Artykuły w czasopismach: „Nursing homes – Ireland – Finance”

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McClean, Pamela, Michael Tunney, Deirdre Gilpin, Carole Parsons, and Carmel Hughes. "Antimicrobial Prescribing in Nursing Homes in Northern Ireland." Drugs & Aging 28, no. 10 (2011): 819–29. http://dx.doi.org/10.2165/11595050-000000000-00000.

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Shanagher, D. "70 NURSING HOME MODEL OF CARE POST COVID-19." Age and Ageing 50, Supplement_3 (2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.70.

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Abstract Background The COVID-19 pandemic is recognised as having a significant impact on older people, particularly on those within nursing homes. Prior to the pandemic, a significant focus was placed on the application of a social model of care within nursing homes. We know that COVID-19 has required the stringent application of infection prevention and control measures as well as the provision of increased amounts of clinical care. This has resulted in the recent stronger application of a medical model of care within nursing homes. Methods A roundtable event attended by twenty-six people took place. Attendees represented clinical Gerontology, the Irish College of General Practitioner, Sage Family Forum, The Health Information and Quality Authority, Nursing Homes Ireland and nursing home providers. A number of presentations were made, and a roundtable discussion took place about the model of nursing home care post pandemic. Key messages from presentations and the discussion were captured. A report was compiled and shared with attendees to check for accuracy. Results The following key messages were identified: 1. Social care is a cornerstone of nursing home care 2. Increased integration of nursing homes within the wider health and social care system is required 3. Increased access to services for nursing home residents is required 4. Regulatory reform is required 5. Resourcing of nursing home care needs to be appropriately addressed 6. The nursing home sector need to be included in conversations around policy and service development affecting nursing home care in Ireland. Conclusion Nursing homes are an essential part of the healthcare system in Ireland and have been shown to be adaptable throughout the course of the pandemic. A one size fits all approach is an unlikely fit for purpose approach as we look towards the future with COVID-19.

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Robinson, D. J., E. McGovern, E. Doorley, C. Hayden, and D. O'Shea. "The Nursing Homes Support Scheme Act in Ireland – older persons’ views." European Geriatric Medicine 2, no. 3 (2011): 130–33. http://dx.doi.org/10.1016/j.eurger.2011.04.006.

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MacGabhann, Patricia. "Caring for gay men and lesbians in nursing homes in Ireland." British Journal of Nursing 24, no. 22 (2015): 1142–48. http://dx.doi.org/10.12968/bjon.2015.24.22.1142.

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Ó Cathaoir, Katharina, and Ida Gundersby Rognlien. "The Rights of Elders in Ireland during COVID-19." European Journal of Health Law 28, no. 1 (2021): 81–101. http://dx.doi.org/10.1163/15718093-bja10035.

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Abstract This article reflects on COVID-19 restrictions imposed on elders in Ireland through the lens of the right to private and family life (Article 8 ECHR), focusing on stay at home orders and recommendations advising elders to avoid social contact. Furthermore, we examine restrictions on visiting nursing homes given the high death toll in that setting. In our analysis, we zero in on the principles of foreseeability and proportionality, highlighting areas of concern and aspects that we submit should be considered in a proportionality assessment. Ultimately, we argue that it is a mistake to view the COVID-19 pandemic solely as an emergency. In this manner, the solutions suggested through the law – restrictions on movement and visitation bans – are too narrow and fail to address the underlying structures, such as, issues in the healthcare system, the limited home help for elderly and poor conditions in nursing homes.

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McConkey, Roy. "Variations in residential accommodation for adults with intellectual disabilities: the example of Northern Ireland." Irish Journal of Psychological Medicine 23, no. 2 (2006): 68–73. http://dx.doi.org/10.1017/s0790966700009605.

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AbstractObjectives: Over the past three decades, major changes have taken place internationally in the type of residential accommodation provided for people with intellectual disabilities but these appear to be less evident in Northern Ireland.Method: A census was undertaken of all persons in any form of residential placement using a range of existing databases to identify the population, with a short questionnaire completed for each resident.Results: Around 440 persons lived in hospitals and 1,970 in some other form of provision but mostly in large congregated settings such as residential care homes and nursing homes. This was more marked in certain Health and Social Service Boards than in others. Most places are provided by the private sector although voluntary organisations and housing associations now manage around one-third of places. People living in hospitals reportedly had different characteristics to those in all other settings while those in nursing homes tended to require greater personal care. However the characteristics of people living in residential homes, supported living arrangements and village communities were broadly comparable. Around one in 10 persons were deemed to benefit from a move; mostly from residential homes to more independent living arrangements.Conclusions: Compared to Britain and the Republic of Ireland there is an under-provision of residential placements in Northern Ireland. To date, funding from outside of health and social services has been the main driver for the type of accommodation provided. The implications for future policy and provision are discussed.

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Robinson, Katie, Christine Fitzgerald, Rose Galvin, and Aisling O' Connor. "Exploring the facilitation of meaningful leisure activities in designated centres for older persons (nursing homes) in Ireland: A protocol for content documentary analysis of HIQA inspection reports." HRB Open Research 5 (November 18, 2022): 76. http://dx.doi.org/10.12688/hrbopenres.13639.1.

