Abstract
Objective:To determine in a cohort of hospitalized persons with AIDS: 1) their preferences for various postdischarge long-term care settings, 2) the postdischarge settings recommended by primary care providers (doctors, nurses, and social workers), and 3) the impact of these views on the resulting discharge dispositions.
Design:Prospective cohort study.
Setting:Medical wards of five Seattle tertiary care hospitals.
Participants:120 consecutive hospitalized persons with AIDS and their primary care providers.
Measurements and main results:Although 70 (58%) of the patients found care in an AIDS long-term care facility acceptable, 87 (73%) preferred home care. Thirty-eight (32%) of the cohort were appropriate for long-term care after hospitalization, according to primary care providers. Eleven of the 38 patients deemed appropriate for long-term care were discharged to long-term care settings; among these, three had preferred home care. Likelihood of discharge to long-term care settings increased if patients found it acceptable (OR=7.1; 95% CI=3.2, 15.5), if they did not prefer home care (OR=7.7; 95% CI=4.7, 13.5), and if providers judged them to be appropriate for long-term care (OR=29; 95% CI=13, 64). In unstructured interviews, availability of emotional and medical support and privacy emerged as important factors to persons with AIDS considering long-term care.
Conclusions:Hospitalized persons with AIDS willingly express their desires for various postdischarge care settings. A majority find long-term care in AIDS facilities acceptable, although they generally prefer home care. Discharge disposition is associated with acceptability, preference, and appropriateness for long-term care.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Scitovsky AA, Cline M, Lee PR. Medical care costs of patients with AIDS in San Francisco. JAMA. 1986;256:3103–6.
Seage GR, Landers S, Barry MA, et al. Medical care costs of AIDS in Massachusetts. JAMA. 1986;256:3107–9.
Hughes A, Martin JP, Franks P. AIDS hospice and home care manual. Visiting Nursing Services — San Francisco, CA: Caremark Publications, 1988.
Heseltine PNR, Leedom JM, Heddeman M, et al. Comprehensive outpatient based healthcare reduces inpatient stay for persons with AIDS or ARC. Washington, DC: Proceedings of the III International Conference on AIDS [Abstract TH11.1], June 1987:161.
Little J, Daley S, Long A, et al. AIDS home health, attendant or hospice pilot study. Prepared for the Office of AIDS, California Department of Health Services, Los Angeles, 1988.
Grover SA, Coupal L, Gilmore N. The rising demands for hospital beds by AIDS patients and the fiscal implications for globally budgeted hospitals. Washington, DC: Proceedings of the III International Conference on AIDS [Abstract MP.215], June 1987:46.
Weinberg DS, Murray HW. Coping with AIDS: the special problems of New York City. N Engl J Med. 1987;317:1469–73.
McCormick WC, Inui TS, Dayo RA, Wood RW. Long-term care needs of hospitalized persons with AIDS: a prospective cohort study. J Gen Intern Med. 1991;6:27–34.
McCormick WC. Impact of a change in confidentiality law on enrollment of persons with AIDS in a clinical research study. Clin Res. 1990;38:545–50.
AARP Long Term Care Survey. Washington, DC: American Association of Retired Persons, 1984.
Kulys R. Future crises and the very old: implications for discharge planning. Health Soc Work. 1983;8:182–95
Lafferty WE, Hopkins SG, Honey J, et al. Hospital charges for people with AIDS in Washington state: utilization of a statewide hospital discharge database. Am J Public Health. 1988;78:949–52.
Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR. 1987;36:35–45.
Benjamin AE. Long term care and AIDS: perspectives from experience with the elderly. Milbank Q. 1988;66:415–43.
Traska MR. No home means no home care for AIDS patients. Hospitals. 1986;60(1):69–70.
Torres RA, Lefkowitz P, Kales C, et al. Homelessness among hospitalized patients with the acquired immunodeficiency syndrome in New York City. JAMA. 1987;258:779–80.
Afzal N, Wyatt A. Long-term care of AIDS patients. QRB. 1989;15(1):20–5.
Rango N, Anderson EJ, Feldman I, et al. Post discharge needs of hospitalized persons with AIDS and HIV related illnesses in New York City. Montreal, Canada: Proceedings of the V International Conference on AIDS [Abstract MHO 16], 1989:1031.
Blum HL, et al. Report to the Director of Health, San Francisco Committee for Non-Acute Services for Persons with AIDS. San Francisco, CA: Department of Public Health, January 1989.
Author information
Authors and Affiliations
Additional information
Supported in part by the Northwest Health Services Research and Development Field Program (Seattle VA Medical Center) and the Seattle/King County Department of Public Health, AIDS Prevention Project. Dr. McCormick was a fellow in the Robert Wood Johnson Clinical Scholars Program during this project.
The opinions stated herein are those of the authors and may not represent the views of the Robert Wood Johnson Foundation or the Department of Veterans Affairs.
Rights and permissions
About this article
Cite this article
McCormick, W.C., Inui, T.S., Deyo, R.A. et al. Long-term care preferences of hospitalized persons with AIDS. J Gen Intern Med 6, 524–528 (1991). https://doi.org/10.1007/BF02598221
Issue Date:
DOI: https://doi.org/10.1007/BF02598221