Evaluating the quality of care received in long-term care facilities from a consumer perspective: development and construct validity of the Consumer Choice Index - Six Dimension instrument

The Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. This study aims to demonstrate the construct validity of the CCI-6D. Older residents living in long-term care facilities and proxy family carers (where severely impaired cognition precluded resident consent) participated as consumers of long-term care. Data collected included the CCI-6D instrument, quality of life, physical function and characteristics of the care facility. Relationships between these variables and the CCI-6D dimensions were assessed and analysed through chi-squared and Kruskal–Wallis tests to assess the construct validity of each dimension. Of 430 eligible consumers, a total of 253 completed the questionnaire, of whom 68 (27%) were residents and 185 (73%) were informal carer proxy participants. There was strong evidence of construct validity of the dimensions relating to adequacy of individual care time, access to outside and gardens, access to meaningful activities and flexibility of care. There was more moderate evidence of validity of the home-like own room and shared spaces items, which may be in part due to difficulty in identifying strong discriminatory variables for comparison with these items. The results also indicate a strong association between ‘processes’ of care delivery (as measured by the CCI-6D) and quality of life of care recipients.Rachel Milte, Julie Ratcliffe, Clare Bradley, Wendy Shulver, and Maria Crott

A CITIZENS JURY TO INFORM POLICY ON REHABILITATION FOR PEOPLE IN RESIDENTIAL CARE WITH HIP FRACTURE

Abstract It has long been recognised that eliciting the views and preferences of members of the public can improve health care decision making. One way of engaging members of the public in decision making is via Citizens’ Juries. Citizens’ Juries bring together a small group of people (jurors) who represent members of the public and ask them to consider a particular aspect of health care that is often complex (a ‘wicked’ problem). The aim of this jury was to consider (1) should there be an investment in physical rehabilitation services in residential care for older people following hip fracture? and (2) If so, what are some options for providing this service (considering funding, models of service delivery and equity)? A group of 13 jurors in Australia listened to presentations from expert witnesses including rehabilitation and palliative care specialists, a residential care provider, a health economist and three consumers. Following deliberation, all members of the jury agreed that there needs be a greater focus on promoting independence and rehabilitation in residential care and that upskilling of care staff is required. Twelve of the thirteen jurors agreed that in-reach rehabilitation services should be provided for this population with certain parameters. The remaining juror had reservations. The jurors felt that rehabilitation should not focus on physical recovery exclusively but should be flexible to meet the needs of the person; for some people this may include a greater focus on pain management or psychosocial rehabilitation. All jurors agreed that rehabilitation should take place in the residential care setting

Introducing consumer directed care in residential care settings for older people in Australia: Views of a citizens’ jury

Objectives: Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens’ jury to elicit views of members of the public regarding consumer directed care in residential care. Methods: A citizens’ jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results: The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person’s funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions: The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.Kate Laver, Emmanuel Gnanamanickam, Craig Whitehead, Susan Kurrle, Megan Corlis, Julie Ratcliffe, Wendy Shulver and Maria Crott

Direct health and residential care costs of people living with dementia in Australian residential aged care

Objectives: This analysis estimates the whole-of-system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care. Methods: Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals. Results: The average annual whole-of-system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out-of-hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia. Conclusion: This study provides the first estimate of the whole-of-system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom-up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top-down, population costing approaches are taken.Emmanuel S. Gnanamanickam, Suzanne M. Dyer, Rachel Milte, Stephanie L. Harrison, Enwu Liu, Tiffany Easton, Clare Bradley, Rebecca Bilton, Wendy Shulver, Julie Ratcliffe, Craig Whitehead, Maria Crott

CD reference materials fabricated on monolithic 200 mm wafers for automated metrology tool applications