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Background: Nursing homes (NHs) in Ireland are regulated by the Health Information and Quality Authority (HIQA). Regulations for nursing homes under the Health Act 2007 (as amended) states that registered providers must provide residents with facilities for occupation and recreation, and opportunities to participate in activities in accordance with their interests and capacities (Government of Ireland, 2013 - S.I. No. 415/2013). Despite the proven benefits of engagement in meaningful activities, when an older person enters a NH, they often lose autonomy in occupational roles, and engagement in meaningful activities (Causey-Upton, 2015). In 2019, HIQA highlighted that there were relatively high levels of non-compliance in the area of residents’ rights (HIQA, 2020). Aim: Given the central role of leisure activities to older adults’ health and well-being, this study aims to understand how NH residents in Ireland were afforded opportunities for meaningful engagement in activities prior to and throughout the COVID-19 pandemic (2019 – 2021). This will be conducted through analysing a sample of publicly available HIQA inspection reports for NHs from 2019 – 2021. Methods: A content documentary analysis will be conducted using a qualitative deductive approach. Purposive sampling will be used to select 21 nursing home reports for the years 2019, 2020 and 2021. The sample will include nursing homes reported to be non-compliant, substantially compliant and compliant in the regulation of residents’ rights. An inspection report for each of these NHs (n=21) for the year 2019, 2020 and 2021 will create a sample of 63 reports for analysis. This sample will capture three time points for the 21 NHs pre-pandemic and throughout the pandemic.

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Kleinsorge, Ilene K. "Financial and Efficiency Differences in Family-Owned and Non-Family-Owned Nursing Homes: An Oregon Study." Family Business Review 7, no. 1 (1994): 73–86. http://dx.doi.org/10.1111/j.1741-6248.1994.00073.x.

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There has been little empirical research investigating the performance differences between family-owned and non-family-owned businesses. This study investigated differences in efficiency between family-owned and non-family-owned nursing homes in the State of Oregon, as defined and identified by data envelopment analysis (DBA) and by selected traditional financial measures. More family-owned nursing homes than non-family-owned homes were identified as inefficient, and family-owned nursing homes were found to have significantly fewer assets and more liabilities than non-family-owned homes. Suggested reasons for the results are discussed.

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Janus, Sarah I. M., Jeannette G. van Manen, Maarten J. IJzerman, and Sytse U. Zuidema. "Psychotropic drug prescriptions in Western European nursing homes." International Psychogeriatrics 28, no. 11 (2016): 1775–90. http://dx.doi.org/10.1017/s1041610216001150.

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ABSTRACTBackground:Despite the numerous warnings of European and national drug agencies as well as clinical guidelines since the year 2004, psychotropic drugs are still frequently used in dementia. A systematic review comparing the use of psychotropic drugs in nursing homes from different European countries is lacking.Objective:The aim of this study was to examine prescription rates of psychotropic drug use in nursing home patients between different Western European countries since the first warnings were published.Methods:A literature review was performed and the various psychotropic prescribing rates in European nursing homes were investigated. The prescription rates of antipsychotic and antidepressants were pooled per country. Other classes of psychotropic drugs could not be pooled because of the limited number of studies found.Results:Thirty-seven studies on antipsychotic drug use and 27 studies on antidepressant drug use conducted in 12 different European countries. The antipsychotic use in nursing homes ranged from 12% to 59% and antidepressant use from 19% to 68%. The highest rates of antipsychotic drug prescription were found in Austria, Ireland, and Belgium while for antidepressants in Belgium, Sweden, and France.Conclusions:Despite warnings about the side effects and recommendation to focus on non-pharmacological interventions, antipsychotics and antidepressants are commonly used drugs in nursing homes. The data suggest that Norway does best with regards having a low antipsychotic drug usage. Studies are needed to explain the differences between Norway and other European countries.

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O'Neill, Katherine, Fiona Dixon, Glenda Fleming, et al. "Oral nutritional supplements in care homes." Journal of Prescribing Practice 5, no. 10 (2023): 426–37. http://dx.doi.org/10.12968/jprp.2023.5.10.426.

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The aim of this project was to test the concept of dietetic-led ordering of oral nutritional supplements (ONS) for residents in care homes in Northern Ireland without the need for generation of a GP prescription. A new model of dietetic-led ordering was developed involving extensive stakeholder engagement. Data was audited for a 1-week period at the start (April 2021) and end (June 2021) of the pilot. The new model described in this project demonstrated dietitian-recommended, formulary compliant practice with a range of benefits to residents, clinicians and care workers, delivering the right product at the right time to the resident, resulting in cost savings, improved supply mechanisms for care homes, and reduced requirement for GP input. The project demonstrated benefits for care home residents, clinicians and the Health and Social Care system. The results improve understanding of ways to improve the adoption and implementation of evidence-based nutritional support interventions into routine practice.

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Colomer, Jordi, and Jan de Vries. "Person-centred dementia care: a reality check in two nursing homes in Ireland." Dementia 15, no. 5 (2016): 1158–70. http://dx.doi.org/10.1177/1471301214556132.

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Healy, Tom, and Paul Goldrick-Kelly. "Ireland’s housing crisis – The case for a European cost rental model." Administration 66, no. 2 (2018): 33–57. http://dx.doi.org/10.2478/admin-2018-0017.

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AbstractLack of access to affordable quality homes constitutes a significant crisis for workers, families and communities in the Republic of Ireland. Current government plans appear to be insufficient to make a significant impact. Pressure on individuals and families is a direct consequence of under - investment over many years, as well as a failure on the part of a market-led and property-developer-led model of housing to deliver enough dwellings to meet the needs of a growing population. The optimum solution, we propose, is the establishment of The Housing Company of Ireland, which will draw on long-term borrowing combined with an equity injection from the Ireland Strategic Investment Fund, and will undertake or commission, on a commercial basis, a programme of planning, building, acquiring and renting of new homes. This investment will supplement and further strengthen work by the local authorities and the voluntary housing associations in the area of social housing.

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Murphy, E., E. Burke, J. O'Donoghue, et al. "212 BUILT ENVIRONMENT OF NURSING HOMES AND INFECTION CONTROL AND PANDEMIC PREPAREDNESS." Age and Ageing 50, Supplement_3 (2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.212.

