Journal of Gerontological Nursing

THE AIDS EPIDEMIC Challenges for Nursing Homes

Nathan L Linsk, PHD; Patricia J Cich, BSW; Linda Cianfrani, MS, BSN

Abstract

Will AIDS influence the development of specialized skills by nurses in long-term care facilities? As persons with AIDS (PWAs) live longer and increasingly require skilled nursing care in varying degrees, the need for nursing expertise continues to grow. To be prepared to care for clients with AIDS in long-term care facilities, nurses should be familiar with the multiple issues surrounding admittance of this new and often younger population. Not only do these issues encompass the personal beliefs of PWAs, but these issues also affect clients already in long-term care facilities as well as all levels of employees. Additionally, these issues significantly touch the loved ones of each of these groups.

Barriers to providing long-term care services to persons infected with the human immunodeficiency virus (HTV) are embedded in a pervasive fear about AIDS and resulting discrimination against people with AIDS. Implementation of longterm caring for PWAs is complicated by issues of how to efficiently, adequately, and compassionately serve a fairly new population. Kane and Kane (1987) define long-term care as "a set of health, personal care, and social services delivered over a sustained period of time to persons who have lost or never acquired some degree of functional capacity." Although initially care for PWAs was often viewed either as acute, crisisoriented, or terminal care, with the advent of life-sustaining antiviral drugs and application of health promotion principles to PWAs, persons affected are living longer and their continuing care needs are increasingly being viewed as chronic. States are only beginning to give attention to plan policy and programs directed at long-term service needs for PWAs (Engstrom, 1987; Holland, 1988; King County, 1987).

To date there is no universal method for projecting the need for long-term care services; current estimates using several methods show that from 10% to 25% of all living cases may require this type of care (Holland, 1988; King County, 1987; Lawler, 1988). One study (Andrulis, 1989) was conducted by the National Association of Public Hospitals and the Association of American Medical Colleges, Council of Teaching Hospitals. In a survey of 169 member hospitals, it was found that of 5,325 discharges of PWAs, only 5% were placed in a long-term care facility, whereas 6% received skilled care at home.

What long-term care is currently available to PWAs? What developments are integral to meeting their long-term care needs? Descriptive data on the current long-term care situation for persons with HIVrelated illnesses are necessary to close gaps and to propose solutions geared toward enhancing the resources of the health care structure in each locality to develop needed resources that are currently unavailable.

BARRIERS TO LONG-TiRM CARE SERVICES FOR PWAs _____________

Nursing homes have traditionally been sources of skilled nursing and custodial care to frail elderly and disabled people who have functional impairments, including cognitive deficits that preclude independent living or community and home-based care. The long-term care facility comprises an attractive and less expensive alternative to hospitals for 24hour supervised care unavailable at home.

Studies have documented the perceived lack of accessibility to this care for PWAs in care facilities. Carrier and Bressler (1987) surveyed 204 Pennsylvania nursing homes. The responding 54 administrators reported receiving 14 applications (by nine homes) for admission by PWAs. Thirteen applications were rejected and one patient died before a decision was made. Nearly half of the homes expected to receive new or more applications for admission of PWAs. Forty percent of the respondents said that they would not be willing to accept any AIDS patients, 49% were unsure, 6% indicated that they would accept at least one PWA, and 5% indicated that they would only provide…

Will AIDS influence the development of specialized skills by nurses in long-term care facilities? As persons with AIDS (PWAs) live longer and increasingly require skilled nursing care in varying degrees, the need for nursing expertise continues to grow. To be prepared to care for clients with AIDS in long-term care facilities, nurses should be familiar with the multiple issues surrounding admittance of this new and often younger population. Not only do these issues encompass the personal beliefs of PWAs, but these issues also affect clients already in long-term care facilities as well as all levels of employees. Additionally, these issues significantly touch the loved ones of each of these groups.

