Access to care for supported residents

The Aged Care Financing Authority (ACFA) is an independent statutory committee whose role is to provide independent, transparent advice to the Australian Government on financing and funding issues in the aged care sector. ACFA considers issues in the context of maintaining a viable, accessible and sustainable aged care industry that balances the needs of consumers, providers, the workforce, taxpayers, investors and financiers. Under its operating framework, ACFA is required to provide advice by 31 December 2015 to the Assistant Minister for Social Services on cost neutral mechanisms to ensure access to care for supported residents, including reviewing the supported resident ratio. This work entails analysing the efficiency, effectiveness, and appropriate level of: the supported resident ratio for each aged care planning region; and the 25 per cent discount applied to the maximum accommodation supplement amount where a service does not provide more than 40 per cent of its eligible care recipient days to supported residents. In order to assess these two mechanisms it is important to have a clear understanding of what is meant by ‘effective’, ‘efficient’ and ‘appropriate’. For the purposes of this paper a basic definition of each term may include: Effective: successful or capable of producing a desired or intended result Efficient: achieving maximum productivity with minimum wasted effort or expense Appropriate: suitable or proper in the circumstances To assist in the development of its advice to the Assistant Minister, ACFA is seeking the views of stakeholders. Background A principle underlying aged care means testing is that people who can afford to contribute to the cost of their care should do so, and those that cannot afford to pay should not be denied access to services. While aged care accommodation is considered a personal expense, in line with the above principle, the Australian Government has a safety net for those who cannot afford to pay all or part of their accommodation costs. For the purposes of this paper, supported residents are considered to be those residents who are eligible for Government support toward the cost of their accommodation. Submissions closed  9 June 2015

Memory in aged granular media

Stimulated by recent experimental results, we simulate ``temperature''-cycling experiments in a model for the compaction of granular media. We report on the existence of two types of memory effects: short-term dependence on the history of the sample, and long-term memory for highly compact (aged) systems. A natural interpretation of these results is provided by the analysis of the density heterogeneities.Comment: 5 eps figures, uses euromacr.tex and europhys.sty (included

The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor

The ultrasonic cardiac output monitor (USCOM) is a noninvasive transcutaneous continuous wave Doppler method for assessing hemodynamics. There are no published reference ranges for normal values in adults (aged 18– 60 years) for this device. This study aimed to (1) measure cardiovascular indices using USCOM in healthy adults aged 18–60 years; (2) combine these data with those for healthy children (aged 0–12), adolescents (aged 12–18), and the elderly (aged over 60) from our previously published studies in order to present normal ranges for all ages, and (3) establish normal ranges of USCOM-derived variables according to both weight and age. This was a population- based cross-sectional observational study of healthy Chinese subjects aged 0.5–89 years in Hong Kong. USCOM scans were performed on all subjects, to produce measurements including stroke volume, cardiac output, and systemic vascular resistance. Data from previously published studies (children, adolescents, and the elderly) were included. Normal ranges were defined as lying between the 2.5th and 97.5th percentiles. A total of 2218 subjects were studied (mean age = 16.4, range = 0.5–89; 52% male). From previous studies, 1197 children (aged 0–12, 55% male), 590 adolescents (aged 12–18, 49% male), and 77 elderly (aged 60–89, 55% male) were included. New data were collected from 354 adults aged 18–60 (47% male). Normal ranges are presented according to age and weight. We present comprehensive normal ranges for hemodynamic parameters obtained with USCOM in healthy subjects of all ages from infancy to the elderly

Hypoadrenocorticism in an aged cat

A 13-year-old, female, neutered, domestic longhair cat was referred to the hospital with a two-month history of fluctuating weakness, lethargy, inappetence and intermittently soft stools. Physical examination noted variable mentation, mild tachycardia with poor pulse quality and a body condition score of 1/9. In-house haematology and biochemistry abnormalities included a mild neutrophilia, hyponatraemia, and decreased Na:K ratio of 24 and isosthenuric urine (1.012). The cat was admitted to the hospital for intravenous fluid therapy and management of its electrolyte abnormalities. A low basal cortisol (36 nmol/l) was found on analysis of a stored serum sample, and further investigations confirmed the diagnosis of hypoadrenocorticism. Treatment was implemented initially with hydrocortisone and dexamethasone and continued long term with desoxycorticosterone pivalate and oral prednisolone. More than one year since diagnosis, the cat is clinically well and stable on treatment

Safety and efficacy of vismodegib in patients aged ≥65 years with advanced basal cell carcinoma.

Because many patients with unresectable basal cell carcinoma (BCC) are aged ≥65 years, this study explores the efficacy and safety of vismodegib in these patients with locally advanced (la) or metastatic (m) basal cell carcinoma (BCC) in the ERIVANCE BCC trial and the expanded access study (EAS).We compared patients aged ≥65 years to patients aged <65 years taking vismodegib 150 mg/day, using descriptive statistics for response and safety. Patients aged ≥65 years (laBCC/mBCC) were enrolled in ERIVANCE BCC (33/14) and EAS (27/26). Investigator-assessed best overall response rate in patients ≥65 and <65 years was 46.7%/35.7% and 72.7%/52.6% (laBCC/mBCC), respectively, in ERIVANCE BCC and 45.8%/33.3% and 46.9%/28.6%, respectively, in EAS. These differences were not clinically meaningful. Safety was similar in both groups, although those aged ≥65 years had a higher percentage of grade 3-5 adverse events than those aged <65 years. Vismodegib demonstrated similar clinical activity and adverse events regardless of age

An Analysis of College-aged Women’s Personal Relations

Current communication literature regarding personal relations is limited by its focus on romantic, friendship and friends with benefits relations. To better understand the types of relations college-aged women practice, this study sought to explore (a) the types of cross-sex relations college-aged women practice (b) the reasons they give for practicing the relations and (c) the identities they construct by practicing the relations. Results indicated a myriad of relational types. Types were categorized under three supra-categories and were explored in terms of their description, initiation, maintenance and communication rules, as well as their benefits and drawbacks. Identities associated with the relations were also examined, along with relational fluidity, commitment and intimacy

CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities

Describes the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities. Background Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.   Objective To describe the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities when their acute healthcare needs exceed the scope of the aged care facility staff and general practitioners to manage independently of the hospital system.   Discussion The project delivers high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skills sharing across the care continuum and an individualised, resident-focused approach