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Abstract Background The disproportionately high death rate of nursing home (NH) residents from COVID-19 in many countries, including Ireland, has focussed attention on infection prevention and control, including the built environment, in nursing homes. This has been a poorly researched topic to date, and we undertook a systematic review of evidence for architectural design measures which support infection control and pandemic preparedness. Methods Databases were screened for keywords related to NHs, built environment, infection prevention and control, and COVID-19; relevant papers were uploaded onto Covidence and screened for relevance. Data extracted from included articles was tabulated under 8 specific aspects of the built environment. Results Of 17 papers included in the final analysis, four studies found that larger nursing homes carried an increased risk of COVID-19 infection. Crowding in NHs was also a risk factor for infection, with a high crowding index associated with COVID-19 infection in five studies. Green House care homes, which are based on small clusters of domestic dwellings, fared better than traditional NHs. Two papers found an association between the location of NHs and the risk of COVID-19 infection, with urban NHs and those in areas of high prevalence being more at risk. Two papers identified internal fittings as a target for infection prevention and control. Seven papers highlighted the role of adequate ventilation in NHs in the prevention of spread of COVID-19. Only one paper described easy access to the outdoors as beneficial to infection control. Conclusion Residents of NHs are amongst the most vulnerable to COVID-19 infection. When designing and building NHs, the role of the built environment in controlling the spread of the virus should not be underestimated. This research supported by Science Foundation Ireland.

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Grabowski, David C., and Thomas G. McGuire. "Black-White Disparities in Care in Nursing Homes." Atlantic Economic Journal 37, no. 3 (2009): 299–314. http://dx.doi.org/10.1007/s11293-009-9185-7.

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Deviana, Deviana, and Dimas Iqbal Nurrahman. "SPACE DESIGN STUDY OF ELDERLY BEHAVIOR; CASE STUDY OF THE PURI KEBAJIKAN NURSING HOME, BATAM." Journal of Architectural Research and Education 5, no. 1 (2023): 103–20. http://dx.doi.org/10.17509/jare.v5i1.52451.

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Along with the changing years, the elderly population in Batam City has increased rapidly. However, facilities such as nursing homes for the elderly are still minorly found in Batam City. Regarding quality, nursing homes in Batam City also have not fully met the standards of design that should be both in terms of quality, facilities, and needs for the elderly. The Elderly being the prime residents in a nursing home, of course, need to pay attention to their needs in living in that place, especially the relationship between the behavior of the elderly and the nursing home that provides a reciprocal relationship in the life of the elderly or known as behavioral architecture. Therefore, through this research, it is expected to find out the situation related to nursing homes in Batam City by paying attention to the psychological side and comfort of the needs of the elderly. This study uses a combined method of qualitative research and quantitative research (mixed methods). Researchers conducted direct observations and interviews at one of the assisted living in Batam City in addition to literature studies in completing the data collection process. Through this research, it can be concluded that the Puri Kebajikan nursing home has not fully implemented the appropriate design requirements and the application of behavioral architecture to the elderly in nursing homes. It expected to be an increase in the application of facilities at the Puri Kebajikan nursing home as a comfortable residence for the elderly according to their needs.

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Bell, Sue Anne, Jennifer Inloes, Michael Wasserman, John Donnelly, and Tamar Wyte-Lake. "IMPROVING NURSING HOME DISASTER READINESS THROUGH IMPLEMENTATION SCIENCE." Innovation in Aging 7, Supplement_1 (2023): 208–9. http://dx.doi.org/10.1093/geroni/igad104.0688.

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Abstract The new investigation on the state of emergency preparedness in nursing homes from the Senate Finance and Aging Committee Chairs is a call to action. As large-scale disasters continue to become increasingly common worldwide, nursing homes, whose residents are more vulnerable to disaster-related health and psychosocial shocks, and their staff, are carrying progressively more responsibility for healthcare readiness practices. Implementation science is a research discipline that seeks to improve uptake of evidence-based practices, such as healthcare readiness planning, and thus has potential to improve nursing home care delivery during and after disasters. The purpose of this review was to describe the limited field of existing evidence-based strategies in the peer-reviewed literature that seek to advance healthcare readiness in the nursing home setting and illustrate how implementation science can better support healthcare readiness planning for nursing homes. We discuss three main themes: 1) implementation science frameworks can strengthen nursing home staff engagement around healthcare readiness; 2) implementation science can support tailoring of emergency preparedness plans to individual nursing homes’ unique needs; and 3) implementation science can advance the integration of nursing homes into local, state, and federal healthcare readiness planning initiatives. Finally, research is urgently needed to both generate and disseminate implementation strategies that increase uptake of evidence-based health care readiness practices in the nursing home setting.

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Murphy, Claire, Una Molloy, Sarah McLean, and Daniel Ryan. "230 The Impact of a Palliative Care ECHO Programme on Symptom Severity Scores and Phases Score in a Nursing Home Population." Age and Ageing 48, Supplement_3 (2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.139.

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Abstract Background In Ireland most deaths occur in acute hospitals however 20% of deaths occur in residential facilities. Less than 30% receive specialist palliative care input. ECHO (extension for community healthcare outcomes) is a palliative care education programme consisting of a 10 part lecture series. Twenty nursing homes and 353 staff participated. A phases score is a 5-point rating scale classifying the status of a palliative care patient ranging from stable to bereaved. Methods Data collected by palliative care professionals from September 2017 to December 2018 was analysed. This included demographic features, a phases score and scores for pain, carer stress, spiritual and psychological need. Nursing homes that attended ≤ 3 ECHO sessions were excluded, 15 participating nursing homes were included. Age matched control subjects were selected from non-participating nursing homes on a 2:1 basis. Data was analysed using the paired T Test and Chi squared was analyzed for frequency data. Results There were 40 patients in the intervention group and 80 in the control group. Mean ages were 83yrs and 82yrs respectively. Palliative care referral numbers did not change significantly between the two groups (111 and 114). The Phases score was significantly reduced in the ECHO group compared to controls (P=< 0.007). There was no significant reduction in the phases score in the ECHO group pre and post intervention (P=0.29). There was no difference in Pain scores between groups (P=0.98) Conclusion The ECHO intervention led to a reduction in the overall phases score in participating nursing homes. This was not the result of increased palliative care referrals. We would infer it is a reflection of better control of symptoms overall. We did not demonstrate a significant reduction in individual symptoms. The phases score is an overall representation of a patient’s status. With the expansion of the ECHO programme on-going analysis will be performed.