Barriers to providing long-term care services to persons infected with the human immunodeficiency virus (HTV) are embedded in a pervasive fear about AIDS and resulting discrimination against people with AIDS. Implementation of longterm caring for PWAs is complicated by issues of how to efficiently, adequately, and compassionately serve a fairly new population. Kane and Kane (1987) define long-term care as "a set of health, personal care, and social services delivered over a sustained period of time to persons who have lost or never acquired some degree of functional capacity." Although initially care for PWAs was often viewed either as acute, crisisoriented, or terminal care, with the advent of life-sustaining antiviral drugs and application of health promotion principles to PWAs, persons affected are living longer and their continuing care needs are increasingly being viewed as chronic. States are only beginning to give attention to plan policy and programs directed at long-term service needs for PWAs (Engstrom, 1987; Holland, 1988; King County, 1987).

To date there is no universal method for projecting the need for long-term care services; current estimates using several methods show that from 10% to 25% of all living cases may require this type of care (Holland, 1988; King County, 1987; Lawler, 1988). One study (Andrulis, 1989) was conducted by the National Association of Public Hospitals and the Association of American Medical Colleges, Council of Teaching Hospitals. In a survey of 169 member hospitals, it was found that of 5,325 discharges of PWAs, only 5% were placed in a long-term care facility, whereas 6% received skilled care at home.

What long-term care is currently available to PWAs? What developments are integral to meeting their long-term care needs? Descriptive data on the current long-term care situation for persons with HIVrelated illnesses are necessary to close gaps and to propose solutions geared toward enhancing the resources of the health care structure in each locality to develop needed resources that are currently unavailable.

BARRIERS TO LONG-TiRM CARE SERVICES FOR PWAs _____________

Nursing homes have traditionally been sources of skilled nursing and custodial care to frail elderly and disabled people who have functional impairments, including cognitive deficits that preclude independent living or community and home-based care. The long-term care facility comprises an attractive and less expensive alternative to hospitals for 24hour supervised care unavailable at home.

Studies have documented the perceived lack of accessibility to this care for PWAs in care facilities. Carrier and Bressler (1987) surveyed 204 Pennsylvania nursing homes. The responding 54 administrators reported receiving 14 applications (by nine homes) for admission by PWAs. Thirteen applications were rejected and one patient died before a decision was made. Nearly half of the homes expected to receive new or more applications for admission of PWAs. Forty percent of the respondents said that they would not be willing to accept any AIDS patients, 49% were unsure, 6% indicated that they would accept at least one PWA, and 5% indicated that they would only provide care to a PWA if that individual was currently a resident. The reasons administrators indicated for rejection of PWAs included: "presently no isolation areas in facility, concern for both staff and patient safety, lack of staff education, inappropriate reimbursement, fear of losing future admissions, and union problems with staffing" (Carner, 1987).

In 1986, the Minnesota AIDS Project completed telephone interviews of 106 nursing homes. Eighteen homes reported they would provide services to PWAs. When these 18 homes were actually confronted with accepting a patient, only one agreed to do so. Forty-seven homes replied that they may provide services in the future. As of July 1987, the project reported that there were only three beds designated for PWAs in the state (Engstrom, 1987). More recent reports from Minnesota, however, indicate that after litigation occurred, an increased number of facilities have accepted residents, and at least two facilities have publicly reported their willingness to care for residents infected with HIV.

In 1988, the Wisconsin Department of Health and Social Services surveyed licensed nursing homes in the state and reported that 36 (13%) of the 277 homes that responded were approached to admit a person with HIV infection (Wisconsin Department of Health, 1988). Of those 36 facilities, only two reported that they had knowingly admitted a PWA. Of those facilities who had not received any requests to admit a PWA, 20% indicated they would have admitted someone if approached, 69% responded that they would not have, and 10% were undecided.

A 1986 Illinois survey of 240 nursing home decision makers reported that of the 35 respondents, 7 said yes, they planned to admit a patient with AIDS; 24 replied no; and 4 were uncertain, including inadequate admission (Moreau, 1986). Obstacles to providing long-term care services reported by a majority of the nursing home decision makers included: current policies; anticipated additional costs; inadequate Medicaid reimbursement rate to cover the costs of caring for the PWA; and anticipated problems among residents, staff, and families of residents.

