Community-Based Initiatives in Long-term Care. Mitty E, McNichoIl AM, Schraff S, et al. New York. National League for Nursing, 1986, 82 pages, paperback.
This book contains papers that were presented at the Third Invitational Conference of the National League for Nursing Committee on Long-Term Care and Ross Laboratories. The emphasis throughout the book is on services needed by the elderly to maintain themselves in the community. The lack of continuity of services, the lack of education in gerontological nursing, and funding deficits in programs for the elderly are discussed. The text is clearly written, very concise, and contains information on meeting the nutrition and housing needs of elderly persons. It also includes educational programs, professional education, hospice programs, congregate living, and recent trends in management and funding of community-based programs.
The first paper discusses the two-tier system of intensity of care in nursing homes, short-term rehab and permanent care, the RUG 's. Resource Utilization Groups, as well as educational and training needs of gerontological staff. The paper on congregate housing emphasizes the need for environments that adapt to the changing needs of the older person, rather than requiring the older person to relocate as their dependency levels change.
The third paper reviews the historical development and legislation for hospices and discusses the five major models of palliative and supportive services provided to patients, families, and friends. Hospice is one communitybased initiative that follows the current trend toward choice, responsibility for self, and maximizing one's potential. Organizational dilemmas of home health services based on financial constraints and regulatory definitions that restrict access to home care are addressed in the fourth paper.
A profile of present home health agencies and factors leading to their growth and expansion of types of services offered are presented, as well as legislative and financing issues. The paper on housing addresses the problems of the older homeowner, lack of transportation and other services in rural and suburban areas, the nurses' role in assessing environment, shared housing, relocation, and the needs of children of elderly people who are aging themselves. "Health Care and Nutrition Services" give an overview of nutritional status and needs, discusses the present status of community nutrition programs and issues such as funding, safety and sanitation, nutrient standards, nutrition education and health promotion and outreach, and gives recommendations for the future. The final paper, "Professional and Public Education Initiatives: Addressing Health and Related Needs of Elderly persons" gives an overview of the current older population and projects what their needs will be. Also, a current status of professional and public educational programs is given.
All papers conclude with references and study questions and the conference recommendations are included. This text would be useful to nurses in clinical and educational settings, as well as to other health professionals who must as a team prepare to meet the challenge of expanding services to the elderly through new and creative programs.