No abstract

Heart failure is one of the most common reasons for admission to home health care among older adults Patients with heart failure present complex challenges for home health care agency staff, given the chronic yet variable nature of the disease and the importance of behavioral factors in long-term management of heart failure. The purpose of this study was to examine the patterns of health service utilization and outcomes of home care among elderly home care patients with heart failure. The sample included 104 patients with a primary or secondary diagnosis of heart failure admitted to a large Medicare-certified home care agency. Finding from the study revealed that subjects received an average of 11 skilled nursing visits over a 37-day period. Twelve percent of the subjects were rehospitalized before their home care treatment plans were completed. Although the percentage of patients rehospitalized in this study was relatively low, additional research is needed that will investigate the relationship between home care nurses' interventions and the patient outcomes associated with these interventions.

After a poor response to advertisements for employment for older adults, a community health nursing agency surveyed 216 individuals ranging in age from 60 to 96 years to examine their attitudes toward postretirement work, perceptions of barriers to and facilitators of employment, and the influence of perceived health status and income on these factors related to labor force participation. The findings are consistent with continuity theory of aging, and underscore the need for public policies aimed at supporting the decision of older persons to work or retire.

So much has been written, discussed, and analyzed regarding the impact that managed care has had and will continue to have on the health care delivery system. This article focuses on what is occurring nationally with managed care and how managed care relates to the history of visiting nurse associations (VNAs). The characteristics inherent to VNAspartnership, innovation, commitment to staff education, case management responsiveness, geographic accessibility, quality focus, preventive effort, and mastery of technology—will be analyzed as they relate to their viability in the current climate.

In the past 20 to 30 years the number of sheltered care facilities in the United States has risen dramatically. Serving what many consider to be marginal populations, they are often poorly regulated or unregulated, with little or no attention to the health of residents. A retrospective record review of 647 clients residing in boarding homes, rooming houses, a homeless shelter, and residential facilities in Monmouth County, New Jersey, suggested that whereas some differences exist among facilities in terms of clients' physical and psychosocial health problems, these differences may not be meaningful. Since New Jersey regulations require some minimal health supervision to be provided by residential facilities but not by the others, these results suggest that regulations of the other facilities should be revised to reflect better the needs and problems of the populations they serve.