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The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in‐home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in‐home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in‐home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue.

J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams.

Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations.

This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.

This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.

The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.

Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment; welcoming, caring, mobilized and supportive community; spatiotemporal life and care trajectories; and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.

Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.

Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.

I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.

Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.

Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.

The purpose of this paper is to add to the stream of research examining the difference between the amount of taxes waived for nonprofit hospitals and the amount of charity care they provide.

The study is an archival study.

Almost all nonprofit hospitals in the sample provide enough charity care to cover their waived taxes. Almost none provide enough charity care at the level that has been proposed to the federal government for hospitals to maintain their nonprofit status.

As with most hospital research, a limitation is this study’s focus on a single state to control for regulatory differences among states.

The data on the new Form 990 allow better measurement and transparency regarding a nonprofit hospital’s charity care. For legislators, regulators, and taxpayers, the results from this study raise questions about: the large variations in the amount of charity care provided among nonprofit hospitals and whether enough is being done in terms of providing charity care.

There is great variation among nonprofit hospitals as to the amount of charity care provided. Relying upon a nonprofit hospital’s altruistic nature may not be enough to ensure that they act in the best interest of society.

This study is unique because, for the first time, a true measure of taxes waived is used in the analysis. All previous research has had to proxy taxes.

Connected Care, Turning Point's model for involving the community in the design and delivery of integrated health and well‐being services, aims to involve the community in the commissioning process in a way which fundamentally shifts the balance of power in favour of local people. The model has been tested in a number of areas across the country, and previous articles in the Journal of Integrated Care have charted the progress of the original pilot in Hartlepool. Cost‐benefits of the approach are now becoming clearer. Implementation of a new community‐led social enterprise in Hartlepool began in 2007, and today its Connected Care service provides community outreach, information, access to a range of health and social care services, advocacy, co‐ordination and low‐level support to the people of Owton. Key lessons, from Hartlepool and elsewhere, have centred on the value of making the case for service redesign from the ‘bottom up’ and building the capacity of the community to play a role in service delivery, while also promoting strong leadership within commissioning organisations to build ‘top‐down’ support for the implementation of outcomes defined through intensive community engagement. The new Government's ‘localism’ agenda creates new opportunities for community‐led integration, and the Connected Care pilots provide a number of learning points about how this agenda might be successfully progressed.

There has been much research focusing on contracting and its effect on individual voluntary sector organisation, and some mapping of the extent of voluntary sector participation in joint community care planning. Each of these is a new and formal relationship with the statutory sector, and in many cases the tasks are fulfilled by the same voluntary sector worker (usually the senior paid officer of the agency). But the impact that these two new relationships have on the voluntary organisation’s perception of its dependence and inter‐dependence has received less attention. The paper will draw on structured interviews in three local authorities, with voluntary sector participants in contracts for social care, and with participants in joint community care planning groups, as well as on documentary research. It will explore the impact of the evolving roles for those seeking to operate effectively in the pluralist provision of public services. It will analyse experiences within joint community care planning structures, and will analyse experiences of contractual relationships. The paper will seek to identify the elements present in each research site which influence the culture of joint working within the two statutory/ voluntary relationships.

Recently arrived older refugees in resettlement countries are a particularly vulnerable population who face many risks to their health and well‐being, and many challenges in accessing services. This paper reports on a project undertaken in Victoria, Australia to explore the needs of older people from 14 recently arrived refugee communities, and the barriers to their receiving health and aged care. Findings from consultations with community workers and service providers highlight the key issues of isolation, family conflict and mental illness affecting older refugees, and point to ways in which policy‐makers and service providers can better respond to these small but deserving communities.

The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.

A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.

The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.

The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.

The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy.