An alternate level of care, the prospective payment system and the challenge of extended care

Due to demographic, morbidity and public policy shifts, the health care system is undergoing a profound change. In this unsettled context the problem of the alternate level of care (ALC), or sub-acute care, patient has acquired a new meaning and importance. An ALC patient falls between the traditional levels of acute and skilled care. This study tries to identify the nature and scope of the ALC problem in Illinois, because it is symptomatic of changing morbidity patterns; because it exemplifies the consequent dilemmas for the health care industry; and because it typifies the ambivalent response of the health care institutions. The data reveals that the ALC patients are backed up in 78% of the hospitals in the state, and they pose a heavy burden and future risk both to hospitals and nursing homes. The hospital industry has sensed the challenge of extended care, but it is not responding with a reasoned and concerted strategy. Rather, in a worsening competitive situation, a unique opportunity to bridge the hiatus between acute and long-term care, and to build towards a humane and equitable system of care, may pass us by.hospitals prospective payment system alternative level of care long-term care

Games that professionals play: The social psychology of physician-nurse interaction

The paradox of power dictates that though a society segregates its members into stratified groups, society has to bring these socially distant groups together in a collaborative effort in order to make the social enterprise possible. In terms of professional power, physicians and nurses are hierarchically related in a disparity which is firmly grounded in the social structure. But in a hospital setting these unequal professionals share a common environment and a common goal; they collaborate and communicate in deep interrelationships. Power asymmetry and social intimacy are contrasting categories, and when they are brought together, as in a physician-nurse relationship, there arises an elaborate social ritual that makes an effective communication between them possible without diluting the differences in their status and authority. Their social psychological game manifests itself in both institutional and behavioral expressions. The perpetuation of power rests on a structural and symbolic legitimacy. Any attempt to change the status quo would require that one recognize and deal with both these faces of power.

Religion and happiness: Consensus, contradictions,comments and concerns

The relationship between religion and happiness has been the focus of much research. The present review provides a critical examination of this research and, in particular, focuses on conceptual and methodological concerns. The majority of studies report a positive association between measures of religion and happiness; however, contradictory findings are common. This is exemplified in the literature that has systematically employed the Francis Scale of Attitude toward Christianity alongside two different measures of happiness among a variety of samples. Two opposing conclusions have found consistent support. Research with the Oxford Happiness Inventory has consistently found religiosity to be associated with happiness, while research employing the Depression–Happiness Scale has consistently found no association. It is argued that such contradictions may reflect both conceptual and methodological weaknesses in this literature