This article describes the assistance provided to 209 elderly patients with heart disease who
received discharge planning before returning home from the hospital. Telephone interviews at
two weeks postdischarge focused on their needs and the assistance received. The findings reveal
that patients are very needy in the posthospital period and that families provide the bulk of care.
Formal service use is most frequent in nursing care, bathing, and grooming but limited in areas
of highest need-transportation, housekeeping, and shopping. Of the patients interviewed, 30%
report insufficient help with personal care Patients rate the quality of care provided by formal
sources higher than care provided by informal sources Questions are raised about the ability
of families to meet the demands of post-acute care.
Get full access to this article
View all access options for this article.
References
1.
Abraham, R. & Barry, M. (1992). Needs of the family caregivers of frail elderly . Canadian Journal of Public Health, 83, 147-149.
2.
Bassett, S., Magaziner, J., & Hebel, J. (1990) Reliability of proxy response on mental health indices for aged, community-dwelling women. Psychology of Aging, 5, 127-132
3.
Benjamin, A. (1992). An overview of in-home health and supportive services for older persons. In M. Ory & A. Duncker (Eds.), In-home care for older people (pp. 9-52). Newbury Park, CA: Sage.
4.
Benjamin, A., Swan, J., Feigenbaum, L., Newcomer, R., & Fox, P. (1989). Medicare posthospital study: Final report to the Commonwealth Commission on Elderly People Living Alone. San Francisco: University of California, Institute for Health and Aging.
5.
Bonneux, L., Barendregt, J., Meeter, K., Bonsel, G., & van der Maas, P. (1994) Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure. American Journal of Public Health, 84, 20-28.
6.
Brody, J., Brock, D. , & Williams, T. (1987) Trends in the health of the elderly population. Annual Review of Public Health, 8, 211-234.
7.
Bull, M.J. (1994) Use of formal community services by elders and their family caregivers 2 weeks following hospital discharge. Journal of Advanced Nursing, 19, 503-508.
8.
Cantor, M. (1989). Social care: Family and community support systems . Annals of the American Academy of Political and Social Science , 503, 99-112.
9.
Coe, M., Wilkenson, A , & Patterson, P. (1986). Preliminary evidence on the impact of DRG's: Dependency at Discharge (Final report). May Beaverton, OR: Northwest Oregon Health Systems .
10.
Corder, L., Woodbury, M. , & Manton, K. (1996). Proxy response patterns among the aged. Journal of Clinical Epidemiology, 49, 173-182.
11.
Duke University Center for the Study of Aging and Human Development. (1978) Multidimensional functional assessment: The OARS methodology (2nd ed.). Durham, NC: Duke University.
12.
Estes, C. & Swan, J (1993). The Long Term Care Crisis: Elders trapped in the no-care zone. Newbury Park, CA. Sage.
13.
Fillenbaum,G. (1988). Multidimensional Functional Assessment of Older Adults. Hillsdale, NJ: Lawrence Erlbaum
14.
Fisher, J. (1972). New York Heart Association Classification. Archives of Internal Medicine, 129, 836.
15.
Furberg, C., Yusuf, S. , & Thom, T. (1985). Potential for altering the natural history of congestive heart failure. American Journal of Cardiology, 55, 45-47.
16.
Guterman, S., Eggers, P., Riley, G., Greene, T., & Terrell, S. (1988). Special report: The first three years of Medicare Prospective Payment System. Health Care Financing Review, 9, 67-77.
17.
Helbing, C., Sangle, J. , & Silverman, H. (1992). Home Health Agency Benefits . Health Care Financing Review, 1992 Annual Supplement, 125-148.
18.
Hughes, S. (1992). Home care: where we need to go. In M. Ory & A. Duncker (Eds.), In-home care for older people (pp. 53-74). Newbury Park, CA: Sage.
19.
Jones, E.W., Densen, P.M., & Brown, S.D. (1989). Posthospital needs of elderly people at home: Findings from an eight-month follow-up study. Health Services Research, 24(5), 643-664.
20.
Kane, R. (1994). A study of post-acute care (Report No. 317-C98891 . Minneapolis: Institute for Health Services Research.
21.
Kane, R., Finch, M., Chen, Q., Blewett, L., Bums, R., & Moskowitz, M. (1994) Post-hospital home health care for Medicare patients . Health Care Financing Review, 16(1), 131-153.
22.
Kosekoff, J., Kahn, K.L., Rogers, W.H., Reinisch, E.J., Sherwood, M.J., Rubenstein, L.V., Draper, D., Roth, C.P., Chew, C., & Brook, R.H. (1990). Prospective payment system and impairment at discharge . Journal of American Medical Association, 264, 1980-1983.
23.
Mamon, J., Steinwachs, D., Fahey, M., Bone, L., Oktay, J. & Klein, L. (1992). Impact of hospital discharge planning on meeting patients needs after returning home. Health Services Research , 27(2), 155-175.
24.
