RESUMEN
The authors describe results from Partners in Caregiving: The Dementia Services Program, and present information on service utilization and financial performance among a group of 48 adult day centers across the United States from 1992 to 1996. Centers, with nonrandom assignment, received either grant support (average value: $93,000) or intensive technical assistance (average value: $39,000). Sites reported baseline data and submitted utilization information (enrollment and census) and financial data (revenue and expenses) quarterly. Overall, there were significant increases in enrollment, census, and financial performance (percent of cash expenses met through operating revenue) over the 4-year period. The grant-supported and technical-assistance sites had similar rates of improvement. Results provide data on service utilization and financial performance and demonstrate gains that can be achieved in these areas through improved marketing and financial management.
Asunto(s)
Financiación del Capital/economía , Centros de Día/economía , Demencia/economía , Demencia/terapia , Gastos en Salud , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Adulto , Costos de la Atención en Salud , Humanos , Valores de Referencia , Estudios Retrospectivos , Factores de Tiempo , Estados UnidosRESUMEN
The authors conducted a survey of members of the International Psychogeriatric Association (IPA) to determine the state of development of both the profession of geriatric psychiatry and services for mentally ill elderly. Ratings for both issues were based on a scale of 1 to 4, with 1 being little to no development and 4 being the highest. A rating of 2 was set as the desired minimum, and 12 countries met this goal in both categories, with 6 more countries reaching this goal in service development only. We conclude that although the field of geriatric psychiatry and services for mentally ill elderly are still underdeveloped in much of the world, in many countries they are developed sufficiently enough that the IPA is in an excellent position to provide both information and technical assistance to nations wishing to advance.
Asunto(s)
Psiquiatría Geriátrica/normas , Servicios de Salud Mental/normas , Anciano , Certificación/organización & administración , Psiquiatría Geriátrica/educación , Psiquiatría Geriátrica/tendencias , Salud Global , Encuestas de Atención de la Salud , Instituciones de Salud/normas , Instituciones de Salud/estadística & datos numéricos , Humanos , Servicios de Salud Mental/tendencias , Práctica Profesional/normas , Práctica Profesional/tendencias , Desarrollo de ProgramaRESUMEN
The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries.
Asunto(s)
Psiquiatría Geriátrica , Servicios de Salud Mental , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Honorarios y Precios , Femenino , Psiquiatría Geriátrica/economía , Psiquiatría Geriátrica/normas , Psiquiatría Geriátrica/estadística & datos numéricos , Humanos , Irlanda , Masculino , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/estadística & datos numéricos , Reino Unido , Estados UnidosRESUMEN
OBJECTIVES: This paper describes the financial performance (defined as percent of total expenses covered by net operating revenue) of 16 adult day centers participating in a national demonstration program on day services for people with dementia, including examination of possible predictors of financial performance. METHODS: Participating sites submitted quarterly financial and utilization reports to the National Program Office. Descriptive statistics summarize the factors believed to influence financial performance. RESULTS: Sites averaged meeting 35% of expenses from self-pay and 29% from government (mainly Medicaid) revenue, totaling 64% of all (cash plus in-kind) expenses met by operating revenue. Examination of center characteristics suggests that factors related to meeting consumer needs, such as being open a full day (i.e., 7:30 am to 6:00 pm) rather than shorter hours, and providing transportation, may be related to improved utilization and, thus, improved financial performance. Higher fees were not related to lower enrollment, census, or revenue. CONCLUSIONS: Adult day centers are able to achieve financial viability through a combination of operating (i.e., fee-for-service) and non-operating revenue. Operating revenue is enhanced by placing emphasis on consumer responsiveness, such as being open a full day. Because higher fees were not related to lower utilization, centers should set fees to reflect actual costs. The figure of 64% of expenses met by operating revenue is conservative inasmuch as sites included in-kind revenue as expenses in their budgeting calculations, and percent of cash expenses met by operating revenue would be higher (approximately 75% for this group of centers).
Asunto(s)
Centros Comunitarios de Salud/economía , Centros de Día/economía , Administración Financiera/estadística & datos numéricos , Anciano , Centros Comunitarios de Salud/organización & administración , Centros Comunitarios de Salud/estadística & datos numéricos , Costos y Análisis de Costo , Centros de Día/organización & administración , Centros de Día/estadística & datos numéricos , Demencia/terapia , Honorarios y Precios , Humanos , Renta , Medicaid , Cuidados Intermitentes/organización & administración , Factores de Tiempo , Transportes , Estados UnidosRESUMEN
Dementia and depression are the two most common mental illnesses in late life, and it is probable that they will coexist in many patients. This coexistence is complicated by the fact that both illnesses can be mistaken for each other, so that many patients with Alzheimer's disease (AD) may initially be diagnosed as depressed, whereas depression is a recognized cause of cognitive impairment. It is important to correctly differentiate between these two diagnoses; if depression is the cause of the cognitive impairment, full recovery is possible. It is also important to recognize depression in patients with AD, because depression represents a treatable source of additional disability. For patients with AD living in the community, functional limitation can determine whether the patient remains at home or is institutionalized, so treatment that can improve functional ability should be strongly considered. The newer antidepressants are better tolerated without increase in cost, so these drugs may provide a therapeutic advantage over the older tricyclic drugs. This article focuses primarily on techniques for establishing a differential diagnosis, with particular emphasis on patients in the primary care setting, and briefly considers the value and impact of treatment.
