Chifukwa chake zoleza mtima zimasiyana pakati pa odwala awiriwa
Kafukufuku wofalitsidwa m'magazini ya Journal of the American Medical Association (JAMA) wapeza kusiyana kwakukulu kwa anthu odwala omwe ali ndi mabungwe othandizira anthu opindula poyerekeza ndi anzawo omwe sapanda phindu. Makamaka, odwala omwe amapita kuchipatala omwe amapindula nawo ntchito amakhala ndi zosowa zochepetsetsa ndipo amakhala kuzipatala zoposa nthawi yomwe amagwira ntchito m'maofesi osamalira ndalama.
Pezani zenizeni pa kusiyana ndi kufanana pakati pa mabungwe osamalira zopindulitsa ndi osapindulitsa ndi kusanthula izi.
Maofesi Okula Zipatala Zopindulitsa
Gulu la anthu osowa chithandizo lopindulitsa kwambiri lawonjezeka kwambiri m'zaka za m'ma 2000. Chiwerengero cha mabungwe opindulitsa amapitirira kawiri kuchoka pa 2000 mpaka 2007 pamene chiwerengero cha mabungwe osamalira anthu osapindulitsa sichinasinthebe.
Ngakhale kuti akulonjeza kuti chiwerengero cha mabungwe operekera kuchipatala chikuwonjezereka, zimabweretsa nkhawa zomwe mabungwe ogwira ntchito kuzipatala amapindula kwambiri kuposa anthu osalandira ndalama. Kuphunzira kwa JAMA kunayang'ana kusiyana pakati pa odwala ndi machitidwe a mabungwe osapindulitsa ndi osapindulitsa kuti amvetsetse chifukwa chake kusiyana kwapindula kunali kwakukulu.
Medicare Hospice Kubwezeredwa
Medicare kubweza ngongole amapereka 84 peresenti ya odwala m'chipatala. Medicare imabweza ndalama zothandizira anthu ogwira ntchito kuchipatala pafupipafupi, kutanthauza kuti wodwala aliyense amalandira kubwezera komweko patsiku ngakhale kuti akudziŵa kapena kusamalira munthu aliyense.
Ndondomeko yobwezeretsa izi zingakhale zolimbikitsa magulu othandizira odwala kuti azisankha odwala omwe alibe zosowa zochepa komanso odwala nthawi yaitali. Pochita izi, mabungwe opindulitsa angakhale osungira ndalama mwa kupereka chisamaliro chochepa kwambiri ndi kupindula phindu posankha odwala omwe akhala moyo wautali.
Achipatala Amapindula Ambiri Odwala
Kwa kafukufuku wa JAMA, ofufuza anagwiritsa ntchito data kuchokera ku 2007 National Home and Hospice Care Survey, ndi oimira 4,705 omwe achotsedwa kuchipatala.
Kuyerekeza deta kuchokera kuzipatala zopindulitsa komanso osamalira anthu osapindula, kunawonetsa kuti zochitika zonse zothandizidwa ndi malo omwe akusamalidwa zimasiyana ndi phindu la phindu. Poyerekeza ndi anthu osowa chithandizo chopanda phindu, ogwira ntchito zothandiza anthu odwala matenda opatsirana amapindula ndi odwala omwe ali ndi khansa (48.4 peresenti ndi 34.1 peresenti) komanso ochuluka odwala odwala matenda a maganizo (8.4 peresenti poyerekeza ndi 17.2 peresenti) ndi matenda ena (43.2 peresenti pa 48.7% ).
Detayi inasonyezanso kuti pafupifupi aŵiri mwa atatu mwa odwala omwe ali ndi chipatala chofuna kupeza phindu ali ndi matenda a dementia ndi ena omwe alibe khansa, pamene pafupifupi theka la odwala omwe ali ndi chipatala chopanda phindu anali ndi matendawa.
Odwala khansa ali ndi chiyembekezo chokhazikika cha moyo komanso mankhwala. Panthaŵi yomwe odwala khansa amapita kuchipatala ambiri amatha kumwa mankhwala ena onse ndipo ali pafupi kufa . Odwala khansa ya kumapeto amakhalanso osowa mtengo wambiri ndi ululu waukulu.