Mauser, E., & Miller, N (1994). A profile of home health users in 1992. Health Care Financing Review, 16, 17-33
25.
May, D., Kelly, J., Mendlein, J. , & Garbe, P. (1991). Surveillance of major causes of hospitalization among the elderly, 1988. Morbidity and Mortality Weekly Report , 40(SS-1), 7-21.
26.
Maynard, C.Fisher, L., Passamini, E., & Pullum, T. (1986). Blacks in coronary artery surgery study. American Journal of Public Health, 76, 1446-1448.
27.
Morrow-Howell, N. & Proctor, E. (1994). Discharge destinations of Medicare patients receiving discharge planning: Who goes where? Journal of Applied Gerontology , 12(2), 188-205.
28.
Morrow-Howell, N., Proctor, E., & Berg-Weger, M. (1993). Adequacy of informal care for elderly patients going home from the hospital: Discharge planner perspectives . Journal of Applied Gerontology, 12(2), 188-205.
29.
Morrow-Howell, N., Proctor, E., & Dore, P. (1998). Adequacy of care: The concept and its measurement. Research on Social Work Practice , 8, 86-102.
30.
Morrow-Howell, N., Proctor, E., & Mui, A. (1991). Adequacy of discharge plans for elderly patients . Social Work Research & Abstracts, 27(1), 6-13.
31.
Noelker, L., & Whitlatch, C. (1995). Caregiving. In Maddox, G. (Ed.), Encyclopedia of Aging (pp. 144-146). New York: Springer.
32.
Olson, M. (1989). Family participation in post-hospital care: women's work. Journal of Psychosocial Oncology, 7(1/2), 77-91.
33.
Picavet, H. & van den Bos, G. (1996). Comparing survey data on functional disability: the impact of some methodological differences. Journal of Epidemiology and Community Health, 50, 86-93.
34.
Proctor, E. & Morrow-Howell, N. (1988). Factors in Effective Discharge Planning (Report No. HS05804-01. Washington, DC: Health Promotion and Service Delivery Cluster, Division of Extramural Research, National Center for Health Services Research and Health Care, Department of Health and Human Services, Public Health Services .
35.
Proctor, E., Morrow-Howell, N., and Kaplan, S. (1996). Implementation discrepancies in discharge plans for older adults going home from the hospital. Health and Social Work, 21, 30-40
36.
Prospective Payment Assessment Commission (ProPAC).1990. Medicare Prospective Payment and the American Health Care System (Report to Congress. Washington, DC: Author.
37.
Rothman, M., Hedrick, S., Bulcroft, K., Hickam, D., & Rubenstein, L. (1991). The validity of proxy-generated scores as measures of patient health status. Medical Care , 29, 115-124.
38.
Schwartz, P., Blumenfield, S., & Simon, E. (1990). The interim homecare program: An innovative discharge planning alternative. Health and Social Work, 15, 152-160.
39.
Short, P. (1987). Estimates of the uninsured population, calendar year 1987. Public Health Service, DHHS #90-3469.
40.
Stark, F. (1987). Testimony. In Medicare Hospital DRG Margins: Introduction. Hearing before the U.S. House of Representatives Committee on Ways and Means, Subcommittee on Health. Washington, DC: Government Printing Office.
41.
Starrett, R. (1986). Home health care: the elderly's perception. Home Health Care Services Quarterly, 7(1), 69-80.
42.
Steinwachs, D. (1989). Impact of discharge planning on patient outcome. (Final Report to the Agency for Health Care Policy and Research, DHHS grant no. 5R18-HS-0541002Baltimore, MD: Johns Hopkins University.
43.
Stewart, A., Greenfield, S., Hays, R., Wells, K., Roger, W., Berry, S., McGlynn, E., & Ware, J. (1989). Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study. Journal of the American Medical Association, 252, 907-913.
44.
Tennstedt, S., Skinner, K., Sullivan, L., & McKinlay, J. (1992). Response comparability of family and staff proxies for nursing home residents. American Journal of Public Health , 82, 747-749.
45.
U. S. Department of Health and Human Services. ( 1987). Long-term care for the functionally dependent elderly. Vital and Health Statistics (Publication No. PHS-90-1765. Hyattsville, MD: Department of Health & Human Services Publication.
46.
Vinson, J., Rich, M., Sperry, J., Shah, A., & McNamara, T. (1990). Early readmission of elderly patients with congestive heart failure. Journal of the American Geriatric Society, 38, 1290-1295.
47.
Wallace, S. (1990). The no-care zone: availability, accessibility, and acceptability in community-based long-term care. The Gerontologist , 30(29), 254-261.
48.
Williams, B., MacKay, S., & Tomer, J. (1991). Home health care. Medical Care , 29, 583-587.
49.
Wolock, I., Schlesinger, E., Dinerman, M., & Seaton, R. (1987). The posthospital needs and care of patients: Implications for discharge planning. Social Work in Health Care, 12(4), 61-76.
