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Advertising and market research Appendix E: Carer recognition Appendix F: Work health and safety Appendix G: Ecologically sustainable development and environmental performance Appendix H: Treatment monitoring Appendix I: List of figures and tables Appendix J: Compensation and Support Program 1. General Medical Consultations and Services Program 2.

War Graves and Commemorations Program 3. Summary of Significant Accounting Policies Note 2: Events After the Reporting Period Note 3: Financial Assets Note 7: Non-Financial Assets Note 8: Cash Flow Reconciliation Note Contingent Assets and Liabilities Note Senior Executive Remuneration Note Remuneration of Auditors Note Financial Instruments Note Financial Assets Reconciliation Note Administered Expenses Note Administered Income Note Administered Financial Assets Note Administered Payables Note Administered Provisions Note Administered Cash Flow Reconciliation Note Administered Contingent Assets and Liabilities Note Administered Financial Instruments Note Administered Financial Assets Reconciliation Note Contribution Accounts Note Compensation and Debt Relief Note Reporting of Outcomes Note Competitive Neutrality and Cost Recovery Note Net Cash Appropriation Arrangements Note Significant Accounting Policies Note 2.

Events After the Reporting Period Note 3. Financial Assets Note 6. Non-Financial Assets Note 7. Insurance underwriting expenses Note 9. Contingent assets and liabilities Note Financial instruments Note Risk Management Note He enjoyed going, didn't he?

He took up painting when he was there. And I think - did he just go once a week? I think he did, and they used to pick him up. And because our son was on holiday, we decided that he would take Ken, which he done, didn't he, the first day. And then he picked me up from work. And he said, 'Oh, I didn't like leaving Dad there. All these old people just sitting around in chairs. I must admit we got there a little bit late because we got behind a tractor [laughs]. And so you know what it's like when you want to get somewhere.

And so when I arrived people were being picked up. And all I could see was Ken in a chair and lots of old ladies with perms, like the blue-rinse brigade. And I thought, 'That's it. He's not coming here any more. But Ken wanted to go again, because they were going to massage his legs the next week. So I let him go again. Again our son took him and I went to pick him up with [son's name], our son. And we got there a little bit earlier, and Ken was playing bowls. A lady had picked, playing bowls with you, and he'd won twice.

And he was playing with his left hand. So I said, 'The others couldn't have been very good. And the nurses there are very nice. And I don't mean to be unkind, and it sounds really horrible, but I feel, they're all volunteer workers, but sometimes I feel they're a bit overenthusiastic, you know.

I just feel - like they were playing bowls and the lady that was doing it, obviously she must go about every day, every week, I don't know, but Ken rolled his bowl and it was all this, 'Oh, well done, Ken! And I just feel like, you know, you're being, not, I don't know what I mean really, but' A bit patronising?

And obviously they don't, you know - and they come round with tea and cake. And I had a cup of tea and a bit of cake. And it is a nice place, isn't it? Several people talked about their plans for future care. Many hoped they would be able to stay at home and be cared for by their family, but some recognised this might not be possible. In that case, most preferred the idea of professional nursing care at home or in a hospice to being in a hospital ward.

One woman was interviewed after she had moved permanently into a nursing home and she was happy with the decision.

If he hadn't come you wouldn't have been able to stay at home. And I thought it was the nicest one of them all. But I didn't want to leave Bristol because of all my friends. From March, my son, he came again from Australia and he helped me during the night to get up. I was losing more and more balance. And the carer said we should have two carers. Even I had a fantastic bath.

If I went in that it became too hard for one carer and that was when I realised that it was time to do something. And [daughter] said, 'Let's ring up this place. I came here on the 10th January. It's amazing, I came here voluntarily and it's my home. Something, I don't know what it is, but it's playing a positive influence, yes. And I've got that, and they've got that at the hospice and I've no doubt that I've no problem there, really, honestly.

And I hope if that awful day cometh, I'd rather be cared by my friends and family, most of my friends or the hospice' I've made all the decisions that I want. I'm not interested whether my family like it or my friends like it. That's for me to decide. I don't want a tracheotomy and I don't want to be force-fed.

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I've seen that once and I cannot see the point of it. I don't want my life to drag on when it's not necessary and they're fully aware at the hospice, they're brilliant. If I couldn't look after myself and I had the choice of a nursing home, well, those that I've seen, no thank you. And the care I've seen, no thank you. I certainly wouldn't go into a hospital. If [the hospice] could, that would be my dreams come true. I have enough trust in them to know that they wouldn't push me home if they didn't think I could cope and I certainly wouldn't go to the hospital.