STUDY BACKGROUND AND DESIGN

At the inception of the study, there was only one known Illinois longterm care facility that had dedicated four beds to the care of PWAs (Engstrom, 1987). Actions taken by state decision makers included a letter from the state health director to all long-term care facility administrators calling on administrators to provide care for persons with HIV infection and indicating that they "must not only prepare long-term staff to care for diagnosed cases, but assure that staff protect themselves from undiagnosed residents already in their care." The letter cited section 504 of the Rehabilitation Act of 1973 mandating that health facilities may not refuse to admit patients on the basis of their disability, with AIDS being considered a disability. In addition, the letter informed administrators that the barrier caused by the state requirement of written approval for admission of a person with an infectious disease had been lifted for HIVinfected persons; permission from the state health department could be obtained over the telephone on the same day as the request.

A study was designed in response to increasing reports of frustration in arranging for post-hospital care for PWAs by discharge planners, social workers, and PWAs in Illinois. Service workers brought their concerns to the attention of a Service Providers Council at the AIDS Foundation of Chicago. A two-part study was devised to assess the views of both halves of the referral network: the referrers, the discharge planners, and social workers who predominantly refer PWAs to long-term care facilities; and the receivers, the nursing directors, and administrative staff within long-term care facilities who may oversee the reception of PWA referrals. This report addressed the results of the survey of long-term care facilities (Cich, 1989, and Linsk, 1990, offer additional information about discharge planner responses). Four specific research questions were addressed:

* What is the level of accessibility reported by nursing home facility administrators?

* What are the barriers or obstacles to access or provision of longterm care services to persons with HIV infection?

* What role does reimbursement play in access to or provision of care?

* What AIDS-related activities are nursing homes involved in at this time?

METHODS

Instruments and Data Analysis

A self-report questionnaire was devised for the nursing home administrators. Questions were both openended, closed, and partially closed choice items to assess the following information: description of the facility, staff needs and experiences, service provision to persons with HIV infection, admissions and finances, and respondent information. Many of the descriptive questions were in simple multiple choice or fill-in-theblanks format. Respondents were asked to list three obstacles or disadvantages and three changes that would be needed (service, policies, and programs) to facilitate care for those with AIDS-related infections in long-term care facilities. Respondents also responded to a list of 15 possible consequences of admitting PWAs to long-term care facilities using a Likert-type scale to rate their perceived likelihood of occurrence. Finally, respondents indicated additional costs per day per resident they estimated would be entailed in caring for PWAs.

All responses were coded to compute frequencies and descriptive statistics. The Likert-type scale responses were tallied in terms of frequency of responses, and for purposes of comparison, mean scores were calculated. Responses to open-ended questions were sorted according to the main idea expressed. The questions about obstacles/disadvantages and needed changes were organized using a thematic analysis with answers broken down into themes and subthemes and reported in detail. To ensure recognition of views other than those assumed by the researchers to be relevant, atypical responses and variations on themes were noted.

Sample

The survey was sent to all Cook County nursing facilities and a random sample of 70 other nursing homes across the state, for a total of 235. Cook County, which includes Chicago and its surrounding suburbs, received primary attention because 90% of all reported AIDS cases had occurred in this area. This report gives the results of 54 completed surveys. In telephone follow-up calls, some administrators suggested they avoided completing the questionnaire because they do not admit HIVinfected residents and do not have plans to do so.

Table

TABLE 1Admission Request for Persons With AIDS/HIV

TABLE 1

Admission Request for Persons With AIDS/HIV

Survey or Nursing Homes

The sample of nursing homes represents the variety of facilities in the county. Two-thirds offered skilled care, whereas almost half offered intermediate care and many offered both. Only a few identified themselves as offering lower-level sheltered or residential care. Profit status was evenly split, as was urban/ suburban status. Few were rural. Sixty percent described themselves as private facilities, whereas only 9% were identified as public. About a quarter each were affiliated with hospitals or churches.

