The shift in care from hospital to home has raised concerns about increased financial, physical and emotional burdens placed on families, especially women. Much of the care is assumed by informal caregivers and 27% of caregivers said that it affected their health and had reproach as a result of their health care activities.
Demographics of Patient Populations
Traditionally there are two cohorts of patients that are high users of comunity health services - young mothers and the elderly. It is well documented that the elderly are high users of health care services. In addition to this cohort there is now many acutely ill patients with coexisting chronic conditions requiring community services. Governments are concerned with the aging population and the increased demands and costs of community care. It is striking to see Japan's aging population in comparison to other developed countries. On the positive side, there is an increase in what is now commonly called “the walking well”. It should be emphasized that the majority of elderly are still in their homes and maintain a high quality of life and do not access services until they need support of services. Dr.Watanabe noted that clients in intermediate care facilities were elderly females with a low degree of independence and dementia. In Canadian home care services the rate of home care utilization were highest among seniors, particularly women, who lived alone.
Characteristics of Hospital Care
This topic focuses on the implications of shorter length of stay in hospitals and the demographics of the patient population. There is a perception that there are not enough homecare services to meet the demand. The additional demand has been absorbed by family members rather than professional services. Hospitals are trying to address the increased need by increasing ambulatory services and strengthening their relationship with home care agencies. Studies have shown that even a modest targeted intervention can prevent or delay costly re-admissions or nursing home placement. Effective discharge planning includes the following key variables: multidisciplinary, agency cooperation, systems approach, good technological capacity, patient and family involvement. Levine (1999) suggests that discharge planning has to be considered a process, not a last minute event. Discharge has to be started at the time of hospital admission in order to adequately assess and plan for successful discharge. In fact. Arthur (2000) has found that pre-discharge planning with clients awaiting coronary bypass surgery has a positive impact on their recovery and reduces the length of hospital stay.
