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DEMENTIA WITH A SEASONAL ONSET SECONDARY TO CARBON MONOXIDE POISONING
Author(s) -
Webb Crispin J.,
Vaitkevicius Peter V.
Publication year - 1997
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1997.tb03790.x
Subject(s) - medicine , carbon monoxide poisoning , gerontology , dementia , library science , family medicine , pediatrics , poison control , emergency medicine , disease , computer science
nursing home, Whether a nursing home eligible person actually enters a nursing home depends on a number of crucial factors, including personal choice and state policies regarding the available number and regional distribution of nursing home beds. For the eligible person who chooses not to live in a nursing home under any circumstances, PACE offers a responsible and compassionate community alternative. Additionally, in many areas of the country there is a severe shortage of nursing home beds. The alternatives for individuals living in such areas are to remain in the community without appropriate services or to move into a nursing home out of county or, in some cases, out of state, far away from their families. In this era of cost control, states are seeking ways of controlling long-term care expenditures, particularly institutional long-term care costs. Construction of additional nursing homes is severely restricted, and Medicaid reimbursement rates are low for the existing beds. The latter policy creates a disincentive for nursing homes to admit low income older patients on Medicaid. The net effect is an ever decreasing availability of nursing home beds for eligible persons. PACE offers a solution that allows states to adequately serve a vulnerable population at lower cost. The report cited by Dr. Leff, which gave the impression that PACE programs “skim” by avoiding difficult to serve or high cost clients, was formally repudiated by the co-authors of the report.” Moreover, HCFA the sponsor of both the PACE demonstration and its evaluation, refuted the report’s inferences.6 Dr. Leff asserts that a randomized control group study would be the only means of determining what proportion of PACE enrollees would have entered a nursing home in the absence of the program. We contend that the number of variables, and the relationship among variables, affecting an individual’s decision to enter a nursing home makes the identification of a true control group virtually impossible. The Channeling demonstration was a randomized control study.’ Despite serving an extremely frail older population, the Channeling program showed no significant reduction in either nursing home use or acute hospital use compared with controls. The percentage of patients in the Channeling program residing in nursing homes after 1 year of study (13%) was three times the percentage of PACE enrollees (4%) who are permanent nursing home residents. PACE has achieved significant reductions of inpatient utilization in both acute hospitals and nursing homes. We believe that PACE programs have passed Dr. T. Franklin Williams’ test of “face validity.”*