Four-fifths were Medicaid-related facilities, whereas more than a third identified themselves as private pay. A quarter identified Medicare payment as a payment source, which is limited to skilled facilities in the nursing home area.

Although the size of the sample is too small to generalize easily, it is notable that the varied characteristics of the sample paralleled the general patterns in the area. The study was descriptive only with no attempts to correlate outcomes by facility characteristics due to limited sample size.

Three quarters of the respondents were the facility adrninistrators, as targeted. All respondents were in administrative decision making roles regarding admissions. Directors of nursing responded to the survey occasionally as active decision makers in many facilities. Disciplinary background and years in long-term care or at the current facility indicated that the respondents have been invested in the long-term care industry and have a fair amount of experience providing long-term care services.

FINDINGS _____________________

Admission Applications Received

Most facilities reported an almost total lack of referral activity. More than 90% of the facilities reported they had never received an application for admission of a PWA from hospital discharge planners. Table 1 details the reports from the six homes that received PWA referrals. It was notable that all of these accepted Medicaid as payment, suggesting a more accountable relationship to the state agencies.

When asked why admission was incomplete, two indicated the care required exceeded capacity, and one indicated that the patient chose another facility. The others gave no reason for nonadmission. Two of the homes replied that in general they would admit a PWA if adequate reimbursement was made readily available. Most (4 of the 6) were skilled nursing facilities that would be likely referral targets for individuals requiring a range of posthospital care. Two, however, were facilities dedicated to care of the young chronically mentally ill. Given the preponderance of geriatric facilities in the overall nursing home arena, the number of those with previous experience serving younger adults suggest that these appear more attractive to discharge planners or are more receptive to early referral attempts.

Table

TABLE 2Obstacles or Disadvantages Perceived in Providing Care to Persons with AIDS-Related Infections*

TABLE 2

Obstacles or Disadvantages Perceived in Providing Care to Persons with AIDS-Related Infections*

The homes varied in size, but most were medium to large. Notably these were all for-profit homes, without other affiliations. They were predominantly urban, with two being from suburban areas.

Overall, the actual level of accessibility as reported by nursing home administrators was extremely limited. With only a small number of homes having received applications, they had little experience or demand to develop policy or understand the actual consequences of admitting a PWA.

Anticipated Outcomes

Anticipated consequences for admitting PWAs were elicited in two ways. First, early in the survey, administrators were asked to respond in their own words to the openended request, "Please list three obstacles or disadvantages in providing care to persons with AIDSrelated infections in your facility" (Table 2). Second, the respondents rated a number of specific outcomes in the questionnaire in terms of their likeliness to occur (Table 3). These latter choice selection questions assessed both positive and negative outcome predictions.

Reimbursement

On the open-ended questions, 11 of the 94 responses dealt with financial concerns. These related mainly to general care costs (2 responses), supply costs (2 responses), or reimbursement concerns (5 responses). Notably with regard to reimbursement, two of the five who mentioned this as a main concern noted that their reimbursement for existing residents was already low.

Table

TABLE 2Obstacles or Disadvantages Perceived in Providing Care ft Persons with AIDS-Related lnfections*

TABLE 2

Obstacles or Disadvantages Perceived in Providing Care ft Persons with AIDS-Related lnfections*

On the choice selection responses, a majority of the administrators voiced reimbursement concerns, comprising one of the strongest trends. Eighty-three percent of the respondents felt that reimbursement difficulties were either very likely or likely to occur, whereas only 6% reported this was not a likely problem. One reported that they could accept private pay HIV patients only. It is notable that when asked to rate problems, most cited financing, but when asked to list their concerns, only 5 of the 54 respondents noted this concern.

Staffing

Staffing problems emerged as major problems on both the openended and choice selection questions. In both sets of responses, administrators expressed concern about staff recruitment or attrition. When the "very likely" and "likely" categories of anticipated likelihood were combined, 87% reported they anticipated recruitment problems, and none felt that recruitment of staff would not be a problem. One remarked, "we would have problems in staffing the facility to care for AIDS patients." Four reflected concerns about staff turnover.

