Despite efforts to decrease lengths of acute psychiatric hospital stays, some geriatric inpatients continue to have extended stays. This research examined factors related to length of stay (LOS), including legal and administrative factors not traditionally included in prior studies. The charts of 384 patients, representing all 464 discharges from an inpatient geropsychiatric unit over a one-year period, were evaluated retrospectively and analyzed using logistic regression and logarithmic transformation. The LOS of over 12% of the inpatients was 26 days or more (average LOS 14.1). Factors significantly associated with longer LOS were: receiving electroconvulsive therapy (ECT), higher Brief Psychiatric Rating Scale (BPRS) positive symptoms scores, falling, pharmacology complications, multiple prior psychiatric hospitalizations, requiring court proceedings to continue hospitalization or medicate against will, consultation delays and not performing ECT on weekends. Neither demographics nor diagnoses alone had influence on length of stay. Incorporation of LOS predictors into Medicare Inpatient Prospective Payment System (IPPS) would more accurately account for the complexity in the cost of caring for geropsychiatry patients.
In social policy analysis, cross-national case studies can be particularly challenging to write. Even within a region of the world (in this case, Europe), the specific country contexts can vary on so many dimensions (e.g., contrasting welfare models, types of market economies, organization of care delivery and so forth), that there is a risk of 'if you've seen one, you've seen them all' that often limits the insights one can draw. Ervik and Linden attempt to address this challenge by imposing a unifying theme across the chapters of The Making of Ageing Policy. So, in addition to the more typical discussions of stakeholder influence (Chapters 4 and 5) and political power struggles (Chapters 7 and 8) familiar in texts underpinned by the theoretical frameworks of political science, the editors have asked their contributors to discuss ageing policy in the context of two competing policy paradigms: 'productive ageing' and 'active ageing'. This is a clever device that works to varying degrees throughout the book. As they correctly suggest in their introduction 'the differentiation between types of ideas is useful for one to grasp how actors argue for and promote change (p. 17).' Productive ageing, the older of the two ideas, emphasizes the potential for older people to be economically productive; while active ageing is more ambitious in its focus on quality of life as people age and the process of optimising opportunities for health, participation and security. Implicit in the active ageing vision is that ageing policy should place greater value on people's autonomy and choices as they age. The European Union adopted the active ageing concept as a basis for policy practice and issued core policy directives in support of this. Reflecting this broader ideological framework, the policy directives ranged from demographic renewal (i.e., policies to increase birth rates, combining work and childcare) to creating more jobs and longer working lives to addressing health inequalities. Yet, challenges arise from developing indicators for measuring progress on these directives and resources for monitoring them. Consequently, a greatly narrowed focus on pensions and labour markets has been adopted by the EU in recent years. Moreover, the current economic constraints across the EU have resulted in a greater emphasis on shifting responsibility to individuals rather than giving individuals more autonomy and choice. The Making of Ageing Policy follows three policy areas in Europe: public pensions, health and long-term care, and the labour market. The chapters particularly relevant to this Journal's readership are Chapters 5, 6, 7 and 8. Here, the task of looking at differences and similarities between countries is somewhat easier in that now pension policy is largely a debate about the relative roles of public and private pensions, fiscal sustainability of public programs in the face of demographic pressures, and how to get people to work longer (raising retirement ages and discouraging early retirement). Interestingly, among the count...
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