Forbes S A, Hoffart N, Redford L J
University of Kansas School of Nursing, Kansas City 66160-7502, USA.
J Case Manag. 1997 Winter;6(4):166-73.
An analysis of the Minimum Data Set Plus (MDS+) from one midwestern state revealed a group of "high functional elders" entering nursing homes, who potentially could be served in the community at a lower cost. The purpose of this qualitative study was to identify and better understand the reasons why these apparently high functioning elder adults entered nursing homes. Data from the 1995 MDS+ were used to identify "high functional" elders recently admitted to the nursing home from two urban and seven rural counties. Data were collected through in-depth, face-to-face, semi-structured interviews and analyzed using qualitative content analysis. Of the 33 persons judged to be high functional, only 36% remained in the nursing home 3 to 6 months later. Most elders were using a wide array of community-based services and extensive informal support networks prior to entering the nursing home. Most described specific events that forced them into the nursing home environment. Health needs, specifically the need for 24-hour care or supervision, emerged as the dominant factor for remaining in the nursing home. Of the 12 elders interviewed, all demonstrated some evidence of cognitive impairment. This study suggests that there are persons in nursing facilities today for whom community-based services, such as affordable assisted-living, would be reasonable and appropriate. Case managers may be the most qualified not only to assess for and coordinate services, but also to advocate for affordable services that preserve elders' functional status.
对来自中西部一个州的最小数据集升级版（MDS+）进行的分析显示，有一群“高功能老年人”入住了养老院，而他们有可能以更低的成本在社区中得到照料。这项定性研究的目的是确定并更好地理解这些明显高功能的老年人入住养老院的原因。1995年MDS+的数据被用于识别最近从两个城市县和七个农村县入住养老院的“高功能”老年人。通过深入、面对面、半结构化访谈收集数据，并使用定性内容分析法进行分析。在被判定为高功能的33人中，3至6个月后只有36%仍留在养老院。大多数老年人在入住养老院之前使用了各种各样的社区服务和广泛的非正式支持网络。大多数人描述了迫使他们进入养老院环境的具体事件。健康需求，特别是对24小时护理或监督的需求，成为留在养老院的主要因素。在接受访谈的12位老年人中，所有人都表现出了一些认知障碍的迹象。这项研究表明，如今在养老院中有一些人，对于他们来说，诸如经济适用的辅助生活等社区服务将是合理且合适的。个案管理员可能不仅最有资格评估并协调服务，而且还能倡导提供可维护老年人功能状态的经济适用服务。
