Private Financing Options for Long-term Care

Private financing for long-term care now comes almost exclusively from out-of-pocket payments. Long-term-care costs quickly impoverish most elderly, resulting in Medicaid dependency. The consequences are profound for the western Sun Belt with its rapidly growing elderly population. Key private financing options are long-term-care individual retirement accounts (LTC/IRAs), home equity conversion, social-health maintenance organizations and long-term-care insurance. Study of data from the past half century suggests that the LTC/IRA approach would prove unsatisfactory for the purpose despite the intuitive appeal of this mechanism. Experience with home equity conversions is still very limited, and unresolved questions limit this approach to the role of a reserve option for now. While promising, social-health maintenance organizations are still in the experimental stages and not yet commercially available. Long-term-care insurance is currently sold on a thin market and emphasizes nursing home coverage. New approaches to private financing through long-term-care insurance seem to offer the best approach for immediate implementation.     

An Alternative Method for Financing Care for the Non-Institutionalized Geriatric Dental Patient

Developing dental benefit programs for the expanding ambulatory geriatric population represents an important challenge for dentistry. This paper describes Blue Cross of California's experience in developing and providing a dental benefit as part of a HMO. supplement to the Medicare program. A study of a randomly selected sample of 133 Ultra Care enrollees was conducted in a small California city. A dental record review was performed on those individuals who accessed dental care. Patterns of utilization, distribution of planned and rendered treatment, and level of care achieved are presented. The experience of those patients compared to another sample of Ultra Care patients in a California city of comparable size, had similar care patterns. The major difference between the two patient populations was the tendency of one practice to repair existing prosthetic appliances, while the other practice tended to replace the existing appliances. The method of determining a capitation rate for these geriatric enrollees, using this data, is presented.     

Multipurpose Intensive Care Unit in a District General Hospital

The advantages of a four-bedded purpose-built general intensive care unit in a district general hospital are described. In addition to 1,447 inpatients treated between January 1968 and December 1971 the unit was used to conduct outpatient investigations. This has filled an important gap in conventional arrangements, and is practical and economical. The unit has proved to have advantages, not only for seriously ill patients but also has benefited the hospital in other ways. It has been of material assistance in recruiting and training nursing and medical staff and has been welcomed and supported by patients and their relatives. It has also attracted practical support from voluntary organizations whose generosity has enabled much additional equipment to be purchased.     

Prevalence of Dermatomycosis in a Brazilian Tertiary Care Hospital

A total of 233 specimens obtained from suspected cases of dermatomycosis from 189 patients were examined for causative fungi from December 2009 to May 2010 in a tertiary care hospital in the city of Belo Horizonte, state of Minas Gerais, southeastern Brazil. Yeast and fungal isolates obtained from specimens were regarded as conclusive diagnosis of mycoses in 82 cases (35.19?%), with the exception of two patients with pityriasis versicolor (2.4?%), in which the diagnosis was made only by direct examination plus clinical diagnostics of individuals. Forty-four subjects (23.28?%) were infected in more than one anatomical site. There was a higher occurrence on female patients (146, 77.2?%) than male (43, 22.8?%). Most of the infected patients were aged between 41 and 70?years (68.29?%). There were no statistically significant differences between occurrence of fungal infection and gender, presence of secondary disease and contact with animals. The largest number of examined material occurred in samples from toenails, which resulted in 50?% of positive cultures. Candida species were the most frequent group causing dermatomycosis in many anatomical sites, mainly in toenails and fingernails. Candida parapsilosis was the most representative (40.24?%) among all agents causing dermatomycosis of toenails and fingernails, followed by Candida tropicalis (20.73?%) and Trichophyton rubrum (10.98?%). Among the dermatophytes, Trichophyton genus represented over 80?% of the isolates, with T. rubrum representing 64.29?%, T. interdigitale (T. mentagrophytes) (21.43?%) and Microsporum gypseum (14.29?%).