The Long Term Care Crisis or Community Based Nursing

The Long Term Care Crisis: Elders Trapped in the No-Care Zone

Author: Carroll L Estes

Recipient of Choice Magazine's 1994 Outstanding Academic Book Award What happens when efforts to contain spiraling costs collide with health and social services delivery in a competitive market? The unintended results can be alarming. Carroll L. Estes, James H. Swan, and Associates uncover the insidious relationship between recent transformations in hospital care financing and the manner in which older Americans now receive--or, more accurately, do not receive--health and social services in the community. The distinguished authors of The Long Term Care Crisis scrutinize the surprising and pervasive consequences of competition in the health care arena tempered by government attempts to correct an out-of-control system. The authors provide a rich and incisive analysis of the complex events and policies leading to the current crisis in long term care and suggest options to simultaneously revitalize the system and empower older Americans. For all who question the current state of the U.S. health care system, skyrocketing health care costs, and disappearing personal resources, The Long Term Care Crisis is a professional library must. Students, researchers, and professionals in the areas of aging sociology, social work, nursing, policy studies, health administration, communication, and policy will find The Long Term Care Crisis a revealing and exciting resource. "A forceful analysis of the inequities of the U.S. healthcare system, which particularly affect women and people of color." --Lou Glasse, President, Older Women's League "Beyond perceptive analysis of the problem of providing long term care, the authors present policy options that empower the elderly and provide equitable,compassionate care for Americans of all ages." --Maggie Kuhn, Founder and National Convener, Gray Panthers "Once again, Carroll Estes, our great medical sociologist, has given us a painful and invaluable portrait of old age in America in the no-care zone." --Robert N. Butler, M.D., Chairman, Department of Geriatrics, Mount Sinai Medical Center, New York "The absence of rational social policy on long term care is the greatest impediment to reform of the U.S. health care system. This volume documents the further deterioration of access to long term care, resulting from efforts to contain escalating costs of acute care, and points to the policy changes needed to meet national needs in the 21st Century." --Linda H. Aiken, Ph.D., Trustee Professor of Nursing, Professor of Sociology, Director, Center for Health Services and Policy Research University of Pennsylvania "A critically important emphasis in this volume is the goal of maintaining independence and empowerment of older persons. As the book carefully documents, we must recognize how the policy decisions of the past decade have eroded the social, community-based supports needed to maintain elders' independence, and move to correct these lacks." --T. Franklin Williams, M.D. Professor of Medicine Emeritus and of Community & Preventive Medicine University of Rochester Medical Center "This is an excellent, but dense work. . . . Its moral and social dimensions present a chilling scenario for the future. . . . An important book for a wide range of readers." --Choice "Carroll L. Estes is the premiere authority on the political economy of aging, and past writings have had a profound influence on the sociology and economics of aging. The Long Term Care Crisis is another in a long string of significant contributions to the macro understanding of social problems and aging. . . . [This book] is an excellent piece of scholarly literature. I would strongly recommend it for professors of gerontology and health care policy, students, academic and hospital libraries, C.E.O.'s who are responsible for hospitals, nursing homes, health care programs, adult day care programs, and senior center programs." --Clinical Gerontologist "The results of this ambitious study are presented in fifteen chapters divided into five sections and are a 'must-read' for anyone interested in planning community services for elderly people. The arguments also have more general applicability to other populations as well. . . . As a single text, this is an excellent resource." --Canadian Journal of Urban Research

Table of Contents:

	Acknowledgments
	Introduction
Pt. I	Overview
1	Prospective Payment Revolution and Long Term Care	1
2	Restructuring of the Nonprofit Sector	22
Pt. II	From Hospital to Community
3	Discharge Planners as Gatekeepers to Community Care	43
4	Does Out of the Hospital Mean Out of Luck?	64
5	Service Paradox	74
Pt. III	Home Health and Nursing Home Care
6	Metamorphosis of Home Health Care	93
7	Nursing Homes Under Prospective Payment	113
8	Access to Nursing Home and Home Health Services	132
Pt. IV	Elder Care and the Community
9	Informalization and Community Care	155
10	Access in Peril	171
11	Community Variation in Policy Implementation	185
12	Waves of Change	210
Pt. V	The Future
13	Policy Elites and Fiscal Crisis	225
14	Empowerment Imperative	241
15	No-Care Zone and Social Policy	258
	Appendix: Policy Changes Affecting Home Health Care, 1961 to 1990	272
	References	276
	Index	310
	About the Authors	324

