Comparing the resident populations of private and public long-term care facilities over a fifteen-year period: a study from Quebec, Canada

In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: privately-owned facilities in which care is privately financed and delivered, and publicly-subsidised accredited facilities. There are few comparative data on the residents served by the private and public sectors, and none on whether their respective population has changed over time. Such knowledge would help plan services for older adults who can no longer live at home due to increased disabilities. This study compared 1) the resident populations currently served by private and public facilities and 2) how they have evolved over time. The data come from two cross-sectional studies conducted in 1995-2000 and 2010-2012. In both studies, we randomly selected care settings in which we randomly selected older residents. In total, 451 residents from 145 settings assessed in 1995-2000 were compared to 329 residents from 102 settings assessed in 2010-2012. In both study periods, older adults housed in the private sector had fewer cognitive and functional disabilities than those in public facilities. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities while it remained over 80% in their public counterparts. Findings indicate that private facilities care today for less-disabled older adults, leaving to public facilities the heavy responsibility of caring for those with more demanding needs. These trends may impact both sectors’ ability to deliver proper residential care

Promoting advance planning for health care and research among older adults: A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.</p> <p>Methods/Design</p> <p>Dyads (<it>n </it>= 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled <it>My Preferences </it>that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about <it>My Preferences</it>. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.</p> <p>Discussion</p> <p>This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.</p> <p>Trial Registration</p> <p><a href="http://www.controlled-trials.com/ISRCTN89993391">ISRCTN89993391</a></p

Examen de la relation entre le discours environnemental présenté dans le rapport annuel et un indice de performance environnementale

Résumé : Dans un premier temps, cette étude examine la possibilité d'une relation entre le discours environnemental présenté dans le rapport annuel et un indice de performance environnementale. Les rapports annuels des années 1986 à 1988 de 23 entreprises sont examinés. L'information environnementale est mesurée par le pourcentage du rapport annuel en pondérant pour tenir compte du type de message. Un indice de pollution de l'eau, établi à partir de données gouvernementales, sert à définir la performance environnementale. Les résultats ne permettent pas de conclure à la présence d'une relation significative entre le discours environnemental et la performance environnementale mais démontrent toutefois une relation négative entre ces deux variables. Le deuxième volet de cette recherche tente de mesurer la fiabilité de l'information environnementale présentée au rapport annuel. À cette fin, 53 lecteurs ont établi un classement de 10 entreprises suite à la lecture d'un document comprenant l'information environnementale extraite de leur rapport annuel 1988. Ce classement est comparé à celui effectué à partir de la performance environnementale réelle. Les mesures utilisées pour la performance environnementale et le discours environnemental sont les mêmes que celles de la première partie. Les résultats ne démontrent aucune relation entre les deux classements, ce qui permet de conclure à l'impossibilité pour les lecteurs de porter des jugements adéquats sur la performance environnementale relative de diverses entreprises à partir de l'information dont ils disposent

Examen de la relation entre le discours environnemental présenté dans le rapport annuel et un indice de performance environnementale

Résumé : Dans un premier temps, cette étude examine la possibilité d'une relation entre le discours environnemental présenté dans le rapport annuel et un indice de performance environnementale. Les rapports annuels des années 1986 à 1988 de 23 entreprises sont examinés. L'information environnementale est mesurée par le pourcentage du rapport annuel en pondérant pour tenir compte du type de message. Un indice de pollution de l'eau, établi à partir de données gouvernementales, sert à définir la performance environnementale. Les résultats ne permettent pas de conclure à la présence d'une relation significative entre le discours environnemental et la performance environnementale mais démontrent toutefois une relation négative entre ces deux variables. Le deuxième volet de cette recherche tente de mesurer la fiabilité de l'information environnementale présentée au rapport annuel. À cette fin, 53 lecteurs ont établi un classement de 10 entreprises suite à la lecture d'un document comprenant l'information environnementale extraite de leur rapport annuel 1988. Ce classement est comparé à celui effectué à partir de la performance environnementale réelle. Les mesures utilisées pour la performance environnementale et le discours environnemental sont les mêmes que celles de la première partie. Les résultats ne démontrent aucune relation entre les deux classements, ce qui permet de conclure à l'impossibilité pour les lecteurs de porter des jugements adéquats sur la performance environnementale relative de diverses entreprises à partir de l'information dont ils disposent

Burden of chickenpox on families: A study in Quebec

OBJECTIVE: To estimate the nonhospital costs of treating chickenpox and to ascertain the opinion of parents regarding the usefulness of vaccination. DESIGN: Retrospective postal survey. SETTING: Province of Quebec. PARTICIPANTS: Random sample of 3333 families with children aged six months to 12 years. OUTCOME MEASURES: For cases of chickenpox that occurred between September 1, 1997 and August 31, 1998, the use of health services, time away from school or work, patient care required, direct and indirect costs for the families and the health care system, and the opinion of parents regarding chickenpox and the vaccine were evaluated. RESULTS: The response rate was 64.7%, and 18.8% of households reported a history of chickenpox, a total of 693 cases. A physician was consulted in 45.8% of these cases, and medication was used in 91.7%. The frequency of hospitalizations was 0.6%. Time away from work or school caused by the disease was 4.1 days on average, with 46.5% of absences being attributed to the risk of contagion. The total average cost of a case of chickenpox was $225. Direct expenses for households accounted for 11% of the total cost, public sector direct costs 7%, indirect costs related to absence from work 38% and caregiving time 45%. A majority of parents (70%) were in favour of a systematic childhood immunization program. CONCLUSIONS: Chickenpox without complications is disruptive for families, but the direct costs for families and the public sector are relatively small