Odwala a Dementia (komanso odwala ena omwe ali ndi matenda osadziwika bwino) amakhala ndi moyo wautali kuposa odwala khansa osamalidwa bwino. Odwalawa ndi opindulitsa kwambiri chifukwa amalandira Medicare hospice tsiku lililonse kuti azikhala ndi ndalama zambiri.
Malo a Care and Length of Stay
Poyerekeza ndi odwala osapindula, ogwira ntchito zothandiza anthu ogwira ntchito zothandizira anthu ogwira ntchito zopindula, anali ndi odwala ambiri omwe amakhala m'mabanja okalamba komanso ochepa omwe amakhala pakhomo.
Odwala omwe amakhala m'mabanja okalamba nthawi zambiri amawononga ndalama zopangira odwala pang'onopang'ono.
Maofesi achikulire ali ndi azamalire ozungulira nthawi zonse omwe amakhudza zinthu zambiri zomwe odwala a kunyumba angafune kuti azipita kuchipatala. Mabungwe othandizira anthu ogwira ntchito zopindulitsa amaphatikizapo kuchita ntchito yabwino kwambiri yogulitsa malonda ku nyumba zosungirako anthu okalamba kuti akwaniritse "kunyumba" ndi anthu ogwira ntchito yosamalira anthu okalamba komanso kuonjezera chiwongoladzanja.
Kafukufuku wa JAMA anapeza kuti poyerekeza ndi odwala matenda a kansa, awo omwe ali ndi matenda a 'dementia' kapena ena odwala matendawa anali ndi maulendo angapo tsiku ndi tsiku kuchokera kwa anamwino ndi ogwira ntchito . Izi zimakhala zomveka chifukwa odwala khansa amakhala ndi zizindikiro zoopsa kwambiri zomwe zimafuna kufufuza nthawi zambiri.
Chifukwa chakuti mabungwe ogwira ntchito kuchipatala amalipiritsa ndalama tsiku ndi tsiku pa wodwala, odwala ogwira ntchito zopindula angapindulitse ndalama mwa kusankha odwala omwe amafunikira kuchepa kwafupipafupi.
Kutalika kwa mlendo (LOS) ndi chiwerengero cha masiku omwe wodwala ali kuchipatala asanatuluke kapena kufa. Malingana ndi ochita kafukufuku, LOS yapakatikati (LOS) inali masiku anayi m'zipatala zopindulitsa poyerekeza ndi odwala osapindula (masiku 20 vs. 16, kapena 26.2 peresenti yaitali LOS).
Poyerekeza ndi odwala omwe amapita kuchipatala chopanda phindu, odwala omwe amapita kuzipatala zopindulitsa amakhala ndi nthawi yaitali kuposa masiku 365 (2,8 peresenti ndi 6.9 peresenti) ndipo sankakhala ndi masiku osachepera asanu ndi awiri (34.3 peresenti vs. 28.1 peresenti) .
Kutanthauzira kwa Maphunziro Ofufuza
Akatswiri ofufuza a JAMA anati maphunziro ofufuzawa ali ndi mfundo zofunika kwambiri komanso kuti odwala omwe sali opindulitsa amakhala ovuta kwambiri ponena za odwala.
"Chisankho cha chikhalidwe ichi chimasiya mabungwe osamalira anthu osapindula mosamala mosamala odwala omwe ali okwera mtengo kwambiri-omwe ali ndi khansa ndi omwe akufuna kuyamba chiwopsezo kwambiri mochedwa pa matenda awo; Zotsatira zake n'zakuti, odwala omwe amathandiza odwala omwe akufunikira kwambiri akhoza kuthana ndi zovuta zachuma kuti athe kusamalira bwino njirayi. "
Zotsatirazi zikhoza, ndipo ziyenera, zimayambitsa zokambirana za kusintha kwa ndalama ku Medicare Hospice Benefit . Hospice ndi makampani opititsa patsogolo, makamaka mu dipatimenti yopindulitsa, ndipo kufufuza kwina kuli kofunika kuti mumvetsetse bwino mgwirizano pakati pa malo opindula ndi chithandizo cha odwala / osamalira kumapeto kwa moyo.
> Chitsime:
> Wachterman MW, Marcantonio ER, Davis RB, McCarthy EP. Mgwirizano wa Odwala Achipatala Omwe Amapindula ndi Matenda Odwala, Malo a Chisamaliro, ndi Utali wa Kukhala. JAMA. 2011; 305 (5): 472-479. lembani: 10.1001 / jama.2011.70