Generations

Articles from Vol. 23, No. 2, Summer

A Key Piece of the Integration Puzzle: Managing the Chronic Care Needs of the Frail Elderly in Residential Care Settings
Although families continue to be the major source of long-term care, a variety of residential settings with supportive services have emerged to supplement their efforts. These arrangements support those families whose members need more care than the...
A New Model of Chronic Care
The title of this issue of Generations implies a separation between acute and chronic care. The terminology that has crept into care vocabulary is both confusing and dysfunctional. We use terms like acute care and longterm care as though they had meaning....
Experts Answer Five Critical Questions about Integration of Care
In many ways it appears that the next frontier in the care revolution will be in the area of integrating acute and long-term care for older people While the notion that older people will benefit has become almost axiomatic, the real potential value of...
Integrating Acute and Chronic Care
Ah, these issues of GenSrations are such a treat! The Gen Editorial Board selects a topic that is both important enough and murky enough to warrant closer scrutiny The topic at hand - the integration of acute and long-term care - certainly meets both...
Integrating Nursing Home Care in Managed Care
Twenty years ago, the level of care delivered in nursing homes was easily distinguished from that provided in acute-care hospitals. Nursing homes assisted and supported elderly "custodial" residents with activities of daily living and provided maintenance...
Integration of Acute and Chronic Care: Lessons Learned from South Carolina
Three research and demonstration projects, three different approaches. Development of successful models of integration of acute-care and chronic-care services has long been a goal for researchers and practitioners. Over the past twenty-plus years, the...
Moving Responsibility for Long-Term Care to Local Governments: The Experience in the U.K
The reforms sharpened the distinction between healthcare and long-term care. In 1990, the United Kingdom enacted a major reform of its longterm-care system by converting an open-ended, means-tested national entitlement for institutional care into a block...
Our Guest Editor
Larry Branch is a research professor at Duke University's Center for the Study of Aging and Human Development and director of Duke's M.D.-M.PH. Program and its LongTerm Care Research Program. He has amassed more than twenty-five years of distinguished...
Practical Lessons for Delivering Integrated Services in a Changing Environment: The PACE Model
A new look at a pioneering provider of comprehensive care. The Program of AllInclusive Care for the Elderly, or PACE, is the fully integrated managed care system pioneered by On Lok Senior Health Services in San Francisco (Ansak, 1990). Replicated nationwide...
State Issues in the Integration of Acute and Chronic Care
Can the goals of reducing cost and improving quality both be met? States planning to integrate acute and chronic care generally have two goals: reducing the increases in state financial outlays and improving the quality of care (Riley, I998). The first...
Structuring a Universal Long-Term-Care Program: The Experience in Germany
After twenty years of debating how to join the healthcare and long-term-care systems. In 1994, Germany passed la landmark national social insurance program for longterm care. Historically, healthcare and long-term care had been disjointed, a result of...