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Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
Florida has the largest proportion of elderly in the nation- 2.8 million persons are over age 65, representing 17.6% of its total population. The dramatic rise in the number of persons age 65 and over in Florida over the next 20 years-estimated to total 26.3% of total population-will further stretch the already limited resources of the state. Aware of the pressing demand for long-term care services well into the 21 * century, policymakers in Florida have begun seriously to review options for improving financing and delivery of long-term care for the frail elderly and persons with disabilities. Federal and state Medicaid spending in Florida was $2.6 billion in FY2001, and 30.5% of Medicaid spending was for long-term care. In FY2001, 75.3% of total Medicaid spending was for institutional care. Slightly less than 25% of Medicaid spending was channeled towards home and community-based services. Although institutional care dominated Medicaid spending, there has been slow but steady expansion of home and community-based services funding, both through the use of Medicaid's waiver programs as well as significant support through state sources. Among the major issues facing long-term care in Florida are: the fragmentation of long-term care services among state and local agencies, an imbalance in financing that favors institutional care rather than home and community based care, shortage of health care workers and well-trained staff throughout the long-term care , and disparities in availability of services across the state.
As aging trends in the United States and Europe in particular are strongly suggestive of increasingly older society, it would be prudent for health care providers to better prepare for such changes. By including physiology, disease, nutrition, pharmacology, pathology, radiology and other relevant associated topics, Geriatric Gastroenterology fills the void in the literature for a volume devoted specifically to gastrointestinal illness in the elderly. This unique volume includes provision of training for current and future generations of physicians to deal with the health problems of older adults. It will also serve as a comprehensive guide to practicing physicians for ease of reference. Relevant to the geriatric age group, the volume covers epidemiology, physiology of aging, gastrointestinal physiology, pharmacology, radiology, pathology, motility disorders, luminal disorders, hepato-biliary disease, systemic manifestations, neoplastic disorders, gastrointestinal bleeding, cancer and medication related interactions and adverse events, all extremely common in older adults; these are often hard to evaluate and judge, especially considering the complex aging physiology. All have become important components of modern medicine. Special emphasis is be given to nutrition and related disorders. Capsule endoscopy and its utility in the geriatric population is also covered. Presented in simple, easy to read style, the volume includes numerous tables, figures and key points enabling ease of understanding. Chapters on imaging and pathology are profusely illustrated. All chapters are written by specialists and include up to date scientific information. Geriatric Gastroenterology is of great utility to residents in internal medicine, fellows in gastroenterology and geriatric medicine as well as gastroenterologists, geriatricians and practicing physicians including primary care physicians caring for older adults.