Respondents were more concerned about staff resistance. Five of their perceived disadvantages reflected fear or apprehension among staff and three reflected general staff concerns. One specified a staff fear of transmission of HIV and one described the staff resistance as a "panic reaction." One specified concern that the family of staff would be anxious. Some were concerned about the possible low level of staff performance or refusal to care for PWAs. This parallels the 88% who responded on the choice selection questions that they felt that staff assignment difficulties were likely or very likely to occur. One questioned the ethics of requiring a staff member to assume the risk of "devastating effects" in caring for residents.

Table

TABLE 2Obstacles or Disadvantages Perceived In Providing Care to Persons with AIDS-Related Indections*

TABLE 2

Obstacles or Disadvantages Perceived In Providing Care to Persons with AIDS-Related Indections*

Table

TABLE 3Perceived Outcomes of a Policy to Care for Persons With AIDS

TABLE 3

Perceived Outcomes of a Policy to Care for Persons With AIDS

Training and supervision concerns were somewhat less prevalent, although on the choice selection questions, 76% felt these were likely or very likely to occur. On the openended questions, two respondents expressed concern about staff level of understanding or ignorance. Five expressed concerns about the need for training and education of staff. On a related note, some were concerned about education of family members and volunteers.

Market and Admission Concerns

A number of items related to marketing and admissions concerns were perceived to be important. On the choice selection questions, almost half felt that admission of HIVinfected patients would create a kind of uncontrolled demand for care. Alternately, almost two thirds felt that admissions would lead to a decline in community referrals. One explained, "If other residents are not willing to live in this type of environment, you have no census and you cannot exist just on AIDS patients." One was concerned whether "families would accept this." Another felt the facility "would have a difficult time caring for AIDS patients together with geriatric patients." Another stated the facility would not admit an HIV-infected patient "by preference unless it was a geriatric patient," whereas another commented they would not admit PWAs "because of resident population."

These concerns were paralleled in the open-ended responses. Four respondents were concerned about general community apprehension, public relations, public fear, or their reputation. Only one, however, mentioned that fear of AIDS/ AIDSrelated complex would be a deterrent to recruiting residents. Many more, however, were concerned that families would withdraw residents from the home (seven responses) or that families would not accept the policy. Only one expressed concerns that residents might request a move. Some also noted general fears or objections by families.

Resident Concerns

The open-ended responses presented a substantial number of concerns about residents, ranging from resident fears (6 responses), resident lack of knowledge (1 response), and general resident acceptance and reactions (4 responses). A number, however, expressed concern about the effect of admission to their type of facilities on people with HIV infection. These included questions about the PWA's ability to adjust to the setting, and four responses questioned the age mix of PWAs with geriatric residents. The age mix seems to be a particular concern to these respondents, which was also reflected on the choice selection questions. More than three fourths of the respondents rated conflict between residents as very likely or likely to occur, rariking fifth on the list of outcomes. Fewer were concerned about problems in finding suitable activities or difficulty finding physician care.

Physical/Structural Changes Needed

Several respondents noted physical or structural changes needed to accommodate care of PWAs. Five listed general building or space problems, whereas three stated specific concerns such as laundry, bathroom accommodations, or the need for private rooms.

Infection Control

Infection control emerged as a concern in the open-ended questions. Although some of these reflected the types of concerns found in any health care facility (procedures for infection control or disposal of materials), some felt the majority of noninfected residents would pose a particular problem. In particular, the impaired judgment of the majority of the population was noted. Only one explicitly noted concern about sexual activity and none noted drug use. On the choice selection questions, a problem with resident drug use was ranked of lower concern to respondents compared with other issues.

Policy Concerns

A few noted that they felt their licensure or care provision description did not fit an HIV-infected population, noting their sheltered or intermediate status did not allow for the intense nursing care anticipated. One specified a minimum age requirement.