Look this: Definitive Guide to Canadian Artisanal and Fine Cheeses or Herbs

Community Based Nursing: Foundation for Practice

Author: Ginger Armentrout

Focusing on the community and home health care, this new book includes an overview of nursing in the community.Responding to the shift in practice and curriculum, from institutional care to community-based care, this new book helps instructors integrate community health information into their specific nursing programs. Specific topics covered include an overview of the health care system, cultural diversity considerations in the health care setting, client teaching, home visiting, and future trends in community nursing.Nursing students, nurse practitioners.

Cheryl Lapp

This book gives an overview of assessment and practice issues in community settings for those nurse providers who are not normally prepared to deliver comprehensive community health services. The purpose is to provide an introduction to something called "community based nursing," not community health nursing. As explained, this is a response to the economic reality of healthcare delivery, which is cost containment. Because these outside forces have imposed upon our traditional vision of nursing, adaptation to rapidly changing systems is our challenge. As "sicker" patients are being discharged into the community sooner, providers have been mobilized to respond in new ways. It is intended for students of associate degree programs in nursing, and for hospital nurses who find themselves in home care situations. At times the discussion introduces concepts that may seem remote to this audience, such as the levels of prevention or the nature of paradigms. However, discussion is informative and may even stimulate the reader to explore professional nursing further. Where there are illustrations, they are helpful. Examples are sources of healthcare payments, the cultural phenomena assessment, and the epidemiologic triangle. There are several tables, and the book is arranged well to emphasize its content. The references reflect current literature of the mid to late 1990s. The book has a pleasant appearance in its handbook style, and succeeds in not overwhelming the reader. Several of the exercises offered look enjoyable for a small group setting. It covers a wide array of topics such as the healthcare system and its future trends, personal belief systems of the nurse, communicationskills, cultural diversity, and client teaching. Yet despite this range of content, the book is very readable, pleasant, and portable. There are many exercises and activities to stimulate thinking and promote discussion. This basic little book is not only written at a level appropriate for its audience, it is likely to hold their interest.

Doody Review Services

Reviewer: Cheryl Lapp, MPH (University of Wisconsin-Oshkosh)
Description: This book gives an overview of assessment and practice issues in community settings for those nurse providers who are not normally prepared to deliver comprehensive community health services.
Purpose: The purpose is to provide an introduction to something called "community based nursing," not community health nursing. As explained, this is a response to the economic reality of healthcare delivery, which is cost containment. Because these outside forces have imposed upon our traditional vision of nursing, adaptation to rapidly changing systems is our challenge. As "sicker" patients are being discharged into the community sooner, providers have been mobilized to respond in new ways.
Audience: It is intended for students of associate degree programs in nursing, and for hospital nurses who find themselves in home care situations. At times the discussion introduces concepts that may seem remote to this audience, such as the levels of prevention or the nature of paradigms. However, discussion is informative and may even stimulate the reader to explore professional nursing further.
Features: Where there are illustrations, they are helpful. Examples are sources of healthcare payments, the cultural phenomena assessment, and the epidemiologic triangle. There are several tables, and the book is arranged well to emphasize its content. The references reflect current literature of the mid to late 1990s. The book has a pleasant appearance in its handbook style, and succeeds in not overwhelming the reader. Several of the exercises offered look enjoyable for a small group setting.
Assessment: It covers a wide array of topics such as the healthcare system and its future trends, personal belief systems of the nurse, communication skills, cultural diversity, and client teaching. Yet despite this range of content, the book is very readable, pleasant, and portable. There are many exercises and activities to stimulate thinking and promote discussion. This basic little book is not only written at a level appropriate for its audience, it is likely to hold their interest.

Rating

3 Stars from Doody