Asunto(s)
Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/complicaciones , Trastorno Depresivo/complicaciones , Escalas de Valoración Psiquiátrica , Anciano , Trastornos del Conocimiento/diagnóstico , Trastorno Depresivo/psicología , Diagnóstico Diferencial , Humanos , Pruebas Neuropsicológicas , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadAsunto(s)
Centros de Día/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Anciano , Estudios Transversales , Recolección de Datos , Centros de Día/economía , Centros de Día/organización & administración , Competencia Económica , Eficiencia Organizacional , Encuestas de Atención de la Salud , Humanos , Estudios de Casos Organizacionales , Estados UnidosAsunto(s)
Enfermedad de Alzheimer/diagnóstico , Trastornos de Ansiedad/diagnóstico , Demencia/diagnóstico , Trastorno Depresivo/diagnóstico , Trastornos del Sueño-Vigilia/diagnóstico , Actividades Cotidianas/psicología , Anciano , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/terapia , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Ritmo Circadiano , Demencia/psicología , Demencia/terapia , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Evaluación Geriátrica , Humanos , Trastornos del Sueño-Vigilia/psicología , Trastornos del Sueño-Vigilia/terapiaAsunto(s)
Enfermedad de Alzheimer/terapia , Terapia Conductista/métodos , Trastorno de la Conducta Social/terapia , Anciano , Enfermedad de Alzheimer/psicología , Investigación sobre Servicios de Salud , Humanos , Cuidados a Largo Plazo , Grupo de Atención al Paciente , Calidad de Vida , Trastorno de la Conducta Social/psicología , Medio SocialAsunto(s)
Depresión Posparto/diagnóstico , Grupo de Atención al Paciente , Trastornos Psicóticos/diagnóstico , Trastornos Puerperales/diagnóstico , Antidepresivos/uso terapéutico , Depresión Posparto/tratamiento farmacológico , Depresión Posparto/psicología , Femenino , Humanos , Inventario de Personalidad , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/psicología , Trastornos Puerperales/tratamiento farmacológico , Trastornos Puerperales/psicologíaAsunto(s)
Enfermedad de Alzheimer , Cuidadores , Centros de Día , Anciano , Actitud del Personal de Salud , Femenino , Humanos , MasculinoRESUMEN
Depression and dementia are the most common syndromes of geriatric psychiatry. Although emphasis is often placed on distinguishing the two, patients frequently have both disorders. Treating the complications of irreversible dementia, while unaltering the underlying disease process, can result in significant functional improvement in affected patients.
Asunto(s)
Demencia/complicaciones , Depresión/complicaciones , Distribución por Edad , Anciano , Trastornos del Conocimiento/complicaciones , Demencia/tratamiento farmacológico , Demencia/epidemiología , Depresión/diagnóstico , Depresión/tratamiento farmacológico , Depresión/epidemiología , Humanos , Prevalencia , Factores de RiesgoRESUMEN
In 1987 The Robert Wood Johnson Foundation announced the creation of the Dementia Care and Respite Services Program (DCRSP), the first national demonstration project to focus on day center and respite services for persons with dementia. The intent of $5.1 million, 4-year (1988-1992) program was to demonstrate that nonprofit day centers could provide financially viable programs and services needed by people with dementia and their caregivers. Seventeen grantees in 13 states, representing 21 different organizations and operating 24 day centers, participated in the project throughout the entire 4 years. The DCRSP has provided the first overview of dementia-specific day programs in the United States, with specific insight as to who is being served (e.g., participant and caregiver characteristics), types of assistance needed in relation to activities of daily living, and the most common behavior problems being exhibited. In addition, results of the 4-year project support the fact that community-based day centers can effectively care for people with dementia, a demand for these services does exist, and families consider these services of sufficient value that they are willing to pay for them out-of-pocket. Results also show that nonprofit day centers can become financially viable programs if attention is given to factors such as providing consumer-responsive services, charging what services actually cost, and having a high level of community visibility. The net result is increased net operating revenue with improved financial performance and enhanced long-term stability.
Asunto(s)
Enfermedad de Alzheimer/terapia , Centros de Día , Demencia/terapia , Cuidados Intermitentes , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/economía , Enfermedad de Alzheimer/psicología , Costos y Análisis de Costo , Centros de Día/economía , Demencia/economía , Demencia/psicología , Femenino , Implementación de Plan de Salud/economía , Humanos , Masculino , Cuidados Intermitentes/economía , Estados UnidosRESUMEN
This article reports on two not-for-profit adult day centers which became fully self-supporting from participant fees. The intent is to show that financial self-sufficiency solely from operating revenue for such programs is possible.
Asunto(s)
Centros de Día/economía , Administración Financiera/métodos , Renta/estadística & datos numéricos , Adulto , Costos y Análisis de Costo/estadística & datos numéricos , Recolección de Datos , Centros de Día/estadística & datos numéricos , Honorarios y Precios/estadística & datos numéricos , Administración Financiera/estadística & datos numéricos , Humanos , Missouri , New York , Organizaciones sin Fines de Lucro/economía , Desarrollo de ProgramaAsunto(s)
Becas , Investigación , Historia del Siglo XX , Psiquiatría/historia , Estados Unidos , Ingenio y Humor como AsuntoRESUMEN
This article reviews the syndromic concepts of depression and dementia and the concurrence of these common entities. In DAT, depression appears to be a reversible source of excess disability, amenable to pharmacologic as well as environmental interventions. In the vascular dementias, depression appears to be a specific complicating feature, in which localization of the lesion plays a significant role. The abulic state should not be mistaken for a depressive syndrome, although its presence should alert the clinician to evaluate for dementia and depression. Depression is especially prevalent in the subcortical dementias. Future studies using dynamic neuroimaging will help define the limits of this important concept. Reversible forms of dementia are much less common than previously suspected. The clinician's task is to identify causes of excess disability due to superimposed illnesses while avoiding diagnostic or therapeutic nihilism. The appropriate use of medication and the ongoing surveillance for adverse drug reactions are the foremost tasks of today's clinician treating the elderly patient.