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Prawitz, Aimee D., Frances C. Lawrence, Peggy S. Draughn, and Patricia J. Wozniak. "Criteria families use to select nursing homes." Journal of Family and Economic Issues 15, no. 1 (1994): 37–51. http://dx.doi.org/10.1007/bf02353723.

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Brazil, Kevin, Gillian Carter, Chris Cardwell, et al. "1 Supporting family carers in best interest decision-making in dementia care at the end of life: findings from a cluster randomised control trial." BMJ Supportive & Palliative Care 7, no. 3 (2017): A347.1—A347. http://dx.doi.org/10.1136/bmjspcare-2017-001407.1.

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BackgroundDementia is a leading cause of death worldwide. Often, people with moderate to advanced dementia are admitted to nursing homes for specialist care. When a person with dementia no longer has the capacity to make decisions about their care, nursing home staff, in combination with family members, may have to make decisions based on a person’s best interests. Family carers often report feeling unprepared to participate in these decisions. Advance Care Planning (ACP) can support family carers in best interest decision-making on goals of care at the end of life. However, given its relative importance, the prevalence of ACP in dementia care is poor. This study set out to examine the effectiveness of an intervention designed to facilitate ACP with family carers.MethodsA paired cluster randomised controlled trial was employed. The intervention comprised: a trained facilitator; family education; family meetings; documentation of ACP decisions; and intervention orientation for GPs and nursing home staff. Twenty-four nursing homes with a dementia nursing category located in Northern Ireland, UK participated. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in ACP discussions were invited to take part. Participants completed postal questionnaires prior to receiving the intervention or usual care and again, six weeks later.Results12 nursing homes were allocated to each group, 11 from intervention and 12 from usual care were analysed. The primary outcome was family carer uncertainty in decision-making about the care of the resident as measured by the Decisional Conflict Scale (DCS). There was evidence of a reduction in total DCS score in the intervention group compared with the usual care group (−10.5, 95% confidence interval −16.4 to −4.7; p<0.001).ConclusionsThe ACP was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Implications for clinicians and policy makers include the need to recognise the importance of family carer education and improving communication between family carers and formal care providers.

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Stevens, Ann H., Douglas L. Miller, Marianne E. Page, and Mateusz Filipski. "The Best of Times, the Worst of Times: Understanding Pro-cyclical Mortality." American Economic Journal: Economic Policy 7, no. 4 (2015): 279–311. http://dx.doi.org/10.1257/pol.20130057.

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It is well-known that mortality rates are pro-cyclical. In this paper, we attempt to understand why. We find little evidence that cyclical changes in individuals' own employment-related behavior drives the relationship; own-group employment rates are not systematically related to own-group mortality. Further, most additional deaths that occur when the economy is strong are among the elderly, particularly elderly women and those residing in nursing homes. We also demonstrate that staffing in nursing homes moves countercyclically. These findings suggest that cyclical fluctuations in the quality of health care may be a critical contributor to cyclical movements in mortality. (JEL E24, E32, I12, J16, L84)

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Kelleher, Jayne E., Peter Weedle, and Maria D. Donovan. "The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes." Pharmacy 9, no. 4 (2021): 160. http://dx.doi.org/10.3390/pharmacy9040160.

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Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusions: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.

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Abernethy, Margaret A. "THE EFFECTS OF ALTERNATIVE REIMBURSEMENT SYSTEMS ON THE OPERATING BEHAVIOUR OF NURSING HOMES." Accounting & Finance 25, no. 1 (2009): 41–60. http://dx.doi.org/10.1111/j.1467-629x.1985.tb00066.x.

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Mennicken, Roman, Boris Augurzky, Heinz Rothgang, and Jürgen Wasem. "Explaining differences in remuneration rates of nursing homes in Germany." European Journal of Health Economics 15, no. 4 (2013): 401–10. http://dx.doi.org/10.1007/s10198-013-0483-2.

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Galambos, Colleen. "ACHIEVING QUALITY PATIENT-CENTERED CARE IN THE NURSING HOME SETTING." Innovation in Aging 6, Supplement_1 (2022): 58. http://dx.doi.org/10.1093/geroni/igac059.228.

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Abstract In 1987, The Nursing Home Reform Act was enacted as part of the Omnibus Reconciliation Act of 1987 (OBRA 87). At that time, the Health Care Finance Administration (now Centers for Medicare and Medicaid Services) issued comprehensive regulations and survey processes to “ensure that residents of nursing homes receive quality care that will result in their highest practicable physical, mental, and social well-being.” Despite this landmark legislation, nursing homes struggle to provide quality care, and are additionally challenged by natural disasters and pandemics. This presentation will report on recommendations that examine, structures, policies, and care models that promote change and innovation, with a focus on safety, environmental modifications, patient centered approaches, and quality care. Dr. Colleen Galambos, a professor at University of Wisconsin-Milwaukee, with expertise in nursing home care delivery and quality improvement will present the care delivery recommendations from the NASEM report.

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Baldwin, Naomi S., Deirdre F. Gilpin, Carmel M. Hughes, et al. "Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff in Nursing Homes in Northern Ireland." Journal of the American Geriatrics Society 57, no. 4 (2009): 620–26. http://dx.doi.org/10.1111/j.1532-5415.2009.02181.x.

