden)

    Karlsson Bengt

    2012-09-01

    Full Text Available Abstract Background Crisis resolution and home treatment (CRHT is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.

  17. Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.

    Science.gov (United States)

    Kjelle, Elin; Lysdahl, Kristin Bakke; Olerud, Hilde Merete; Myklebust, Aud Mette

    2018-04-25

    In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team. Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities. The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly

  18. Denali Park wolf studies: Implications for Yellowstone

    Science.gov (United States)

    Mech, L. David; Meier, Thomas J.; Burch, John W.

    1991-01-01

    The Northern Rocky Mountain Wolf Recovery Plan approved by the U.S. Fish and Wildlife Service (1987) recommends re-establishment of wolves (Canis lupus) in Yellowstone National Park. Bills proposing wolf re-establishment in the Park have been introduced into the U.S. House and Senate. However, several questions have been raised about the possible effects of wolf re-establishment on other Yellowstone Park fauna, on human use of the Park and on human use of surrounding areas. Thus the proposed wolf re-establishment remains controversial.Information pertinent to some of the above questions is available from a current study of wolf ecology in Denali National Park and Preserve, Alaska, which we began in 1986. Although Denali Park differs from Yellowstone in several ways, it is also similar enough in important respects to provide insight into questions raised about wolf re-establishment in Yellowstone.

  19. When the clinic becomes a home. Successful VCT and ART services ...

    African Journals Online (AJOL)

    2016-09-06

    Sep 6, 2016 ... Successful VCT and ART services in a stressful environment, SAHARA-J: Journal of .... This is an Open Access article distributed under the terms of the Creative ..... In other words, stigma enhances secrecy and denial.

  20. Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews

    Directory of Open Access Journals (Sweden)

    Hameed W

    2018-05-01

    Full Text Available Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal Strategy Department, Marie Stopes Society, Karachi, Sindh, Pakistan Purpose: Despite a general understanding that exit interviews being conducted at service providers’ facilities may influence clients’ responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients’ perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels – nongovernmental organization (NGO clinics, social franchise (SF centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Results: Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality and perception-based (satisfaction questions in the context of SF centers, while at NGO clinics the interview location only affected clients’ responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality. Conclusion: Our study indicates signs of courtesy bias and possibly the Hawthorne effect in