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Market forces are driving a radical restructuring of health care delivery in the United States. At the same time, more and more people are living comparatively long lives with a variety of severe chronic health conditions. Many such people are concerned about the trend toward the creation of managed care systems because their need for frequent, often complex, medical services conflicts with managed care's desires to contain costs. The fear is that people with serious chronic disorders will be excluded from or underserved by the integrated health care delivery networks now emerging. Responding to a request from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, this book reflects the results of a workshop that focused on the following questions: Does the model of managed care or an integrated delivery system influence the types of interventions provided to patients with chronic conditions and the clinical and health status outcomes resulting from those interventions? If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (e.g., income, education, ethnicity) have on patient outcomes? If the type of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified that account for the relationships? If not, what type of research should be pursued to provide the information needed about the relationship between types of health care systems and the processes and outcomes of care provided to people with serious chronic conditions?
Most social studies of older people in the United States have focused upon problems and conditions encountered in urban centers. In Older Rural Americans sixteen social scientists representing various regions examine in depth the circumstances of older people in rural America. The authors first consider older people in the contexts of work, the family, and the community, discussing their social outlook, their place in these contexts, and the profound changes they face as they move away from an active part in these areas of life. Later chapters analyze the distribution of the rural aged population and their economic, housing, and health status. Of particular interest are essays treating the place and condition of older rural people in three major subcultures of the United States—the American Indian, the Spanish-speaking people of the Southwest, and African Americans. Finally, the authors trace the development of local, state, and federal programs designed to assist the aged. The authors argue that an understanding of rural life some sixty years ago is of the utmost importance, for it is the values of that time that have largely formed the attitudes and outlooks of today's rural aged.
By the end of the current decade, many baby boomers will be senior citizens. What policies should we enact to prepare for an aging society?In the coming decade, we have a unique opportunity to create new and better aging policies. This collection of twenty essays by prominent educators, researchers, and policy analysts in the field of gerontology brings together innovative ideas from the United States, Europe, and Japan. Instead of focusing on utopian dreams, these exciting proposals are based on policy changes that may well be attainable in the next ten years. The vital concerns addressed in Advancing Aging Policy as the 21st Century Begins include work and retirement issues, the aging prison population, long-term care, Latino elders, transportation, death and dying issues, and the aging of the baby boom generation. Advancing Aging Policy as the 21st Century Begins explores: innovative policies and care arrangements around the world the importance of a strong economy that provides opportunities for seniors who seek them and support for those who need it the need for flexible retirement and employment policies for older adults the connections between family policy and aging policy the importance of improving training and compensation for workers in long-term care the special needs of our diverse and rapidly growing population of older people the importance of focusing aging policy on people rather than on programsThis forward-looking book on policy and aging in the coming decade puts the experience and insight of leaders in the field from around the world in your hands. Policymakers, educators, and students of gerontology will find it an invaluable resource.
Breakthroughs in medical science and technology, combined with shifts in lifestyle and demographics, have resulted in a rapid rise in the number of individuals living with one or more chronic illnesses. Comprehensive Care Coordination for Chronically Ill Adults presents thorough demographics on this growing sector, describes models for change, reviews current literature and examines various outcomes. Comprehensive Care Coordination for Chronically Ill Adults is divided into two parts. The first provides thorough discussion and background on theoretical concepts of care, including a complete profile of current demographics and chapters on current models of care, intervention components, evaluation methods, health information technology, financing, and educating an interdisciplinary team. The second part of the book uses multiple case studies from various settings to illustrate successful comprehensive care coordination in practice. Nurse, physician and social work leaders in community health, primary care, education and research, and health policy makers will find this book essential among resources to improve care for the chronically ill.