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McDonnell, Mary M., Eileen McGuigan, Joanne McElhinney, Marie McTeggart, and David McClure. "An analysis of the palliative care education needs of RGNs and HCAs in nursing homes in Ireland." International Journal of Palliative Nursing 15, no. 9 (2009): 446–55. http://dx.doi.org/10.12968/ijpn.2009.15.9.44257.

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Schweizer, Anna K., Nuala B. Curry, and Carmel M. Hughes. "An assessment of pharmaceutical inspection reports from nursing and residential homes for the elderly in Northern Ireland." International Journal of Pharmacy Practice 12, no. 3 (2004): 125–31. http://dx.doi.org/10.1211/0022357044319.

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Behan, Laura, Carol Grogan, and Laura M. Keyes. "The impact of regulation on the quality of care in nursing homes in Ireland: a time-series analysis of change in compliance." HRB Open Research 7 (April 24, 2024): 23. http://dx.doi.org/10.12688/hrbopenres.13821.1.

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Background Quality in health and social care is of paramount importance. Regulation is often used for ensuring or promoting quality in care services. Services are typically regulated by independent public authorities, which monitor services for compliance with regulations. There is limited research, however, on services’ compliance with regulations to provide a high quality of care. This study aims to examine nursing home compliance with regulations relating to quality. Methods Secondary legislation used for regulating nursing homes in Ireland was mapped to the Donabedian’s quality framework with each regulation categorised as either “structure”, “process” or “outcome”. The regulations categorised as “outcome” were determined to be quality-related regulations; such regulations were extracted and became this study’s area of focus. Published inspection reports from the regulator in Ireland for a three year period (2019 to 2021) (n=1,153) were assessed. The frequency with which the “outcome regulations” were inspected in nursing homes, and the proportion of compliance achieved, was calculated. Change in compliance levels across the three years was evaluated using Chi2 tests. Results Ten regulations were categorised as “outcome regulations” and addressed the following areas: positive behaviour; protection; residents' rights; communication; visits; personal possessions; food and nutrition; information for residents; medicines and pharmaceutical services; and complaints procedures. Compliance with two regulations (‘Regulation 9: Residents’ rights’ and ‘Regulation 11: Visits’) significantly improved during the three years (p<0.05). Compliance with ‘Regulation 12: Personal Possessions’ significantly decreased over the three years, however, so did the proportion found not compliant. While there was no significant change in the other regulations examined, compliance trended towards improvement, except for one regulation, ‘Regulation 20: Information for residents’, which trended downwards. Conclusion This analysis of national-level data found improvements in compliance across nearly all quality-related regulations demonstrating that regulation can be a positive influence on quality maintenance and improvement.

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RYAN, ASSUMPTA, HUGH MCKENNA, and OLIVER SLEVIN. "Family care-giving and decisions about entry to care: a rural perspective." Ageing and Society 32, no. 1 (2011): 1–18. http://dx.doi.org/10.1017/s0144686x11000055.

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ABSTRACTThe aim of this qualitative study was to explore rural family carers' experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi-structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health- and social-care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.

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Sengers, Frans, and Alexander Peine. "Innovation Pathways for Age-Friendly Homes in Europe." International Journal of Environmental Research and Public Health 18, no. 3 (2021): 1139. http://dx.doi.org/10.3390/ijerph18031139.

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A variety of innovative pilot projects are being implemented to improve the life-course resilience of existing and newly built home environments. We refer to these projects as “socio-technical experiments” that embody different kinds of promising futures and provide direction to current developments in the emerging domain of age-friendly homes. To take stock of this diversity within Europe; this paper provides an overview of 53 ongoing socio-technical experiments that are being conducted in the Netherlands, France, Ireland and Poland. We find that, besides the variation between European countries, there is a more important type variation in terms of the character of the experiments themselves and the differences in development direction that they propose. Our findings suggest that most of the innovations tested in these experiments are not primarily material or technical but primarily social or conceptual in character (i.e., new organizational modes or everyday practices that re-arrange social relations or new housing concepts that bridge the divide between ageing in place individually and a nursing home). This variety of innovations tested in the experiments can be categorized into seven distinct innovation pathways: (1) Showcasing Technology, (2) Innovation Ecosystem, (3) Sheltered Elite, (4) Specific Community, (5) Conscious Retrofitting, (6) Home Sharing and (7) Retrovation Challenge.

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Kelleher, Margaret, Mary O'Sullivan, and Nuala McMahon. "Mental illness in an elderly rural population in Ireland: a prevalence study." Irish Journal of Psychological Medicine 15, no. 4 (1998): 139–41. http://dx.doi.org/10.1017/s0790966700004857.

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AbstractObjectives: The aim of this study was to provide the first Irish prevalence data on mental illness in an elderly, rural, community dwelling population.Method: Subjects were identified from four general practitioners' lists. This included GMS patients, private patients and nursing home residents. Six hundred and fifty people aged 65 years or over were interviewed in their own homes using GMS-AGECAT, a standardised diagnostic instrument.Results: The overall prevalence of mental illness was 14.6%. The prevalence of depression was 9.4%. There was a significantly higher rate among women (13.2%) than men (4.3%). Depression in women was not age related. Of the total sample, 3.7% were classified as organic cases. Of the remaining cases, anxiety disorders occurred most frequently and represented 0.9% of all cases.Conclusions: Elderly people in rural areas experience similar levels of psychiatric morbidity as those in urban centres.

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Stroka, Magdalena A. "Drug overprescription in nursing homes: an empirical evaluation of administrative data." European Journal of Health Economics 17, no. 3 (2015): 257–67. http://dx.doi.org/10.1007/s10198-015-0676-y.