Positive Outcomes

Fewer administrators regarded admission of persons with HTV infection as leading to positive recognition of the home or improved community relations. It is notable, however, that almost half of the respondents felt that some positive outcomes may occur. Respondents reported that they found little in long-term care journals regarding commendable nursing home examples of caring for HIV-infected persons.

The Role of Reimbursement

Reimbursement issues are addressed more closely in Table 4. Table 3 showed that the difficulty securing reimbursement was noted as "very likely" and "likely" to occur in more than three quarters of the respondents. Table 4 displays additional responses related to reimbursement. One quarter believed that if adequate reimbursement was made readily available, they would admit a person with HIV infection, and only 47% answered a definite no. This suggests a larger number of homes who would consider HIV-related admissions than was previously anticipated.

Of those that might admit PWAs however, most indicated limitations. Comments by these administrators included:

Table

TABLE 4Administrators' Beliefs Related to financing of Care

TABLE 4

Administrators' Beliefs Related to financing of Care

* Not with enthusiasm;

* If the patient was a geriatric patient infected by blood transfusion;

* If the facility was a nursing home, not a facility that provided sheltered care;

* With the permission of the Department of Public Health;

* If they met admission criteria; and

* The Public Health Department is changing regulations to prevent refusal.

Reimbursement was a key issue; 80% of the respondents believed that it would cost them more per day to care for a PWA than an average care resident. Respondents were asked to estimate additional reimbursement needed if they could receive a higher reimbursement for a PWA (flat rate over the $38 they received for normal care residents). Their estimates of the additional funds needed ranged from $10 to $250 more per day, averaging $85.50 more per day.

More than two thirds believed that a facility such as theirs could provide quality care at a lower rate per day than a hospital for a patient needing 24-hour skilled care.

AIDS-Rebted Activities

Current activities are presented in Table 5. A majority of faculties reported discussing AIDS care at internal meetings. About the same percentage of those homes have sent staff to AIDS education programs. Few other activities were reported by the homes.

More than 40% reported developing an admissions policy related to HIV infection. It should be noted that this does not necessarily enable admissions for PWAs, as nursing homes may clarify their admissions policies to exclude admissions of PWAs for reasons such as an inability to provide certain needed care or a policy of only admitting geriatric patients.

DISCUSSION

A very low level of activity related to admissions of PWAs into longterm care faculties was found despite considerable work in preparing staff and mounting admissions procedures. This lack of admissions, despite a high documented number of needy persons, may be attributed to several possible forces, which probably work together in leading to the breakdown of possible referrals. These forces may include willful decisions by nursing homes not to admit HIV-infected clients, general ignorance of the care levels required for PWA care, lack of incentives and reimbursement to provide care, inadequate resources for care within facilities, and lack of actual demand on facilities to provide this type of care. Willful refusal to provide care may be a major factor; however, given the likelihood of bypassing civil rights laws, such refusal will remain difficult to document. Our data showed that many homes were considering admitting PWAs, suggesting that in time homes may be more receptive.

What was most compelling in the data is the report that homes did not have incentives to provide care, coupled with fears that if caring for PWAs may have a negative effect on other referrals. A majority of administrators suggested that the current reimbursement rates would be insufficient to cover the costs of caring for a PWA, and this belief may also be attributed to lower levels of AIDSrelated activities. One study estimating the cost of long-term care of PWAs in Illinois that set costs at $139.52 per day (Engstrom, 1987) supports the cost concerns of administrators. However, estimates often overlook the range of care from minimal to intensive for each prospective resident, depending on the complications and progression of the illness.

Disturbingly, owners have tended to class all PWAs and even persons with nonsymptomatic HTV into a labeled category, rather than assessing each prospective resident based on functional care needs. However, since the study, completion a Medicaid-based incentive program has been put in place for homes to developed specialized dedicated areas of care for PWAs. To date, two thirds of the facilities have developed an Exceptional Care Program taking advantage of the incentive payment.

Further investigation of nursing homes' admission/care criteria could be useful. This information may indicate what resource administrators believe is necessary to care for HIV-infected residents, which may or may not be based on accurate information regarding the skilled care needs of AIDS-related patients. More information on admission criteria may indicate to state decision makers the level of resources necessary to properly prepare facilities to care for this population.