Recently, prototype isolated-line, single-crystal critical dimension (CD) reference materials (SCCDRMs) with linewidths as narrow as 40nm±1.5nm have been reported. These reference materials, designated NIST Prototype Reference Material (RM) 8111, were configured as 10 mm by 11 mm silicon test chips mounted in 200 mm carrier wafers. The RM 8111 chips were fabricated using microelectromechanical (MEMS) process techniques, which assure the alignment of the sidewalls of the features to silicon (111) lattice planes, and were calibrated in a sequence involving atomic force microscopy (AFM) and high resolution transmission electron microscopy (HRTEM) metrology. This paper reports initial results on SCCDRMs fabricated on 200 mm bulk wafers; this monolithic approach would eliminate the need for carrier wafers.</p

Design and fabrication of a copper test structure for use as an electrical critical dimension reference

A novel copper damascene process is reported for fabrication of Electrical Critical Dimension (ECD) reference material. The method of fabrication first creates an initial "silicon preform" whose linewidth is transferred into a trench using a silicon nitride mould. The trench is created by removing a portion of the silicon and replacing it with copper to enable both Transmission Electron Microscopy (TEM) and electrical linewidth measurements to be made on the same structure. The technique is based on the use of anisotropic wet etching of (110) silicon wafers to yield silicon features with vertical sidewalls. The paper demonstrates that this method successfully produces copper lines which serve as ECD control structures and the process can be applied to any damascene compatible material for developing electrical linewidth measurement reference material.</p

Design and fabrication of a copper test structure for use as an electrical critical dimension reference

A novel copper damascene process is reported for fabrication of Electrical Critical Dimension (ECD) reference material. The method of fabrication first creates an initial "silicon preform" whose linewidth is transferred into a trench using a silicon nitride mould. The trench is created by removing a portion of the silicon and replacing it with copper to enable both Transmission Electron Microscopy (TEM) and electrical linewidth measurements to be made on the same structure. The technique is based on the use of anisotropic wet etching of (110) silicon wafers to yield silicon features with vertical sidewalls. The paper demonstrates that this method successfully produces copper lines which serve as ECD control structures and the process can be applied to any damascene compatible material for developing electrical linewidth measurement reference material.</p

Extraction of sheet resistance and linewidth from all-copper ECD test structures fabricated from silicon preforms

Test structures have been fabricated to allow Electrical Critical Dimensions (ECD) to be extracted from copper features with dimensions comparable to those replicated in IC interconnect systems. The implementation of these structures is such that no conductive barrier metal has been used. The advantage of this approach is that the electrical measurements provide a non-destructive and efficient method for determining CD values and for enabling fundamental studies of electron transport in narrow copper features unaffected by the complications of barrier metal films. This paper reports on the results of various tests which have been conducted to evaluate the current design.</p

Extraction of sheet resistance and line width from all-copper BCD test structures fabricated from silicon preforms

Test structures have been fabricated to allow electrical critical dimensions (ECD) to be extracted from copper features with dimensions comparable to those replicated in integrated circuit (IC) interconnect systems. The implementation of these structures is such that no conductive barrier metal has been used. The advantage of this approach is that the electrical measurements provide a nondestructive and efficient method for determining critical dimension (CD) values and for enabling fundamental studies of electron transport in narrow copper features unaffected by the complications of barrier metal films. This paper reports on the results of tests which have been conducted to evaluate various extraction methods for sheet resistance and line width values from the current design.</p

Array based test structure for optical-electrical overlay calibration

The novel overlay test structure reported in this paper was purposely designed to serve as an applicationspecific reference material. It features standard frame-inframe optical overlay targets embedded in electrical test features and fabricated by the same process as the parts being manufactured. Optical overlay is commonly used in process control applications due to its utility for determining the relative positions of features patterned in photoresist, Electrical overlay, although it can only be measured on fully patterned test structures, is the metric of interest. Using this combined optical/electrical overlay test structure, we can derive the relationship between the routinely measured optical overlay and the electrical overlay for any specific combination of process and optical overlay tool.</p