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Avery, Brian, and Mike Mulcahy. "Towards a College of Dentistry…" Bulletin of the Royal College of Surgeons of England 88, no. 3 (2006): 80–81. http://dx.doi.org/10.1308/147363506x100338.

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There are royal colleges of surgeons, physicians, psychiatrists, general practitioners, nursing, and speech and language therapists but not a college of dentistry. Why not? Admittedly, dentistry is a relatively small profession with a total of around 30,000 dentists registered within the UK; however, a single recognised academic home for the whole profession is overdue. Indeed, there are many 'academic homes', including the two faculties within this College (the Faculty of Dental Surgery and the Faculty of General Dental Practice (UK)) and the faculties of dental surgery at the colleges of Edinburgh, Glasgow and Ireland. Perhaps this fragmentation is one reason why the concept has not been developed.

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Hurley, Lorna, Máire O'Donnell, Rónán O'Caoimh, and Sean Finbarr Dinneen. "Investigating the Management of Diabetes in Nursing Homes in the West of Ireland using a Mixed Methods Approach." International Journal of Integrated Care 17, no. 5 (2017): 514. http://dx.doi.org/10.5334/ijic.3834.

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Cahill, Suzanne, Daphne Doran, and Max Watson. "Guidelines for nursing homes delivering end‐of‐life care to residents with dementia across the island of Ireland." Quality in Ageing and Older Adults 13, no. 1 (2012): 60–70. http://dx.doi.org/10.1108/14717791211213625.

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Feerick, Fintan. "Introducing Advanced Paramedics into the Rural General Practice Team in Ireland – General Practitioners Attitudes." Prehospital and Disaster Medicine 38, S1 (2023): s167—s168. http://dx.doi.org/10.1017/s1049023x23004351.

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Introduction:As Ireland's population increases and chronic disease becomes more prevalent, demand for limited general practice services will increase. Nursing roles within a general practice are now considered to be standard, yet alternative non-medical professional roles are under-explored within an Irish context. Non-medical personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.Method:A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analyzed.Results:In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes, and even roles within the general practice surgery.Conclusion:GP and AP clinical practice dovetail within many facets of primary care and emergency care. GPs believe that current models for providing rural general practice care are unsustainable, and they realize the potential of integrating APs into the general practice team to help support services into the future. These interviews provide a detailed insight into the opinions of rural general practitioners in Ireland on healthcare provision and the clear necessity for support and change.

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McCann, M., D. O'Reilly, and C. Cardwell. "A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland." Age and Ageing 38, no. 6 (2009): 711–17. http://dx.doi.org/10.1093/ageing/afp173.

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Leskovic, Ljiljana, Sergej Gričar, Raffaella Folgieri, Violeta Šugar, and Štefan Bojnec. "The Effect of Burnout Experienced by Nurses in Retirement Homes on Human Resources Economics." Economies 12, no. 2 (2024): 33. http://dx.doi.org/10.3390/economies12020033.

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The human resources economic implications of nursing burnout amongst nurses working in retirement homes have become a critical concern within the healthcare industry. As the backbone of care provision in these settings, it is crucial to understand the consequences of burnout on the workforce’s well-being and organisational sustainability. This study aims to investigate burnout among nurses working in retirement homes in Slovenia. The reasons for burnout vary across countries and regions, so gathering data specific to this population is essential. Through surveys conducted among 253 nurses and medical technicians, factor analysis revealed three factors for burnout: emotional exhaustion, reduced personal fulfilment, and impersonality. This research aims to pave the way for reducing workplace stress by creating new opportunities for better working conditions. To achieve these goals, executive management in retirement homes should gain proficiency in the four elements of the quality management cycle: planning, execution, evaluation, and continuous improvement. Furthermore, a comparative analysis was conducted to collate the empirical findings with those from Croatia.

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Reddy, Brian P., Stephen O'Neill, and Ciaran O'Neill. "Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis." HRB Open Research 3 (September 16, 2020): 65. http://dx.doi.org/10.12688/hrbopenres.13045.1.

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Background: Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. Methods: We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group). Data for need were derived from census data. Results were mapped to better understand underlying geographical patterns. Results: By comparing local accessibility and need, underserved areas could be identified, which were clustered particularly in the country’s northwest. Suburbs, particularly around Dublin, were by this measure relatively overserved. Conclusions: We have developed multi-dimensional indices of both accessibility to, and need for, nursing home care. This was carried out by combining granular, open data sources and elicited expert/stakeholder opinion from practitioners. Mapping these data helped to highlight clear evidence of inequitable variation in nursing home distribution.

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Griffin, Tomás Patrick, Deirdre Wall, Liam Blake, et al. "Vitamin D Status of Adults in the Community, in Outpatient Clinics, in Hospital, and in Nursing Homes in the West of Ireland." Journals of Gerontology: Series A 75, no. 12 (2020): 2418–25. http://dx.doi.org/10.1093/gerona/glaa010.

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Abstract Background Approximately 1 billion people worldwide have Vitamin D deficiency. The aim of this study was to compare Vitamin D status and serum 25-hydroxyvitamin D (25(OH)D) concentrations among adults sampled in the community, in outpatient clinics, as hospital inpatients and in nursing homes in the West of Ireland. The secondary aim was to determine the associations between length of hospital stay (inpatients) at the time of serum 25(OH)D sampling and Vitamin D status. Methods A cross-sectional study was carried out. Patients who had serum 25(OH)D analysis carried out in Galway University Hospitals (January 2011–December 2015) were identified following interrogation of the electronic laboratory data system. Baseline demographics, location, and date of sample collection were recorded. Vitamin D deficiency was defined as a serum 25(OH)D concentration &lt;25 nmol/L. Results In total, 24,302 patient samples were eligible for inclusion: community 15,319; outpatient clinics 6,371; inpatients 2,339; and nursing home residents 273. Vitamin D deficiency was more common in nursing home residents than inpatients, or those sampled in outpatient clinics or in the community (42% vs 37% vs 17% vs 13%; p &lt; .001). Inpatients sampled further into their hospital stay (≥3 days) had greater Vitamin D deficiency than inpatients sampled on 0–2 days (p = .007). Season (p &lt; .001), sex (p &lt; .001), and age (p &lt; .001) were associated with 25(OH)D concentrations. Vitamin D deficiency was more common in Winter/Spring, in males, and in those aged ≥80 years. Conclusions Nursing home residents and inpatients are at the highest risk for Vitamin D deficiency. Season, sex, age, and day of hospital stay on which serum 25(OH)D concentrations were sampled were associated with Vitamin D status.

