The effects of age and disability on valuations of health states used in deriving QALYs have not been examined. We compared the valuations of seven states of immobility and pain given by 88 subjects aged 20-89 years, and of various degrees of disability. They were asked to score each state, their present health and death, on a range from 'best' to 'worst' health. Only two states of health (no disability but moderate pain, and slight disability and moderate pain) were valued differently by older subjects. Disabled subjects tended to rate most ill-health states more adversely, and to rate death as substantially better than more severe states of ill-health. The development of explicit valuations of survival should take into account differences caused by disability, and examine other dimensions of illness experience.
This article is about the importance of retaining a focus on the humanity of older adults while rendering care to them through community and long-term care services. It is written from my experience as a director of a community service (Adult Day Health Care [ADHC] program), a program officer at a foundation devoted to improving health care for older Americans, a researcher who spent years conducting interviews with staff workers in long-term care services, and from the perspective of a professional and personal caregiver and friend to many elders living in the community--in their own homes and in nursing homes. From these diverse professional and personal roles and perspectives, I have learned that the formation of authentic human relationships, which go beyond the routine medical nursing, and social work approach to care, can play a vital role in healing and addressing loneliness in elders-and transform the lives of their personal and professional caregivers as well. A focus on humanity need not cost money or place a heavy demand on the worker. In fact, it can be one of the most cost-effective approaches to improving quality in health care, attracting workers to the field of long-term care, and boosting the morale of both caregivers and care recipients.
Long term care is often equated with institutional care rather than a more comprehensive definition: the care required by people to permit them to achieve their potential and maintain abilities in the face of chronic and often progressive disability.'
This article chronicles the efforts of the John A. Hartford Foundation to improve the health care of older adults by strategically investing $34 million in geriatric nursing programs nationally. It includes a brief background of the Foundation followed by a description of the Foundation's geriatric nursing programs and the lessons learned that could be relevant to a variety of audiences.
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