Journal of Community tlealth, Vol. 18, No. 6, l)ecembcr 199"~

REVIEW ESSAY HOME CARE FOR THE DISABLED ELDERLY

F I N A N C I N G H O M E CARE IMPROVIN G P R O T E C T I O N FOR DISABLED ELDERLY PEOPLE Edited by Diane Rowland and Barbara Lyons, Baltimore,

MD, Johns Hopkins University Press, 1991, 256 pp., $47.50 (hard cover).

Within fimr sections and ten chapters, sixteen contribntnrs intelligently apply national and state statistics to the problem of assnring adequate home care to the elderly disabled in the U.S. Pie charts translate the abundant nuntl)er laden tahles into easily understandal)le comparisons. There is usually a sunmtary at the end of each chapter. In addition, a list of references supply sources for On)se inclined to pursue the issues fur- ther. An index allows readers to pinpoint specific topics throughout the hook. All of the chapters emerged trom the work and support of the (;ommonweahh Fund Cum,nissinn on Elderly People Living Alone.

Of particular interest to medical practitioners is chapter five on functional lint- itations and home care requirements. Authored by physicians Laurence Z. Rubenstein and Fran E. Kaiser, it provides relevant material for those caring for elderly patients. They supply lists of services, separated into two groupings, to illustrate the broad range of home care services:

Medical and Health Pro]essional Services: visiting nurses; physicians; physical therapists; pharmaceuticals; dieticians; opticians; dentists; psychologists; respiratory therapists; health aides; medical equipment; medications; occupational therapists; speech therapists; comprehensive assessment; care planning; primary health care; and monitoring.

Social and Personal Care services: friendly visitors; transportation; individual activity programs; information and referral; caregiver support: community linkage; meals-on-wheels; homemaker and shopping services; repair and chore services; envi- ronmental safety aid; personal care; respite care for caregiver; legal and tinancial coun- seling; health education; and nutrition counseling.

Obviously, with the spectrum of services indicated, case management and/or coordination is an absolute necessity. By law, physicians are responsible tot determining a l)lan tor the care of the patient. According to Rubenstein and Kaiser, that process begins with "a comprehensive functional assessment that quantifies the paranteters of medical health, functional status, psychological state, social supports and needs, environ- mental quality and safety . . . a care plan can be devised which involves defining care needs, identifying specific services to meet these needs, and specifying the frequency and duration of these services."

To conduct an adequate functional and cognitive assessment, physicians will need to become familiar with Activities of Daily Living [ADL], Instrumental ADL [IADL] and the Short Portable Mental Status Questionnaire [SPMSQ]. Judith Kasper [Chapter 4] lists the following approaches to determine functioning:

ADL: Without help, do you have any problem with: eating? getting in or out of bed or chairs? walking around? dressing? bathing? getting to the bathroom? bowels and/or uri- nation? going outside.

© 1993 Hunum Sciences Press, Inc. "~93

394 JOURNAL OF COMMUNITY HEALTH

IADL: Without help, are you able: to prepare meals? do laundry? go shopping? do light housework? take medicine? make telephone calls? manage money? SPMSQ: Ask about: today's date? day of week? street address ]city and state]? age? birth [month,day,year]? U.S. President? mother's maiden name? addition and/ur substractinn tasks?

Two chapters in the first section identify who needs home care and who pays fi)r it. Eligibility and benefit issues are discussed in three chapters in section two. Lessnns from current experiences in Medicare, Medicaid, and state approaches are covered in section three. Experience in Canada reveals that home care can be provided, that consumers like the services, that utilization can be constrained and emphasizes the importance of case management.

There are 1.6 million severely disabled elderly people in the U.S. who cuuld benefit from an adequate home care program. Typically, those individuals are most likely to be female, of minority race, aged 85 and older, and poor. A proposal to reform home care benefits by editors Diane Rowland and Barbara Lyons ]Chapter 10] may attract attention because more and more physicians are becoming inw)lved in rendering care to disabled elderly people. Rowland and Lyons propose that a personal care pro- gram be added to Medicare to establish a hmg term care system to resolve the crisis. That proposal delves into the organization, funding and delivery of services deviating [rnm Medicare's t~)cus on home care for post-acute illness. A 20 percent co-insurance factor is included and the cost is estimated at $6.8 billion as of 1989.

This book certainly provides a timely and pertinent review with a wealth of accurate infbrmation about the current condition of home care services in the U.S. Most practicing physicians would prubably regard the intensity of data as overkill. There is no doubt that this is not leisure time reading. Individuals would have to be seriously con- cerned with the issues to read the content concentrated in the 256 pages of this book. For those people, however, the rewards would be substantial.

Allen D. Spiegel, PhD, MPH Professor ,

D e p a r t m e n t o f Preventive Medicine &

C o m m u n i t y Heal th State University o f New York,

Heal th Science Cen te r at Brooklyn

450 Clarkson Avenue

Brooklyn, N.Y. 11203