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BOYLE, GERALDINE. "The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings." Ageing and Society 25, no. 5 (2005): 731–48. http://dx.doi.org/10.1017/s0144686x05003703.

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This paper examines the extent of mental ill-health and probable depression among older people in long-term care. It presents selected findings from a study in Greater Belfast, Northern Ireland, that compared the quality of life, autonomy and mental health of older people living in nursing and residential homes with those of older people living in private households who were receiving domiciliary care. Structured interviews were conducted with 214 residents in institutions and 44 older people receiving domiciliary care. The study found that those in private households were more severely physically-impaired and had a higher level of mental ill-health than the residents of institutional homes. It is suggested, however, that the mental ill-health effects were associated less with physical impairments than with the restrictions placed on the older person's decisional autonomy, and that long-term care environments that constrain the older person's autonomy contribute to the development of depression. Although the UK National Service Framework for Older People specified that those with depression should be given treatment and support, priority should also be given to preventing the depression associated with living in long-term care settings.

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Donnelly, Nora-Ann, Eithne Sexton, Niamh A. Merriman, et al. "The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross–Sectional Survey of Nursing Homes in Ireland." International Journal of Environmental Research and Public Health 17, no. 19 (2020): 7203. http://dx.doi.org/10.3390/ijerph17197203.

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Post–stroke cognitive impairment (PSCI) is a common consequence of stroke. Epidemiological evidence indicates that, with an ageing population, stroke and PSCI are likely to increase in the coming decades. This may have considerable implications for the demand for nursing home placement. As prevalence estimates of both cognitive impairment and dementia on admission to nursing home among residents with and without stroke have not yet been compared, they were estimated and compared in this study. We performed a cross–sectional survey to establish the admission characteristics of 643 residents in 13 randomly selected nursing homes in Ireland. The survey collected data on resident’s stroke and cognitive status at the time of nursing home admission. The survey found, among nursing home residents that experienced stroke prior to admission, prevalence estimates for cognitive impairment (83.8%; 95% CI = 76.9–90.6%) and dementia (66.7%; 95% CI = 57.9–75.4%) were significantly higher compared to residents that had not experienced stroke prior to admission (cognitive impairment: 56.6%; 95% CI = 52.4–60.8%; X2 (1) = 28.64; p < 0.001; dementia: 49.8%; 95% CI = 45.6–54.1%; X2 (1) = 10.47; p < 0.01). Since the prevalence of PSCI is likely to increase in the coming decades, the findings highlight an urgent need for health service planning for this increased demand for nursing home care to meet the care needs of these stroke survivors.

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Rice, Niamh, and Charles Normand. "The cost associated with disease-related malnutrition in Ireland." Public Health Nutrition 15, no. 10 (2012): 1966–72. http://dx.doi.org/10.1017/s1368980011003624.

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AbstractObjectiveThe present study aimed to establish the annual public expenditure arising from the health and social care of patients with diet-related malnutrition (DRM) in the Republic of Ireland.DesignCosts were calculated by (i) estimating the prevalence of DRM in health-care settings derived from age-standardised comparisons between available Irish data and large-scale UK surveys and (ii) applying relevant costs from official sources to estimates of health-care utilisation by adults with DRM. No attempt has been made to estimate separately the costs of DRM and any associated disease, since each can be a cause or consequence of the other. The methods used are adapted from an evaluation of the cost of malnutrition in the UK by the British Association for Parenteral and Enteral Nutrition (2009).SettingsHospitals, nursing homes, out-patient clinics, primary-care clinics and home care.SubjectsAll adult patients receiving hospital in-patient, out-patient or specified community health-care services.ResultsThe annual public health and social care cost associated with adult malnourished patients in Ireland is estimated at over €1·4 billion, representing 10 % of the health-care budget. Most of this cost arises in acute hospital or residential care settings (i.e. 70 %), with nutritional support estimated to account for <3 % of spend.ConclusionsThe cost associated with the care of patients with DRM is substantial and may rise as the proportion of older people within the population increases, a group at increased risk of DRM. Despite growing pressure on health-care budgets, little attention has been focused on the economic burden associated with DRM in Ireland or the potential for savings arising from improved detection and treatment of those at risk.

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Tunney, MM, CM Hughes, and J. Magee. "Infection control policies and procedures for meticillin-resistant Staphylococcus aureus in care homes for older people in Northern Ireland: a questionnaire study." British Journal of Infection Control 7, no. 6 (2006): 20–24. http://dx.doi.org/10.1177/14690446060070060601.

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Donnelly, Michael, Sinead McGilloway, Nicholas Mays, et al. "One and Two Year Outcomes for Adults with Learning Disabilities Discharged to the Community." British Journal of Psychiatry 168, no. 5 (1996): 598–606. http://dx.doi.org/10.1192/bjp.168.5.598.

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BackgroundLong-stay patients with learning disabilities (n=214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation.MethodEach resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation.ResultsThere was little or no change in peoples low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P ⩽ 0.01) 12 months after discharge (n=119) and were more satisfied (P ⩽ 0.05) with their new ‘homes’ (n=108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge.ConclusionsThe implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of ‘ordinary’ accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.

