increasing public costs for the care of the elderly have created fundamental changes that are redefining the basic principles of health care funding. In the past, overall institutional funding was predominantly tied to spending. In view of the limitations of this approach to funding long-term care facilities, case-mix classification tries to take into account the characteristics of the residents as a tool for predicting costs. Recently, a new case-mix classification based on the functional autonomy profile of the residents - ISO-SMAF profile - was developed in the Province of Quebec, Canada. This classification can be used to change the funding system to base it on the functional autonomy characteristics of the residents.
the main objective of this study was to apply the ISO-SMAF classification to funding long-term care facilities in one area of the Province of Quebec and to compare the results of this new funding methodology to the formal methodology.
this study used a cross-sectional design.
the population under study comprised all residents of all 11 long-term care facilities in the Eastern Townships area of Quebec. Each resident was assessed using the Functional Autonomy Measurement System. The theoretical budget was calculated based on the adjusted cost per year associated with each ISO-SMAF profile derived from a previous economic study.
the theoretical budget based on the ISO-SMAF profiles may highlight the under- or over-funding of a facility when compared to the usual funding system based predominantly on the number of beds and hours of care.
the results of this study show the feasibility of applying the new funding approach to long-term care facilities. However, implementation of the ISO-SMAF classification for funding must be supported by continued and computerised residents' medical files including the Functional Autonomy Measurement System.
Seniors use a wide variety of health services delivered by numerous practitioners and organizations. Self-report is the most accessible and cost-effective method to collect information on their use. It is thus important to demonstrate the reliability of this approach.
As part of a longitudinal study on the effect of an integrated service delivery system, participants (or their proxies) were instructed to use a calendar to record their use of health services. Every 2 months, an interviewer collected use since the last phone contact. A subsample was recontacted by the same or another interviewer to estimate test-retest and interinterviewer reliability, respectively. Data collections were compared using delta and weighted kappa as well as intraclass correlation coefficients.
Almost perfect agreement was obtained for hospitalization, day surgery, visits to general practitioners and medical specialists, help for home maintenance, and use of voluntary services. Agreement was substantial for visits to the emergency room and home help for personal care. For visits to or by nurses and other health professionals, agreement can be qualified as moderate-to-substantial.
Assisted self-report of health-services use by older adults or their proxies through bimonthly phone calls is reliable.
The aging population and the epidemic of chronic diseases requires an accompanying finance reform of long-term care that will become increasingly dominant. Many countries have faced this situation and have set up a separate public funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec must adopt such autonomy insurance and create a separate fund financed partly by a more judicious use of current budgets and tax credits, and also by a significant investment in home care. An autonomy support benefit could be allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social economy agencies. This benefit would be established following a standardized assessment of functional autonomy achieved by the case manager who will manage the services and control their quality.
To describe the methods and patient characteristics of the Canadian Outcomes Study in Dementia (COSID).
COSID is a 3-year prospective study of dementia patients living in the community at the time of study registration. We assessed patients' cognition, behaviour, and functioning every 6 months, using the Modified Mini-Mental State Examination (3MS), the Neuropsychiatric Inventory (NPI), and the Functional Autonomy Measurement System (SMAF), respectively. We assessed caregivers, using the Zarit Burden Interview (ZBI). Additional information included the Global Deterioration Scale (GDS), patients' driving status, and clinical information including family history, dementia type, concomitant medications, and comorbid conditions. From the patient or caregiver, we collected details of inpatient and outpatient resources used by the patient and (or) caregiver.
We enrolled 766 patients from 31 Canadian sites. Overall mean age was 76.8 years, and mean age of onset was 73.1 years. Of the total patients, 98% were white, 54% were women, and 84% were diagnosed with Alzheimer's disease. Mean baseline 3MS was 66.5, NPI was 9.5, and SMAF was 18.30. Of these patients, 48% reported a GDS score of 3 (that is, moderate), 16% reported a GDS score of 4 (that is, moderately severe), and the remaining 36% reported a GDS score of 1 or 2 (that is, mild or very mild). At baseline, 83% of patients received cholinesterase inhibitors, 46% received nonsteroidal antiinflammatory drugs, 39% received vitamin E, and 25% received antidepressants. Adult day care and home help were the largest cost factors in this population, with mean monthly costs of $65 and $64, respectively. We found interesting differences in the resources used among geographic regions and care settings.
COSID is already generating valuable information about treatment patterns, outcomes, and resource use in Canadian patients with dementia. As the data mature, it will be possible to build robust models on treatment effectiveness and costs of care.
While cognitive impairment (CI) and dementia are among the most common morbid conditions in later life, life expectancies free from CI or dementia have been the object of much less investigation than life expectancy based on measures of physical functioning.
We estimated sex-specific CI-free life expectancy in Canada for people aged 65 and older using data from a nationwide, multicenter Canadian study on the epidemiology of dementia.
The absolute number of years with CI remains virtually constant with increasing age. Whatever the current age, senior men can expect to live 2.5-3 years of their remaining life with some form of CI and about 1.5 years of those with dementia. For women, these figures rise to 3-4 years with CI, of which 2-2.5 years are spent with dementia.
Surviving to an older age does not result in a longer average absolute period of CI. This period is associated with a significant reduction in quality of life, the use of home and institutional services, as well as psychological and physical distress for formal and informal caregivers. Results are compared to findings reported in other countries.
The objectives of the study were to compare the association and responsiveness of the functional autonomy measurement system (SMAF) and functional independence measure (FIM) as outcome measures addressing functional independence in stroke patients involved in an intensive rehabilitation program and to compare their relationships with a social participation measure after rehabilitation period. One hundred and thirty-two people who had a stroke were evaluated with the SMAF and FIM during the rehabilitation period (T1: admission; T2: discharge; n=132) and twice after discharge (T3=2 weeks; n=118; T4=6 months later; n=102). At T3 and T4, a participation measure, the assessment of life habits (LIFE-H), was added. The main findings are: (1) the total scores on the SMAF and FIM are strongly correlated together (r=0.93 to 0.95; p
To estimate the contribution of behavioral and psychological symptoms of dementia (BPSD) to the costs of care.
A one-year prospective study of resource utilization recorded monthly by 500 caregivers of community dwelling patients with dementia. The effect of behavior on total, direct and indirect costs of care was examined.
The total cost of care was $1,298 per month and there was a significant independent relationship between costs and BPSD. The incremental cost of a one point increase in Neuropsychiatric Inventory score was $30 per month (95% CI: $19-$41).
BPSD contribute significantly to the overall costs of dementia care. Interventions targeted at BPSD may help to reduce the staggering societal costs of this illness.
This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.