Table

TABLE 5AIDS Care-Related Activities That Occurred in Individual Facilities

TABLE 5

AIDS Care-Related Activities That Occurred in Individual Facilities

The level of AIDS-related activity reported by administrators may be partially attributed to the lack of PWA referrals they have reportedly received for admission. Almost 10% of nursing homes reported that their facilities sought help from specialists in caring for infected persons; interestingly, this percentage is the same as that of nursing homes receiving applications for admission for HIV-infected patients. This may suggest that applications for the admission of HIV-infected residents to a facility increases the motivation for engaging in AIDS-related activities.

These findings suggest the need for a comprehensive strategy comprising adequate reimbursement based on functional need for care of PWAs. A coalition of nursing homes, community-based care providers, and hospitals is needed to meet longterm care needs of PWAs. Education for care providers, including nurses, administrators, and owners, is necessary. Incentives are needed to develop innovative programs under strong leadership and support from regulatory and funding programs. In addition, discharge planners, nurses, social workers, and consumer advocates need to learn to effectively refer to long-term care facilities in a systematic way so that the industry has accurate information about demand for care.

REFERENCES

  • Andrulis, D.P. The need for a long-term care strategy. In D.L. Infeld, R.M.F. Southby (Eds.), AIDS and long-term care: A new dimension. O wings Mills, MD: National Health Publishing, 1989.
  • Carner, E.A., Bressler, J. AIDS and the longterm system: A nursing home survey. Presented at the Gerontological Society of America Annual Meeting, San Francisco, 1987.
  • Cich, P.J., Linsk, N.L. Long-term care of persons with HIV infection: Views from hospital discharge planners and nursing home decision makers. Final report submitted to Gerontological Society of America, Student Research Fellowship Program. Chicago: University of Illinois at Chicago, Department of Medical Social Work, 1989.
  • Engstrom, E. Supportive non-hospital settings for persons with acquired immunodefiency syndrome in Hennepin and Ramsey counties: Research and recommendations in support of a plan. Technical report. The Minnesota AIDS Project, 1987.
  • Holland, G.K., Conley, K. Report and recommendations on the feasibility of providing care for persons with AIDS in a long-term care (nursing home) setting. Technical report submitted to Illinois Department of Public Health. Dixon, IL: First Health Care Ltd, 1988.
  • Kane, R.A., Kane, R.L. Long-term care: Principles, programs and policies. New York: Springer Publishing Co, 1987.
  • King County Department of Public Health. Residential long-term care for persons with AIDS and disabling AIDS-related complex in Seattle/King County. Technical report. 1987.
  • Lawler, E. Policy making for AIDS in Chicago. AIDS reference guide. Washington: Atlantic Publishing Co, 1988.
  • Linsk, N.L., Marder, R.E. Facing nursing home resistance in hospital discharge planning for people with HIV infection. Chicago: University of Illinois at Chicago, Department of Medical Social Work, 1990.
  • Moreau, M.R., Panfil-Glick, A. AIDS admissions survey of skilled nursing facilities. Nursing Homes 1986; 35:23-27.
  • Wisconsin Department of Health and Social Services. DHHS survey of licensed Wisconsin nursing homes. Wsconsin AIDS Lipdate. 1988, pp 35-36.

TABLE 1

Admission Request for Persons With AIDS/HIV

TABLE 2

Obstacles or Disadvantages Perceived in Providing Care to Persons with AIDS-Related Infections*

TABLE 2

Obstacles or Disadvantages Perceived in Providing Care ft Persons with AIDS-Related lnfections*

TABLE 2

Obstacles or Disadvantages Perceived In Providing Care to Persons with AIDS-Related Indections*

TABLE 3

Perceived Outcomes of a Policy to Care for Persons With AIDS

TABLE 4

Administrators' Beliefs Related to financing of Care

TABLE 5

AIDS Care-Related Activities That Occurred in Individual Facilities

10.3928/0098-9134-19930101-06

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