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Gilpin, D., N. Baldwin, C. Hughes, P. Kearney, D. Gardiner, and M. Tunney. "P4.02 Characterisation of Methicillin Resistant Staphylococcus aureus in Nursing Homes in the Northern Health and Social Services (NHSSB) in Northern Ireland." Journal of Hospital Infection 64 (January 2006): S20. http://dx.doi.org/10.1016/s0195-6701(06)60064-9.

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Müller, Dirk, Lisa Borsi, Claudia Stracke, Stephanie Stock, and Björn Stollenwerk. "Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes." European Journal of Health Economics 16, no. 5 (2014): 517–27. http://dx.doi.org/10.1007/s10198-014-0605-5.

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Lloyd, Liz, Albert Banerjee, Charlene Harrington, Frode F. Jacobsen, and Marta Szebehely. "It is a scandal!" International Journal of Sociology and Social Policy 34, no. 1/2 (2014): 2–18. http://dx.doi.org/10.1108/ijssp-03-2013-0034.

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Purpose – This study aims to explore the causes and consequences of media scandals involving nursing homes for older persons in Canada, Norway, Sweden, the UK and the USA. Design/methodology/approach – This study uses a descriptive case-study methodology which provides an in-depth, focused, qualitative analysis of one selected nursing home scandal in each jurisdiction. Scandals were selected on the basis of being substantive enough to potentially affect policy. An international comparative perspective was adopted to consider whether and how different social, political and economic contexts might shape scandals and their consequences. Findings – This study found that for-profit residential care provision as well as international trends in the ownership and financing of nursing homes were factors in the emergence of all media scandals, as was investigative reporting and a lack of consensus around the role of the state in the delivery of residential care. All scandals resulted in government action but such action generally avoided addressing underlying structural conditions. Research limitations/implications – This study examines only the short-term effects of five media scandals. Originality/value – While there has been longstanding recognition of the importance of scandals to the development of residential care policy, there have been few studies that have systematically examined the causes and consequences of such scandals. This paper contributes to a research agenda that more fully considers the media's role in the development of residential care policy, attending to both its promises and shortcomings.

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Brady, Conan, Ellie Shackleton, Caoimhe Fenton, et al. "Worsening of mental health outcomes in nursing home staff during the COVID-19 pandemic in Ireland." PLOS ONE 18, no. 9 (2023): e0291988. http://dx.doi.org/10.1371/journal.pone.0291988.

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Background Mental health issues in nursing home staff during the COVID-19 pandemic have been significant; however, it is not known if these issues persist following widespread vaccination and easing of restrictions. Objective To quantify the mental health of nursing home staff at different timepoints during the COVID-19 pandemic in the Republic of Ireland. Design/Methods Two identical, online, cross-sectional, nationwide, anonymous surveys of Republic of Ireland nursing home staff at two timepoints (survey 1 (S1, n = 390): November 2020 to January 2021; survey 2 (S2, N = 229: November 2021 to February 2022) during the COVID-19 pandemic. Convenience sampling was used with staff self-selecting for participation. Methods included the World Health Organisation’s Well-Being Index (WHO-5), the Impact of Events Scale-Revised (IES-R), the Moral Injury Events Scale (MIES), two Likert-scale items regarding suicidal ideation and planning, the Work Ability Score (WAS), the Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale, and a 15-item questionnaire assessing perceptions of the outbreak with one additional Likert-scale item on altruism. Descriptive analysis examined differences between staff based on their classification in one of three groups: nurses, healthcare assistants (HCA) and nonclinical staff. Pseudonymous identifiers were used to link responses across surveys. Results An insufficient number of participants completed both surveys for linked analyses to be performed; therefore, we performed an ecological comparison between these two independent surveys. More staff reported moderate-severe post-traumatic stress symptoms (S1 45%; S2 65%), depression (S1: 39%; S2 57%), suicidal ideation (S1: 14%; S2 18%) and suicidal planning (S1: 9%; S2 15%) later in the pandemic. There was a higher degree of moral injury at S2 (S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3)) and use of avoidant (maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3)) with no notable differences found in the use of approach (adaptive) coping styles. Staff reported more concerns at S2 regarding contracting COVID-19, social stigma, job stress, doubts about personal protective equipment and systems and processes. Conclusion In comparison to our previous survey, mental health outcomes appear to have worsened, coping did not improve, and staff concerns, and worries appear to have increased as the pandemic progressed. Follow-up studies could help to clarify is there are any lingering problems and to assess if these issues are related to the pandemic and working conditions in nursing homes.

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Wende, Danny, Alexander Karmann, and Shinya Sugawara. "Does the Design of Welfare Programs Stipulate Nursing Home Utilization? A Comparative Analysis of Long-Term Care Systems in Japan and Germany." Review of Economics 75, no. 1 (2024): 43–61. http://dx.doi.org/10.1515/roe-2024-0011.

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Abstract Japan and Germany are both facing a rapidly aging population and have similar social insurance-based long-term care systems. However, there are significant differences in utilization and costs. This paper presents a microeconomic decision model validated by regression analysis, Blinder-Oaxaca decomposition, and Data Envelopment Analysis to contrast the utilization patterns in the Japanese and German long-term care sectors. The design of the welfare programs for low-income families has been identified as one of the main reasons. In Germany, the welfare system leads to a demand curve for nursing home care that is comparable to that of an inferior good which makes external long-term care in nursing homes the more attractive, the poorer the respective households are. In addition, the resulting inelastic demand of the population groups in need of social benefits seem to reduces competition among Germany’s long-term care providers, which is associated with a loss of efficiency in how they use production factors. In Japan, this negative outcome is avoided by a comfort segmentation in the nursing home market.

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