A number of people talked about planning ahead for future care. This is not legally binding, but can help health and social care professionals to provide appropriate support. This is a form that is legally binding when completed correctly. It allows the person to refuse certain treatments or have them withdrawn in specific circumstances if they are no longer working or have become a burden. Making decisions about future care can be challenging, but the MND Association provides a candid and comprehensive publication called, End of life: This publication covers all aspects of end of life decision making, future care with MND and how to manage difficult conversations, whether with family and friends, or professionals.

They also provide information sheet 14A: Their resources can be downloaded from their website. Information and forms on Advanced Decisions can also be found on the Compassion in Dying website. Several people said they were not interested in making a ADRT. One woman said her father's long-held views started to change when he found himself in that situation. On top of all that, at the same time we had a dialogue going on between the doctors and himself and myself and my stepmother about whether he had a DNR [Do Not Resuscitate] order on him, whether indeed - well, let's say exactly what they should do legally to either lengthen or not lengthen his life.

And my father was a pragmatic, scientific sort of man and he had always said all his life that people should be allowed to die if things got bad. But when he was in that position and things were very bad he didn't want to die. Life still had a lot for him, even though things really were as bad as they could possibly be. He still derived a lot of pleasure from watching the news on the television and I think being able to see the sky from his window and things like that. But it's not something that we discuss. It's not something that we feel, I don't think, that we need to discuss.

Because we're not even placing ourselves there, you know. At this moment in time, I think the place where we're at is we're just trying to manage and be normal. And we don't want to even go there, do we? We're not - we've done other stuff, you know. We've obviously put wills in place for other stuff, which is natural anyway for people.


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But the Living Will, no, we've not talked about that, have we? There was a programme on television the other day. I watched a little bit of it, I think it was Holby City, where they were saying there was a woman who wanted to go to Switzerland and commit suicide. And I looked at it and I thought, 'Well, I don't feel like that at the moment. I don't recognise that feeling of desperation at all. But whatever it is, at my stage of the disease or whatever, my brain is not in that sort of negative time frame, and at the moment I'm enjoying life.

And it would seem an awful betrayal of all the people who are trying to work for me and do things for me to go and decide I want to commit suicide.

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So I'm not in that way at the moment. In the future I wouldn't mind having a Living Will ADRT , and I think I will write one, just simply to say that if I need to be resuscitated I don't want to be, and that if I'm in a position where nothing can help me then they might as well give me a big dose of morphine rather than a small one and let things go easily. Because I don't see any point in sitting round for months in pain and agony. And I would hope that when I come to be in a terminal state, that they will make it as easy as possible for me.

But I think it's very sad that people like Diane Pretty had to go to the Court of Human Rights and ask for help in that way. I thought that was disgraceful, really, that she couldn't be reassured that she would die a painless death. I thought that was very upsetting.

But I don't really look ahead to that. I try to enjoy the way I'm feeling at the moment and stick to the positive kind of thing. Some people had very clear views about what kind of care they would like, and had discussed this with members of their family and sometimes health professionals, but had not written it down. Others felt it was important to put their preferences in writing before their symptoms progressed especially if they were worried about losing their speech and felt secure knowing that their wishes for their future care had been organised.

Some wanted to protect their family from having to make difficult decisions if they themselves were unable to communicate, and some felt strongly it was their own right to decide. Most people we talked to share a general view that they did not want invasive treatment, and did not want to prolong life artificially, but did want the best possible palliative care to ensure they were as peaceful and comfortable as possible.

However, each person has their own definition of what they mean by 'invasive' or 'artificial'. For example, some felt strongly they would not want any kind of ventilation, whereas others would consider non-invasive ventilation but not invasive ventilation. Some people felt it was important to remember that you can set out clearly what treatments you do want, not just what you don't want, and that you can always change your mind.

Several people saw an ADRT as a kind of 'back-up' or insurance, just in case there were any disagreements about their care, but hoped that it would not be needed and trusted that they and their doctors would agree about what was best. Do you ever think about Living Wills and advanced directives and all of that, or? I'm very, very free and relaxed on that. And I've done it in the sense that I've said I don't want any problems if we reach the final point. And the reason I've given to my GP and other people it's very simple.

Suppose we talk about the breathing problem. If I was living in Africa in the condition where I have no access to devices like Nippy [non-invasive ventilator] or other things like that, I will die naturally, because my, my breath, my lung would not be able to, to cope at the point, so I would die. So why would we continue here to give me a Nippy or to put me under therapeutic harassment, and things like that, if the body is finished?

So in this case just let me go. So that's the, the way I feel about it.

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So I'm very, very relaxed on that. I said, 'Before we reach this point, I want to let you know that there's a lot of energy in the body. It's not easy to die. So I will still continue to, to fight until I can't. So if I'm just a, a piece of, a body in the bed cannot even any, unable to do anything, it's better to let me go slowly because it means that we're reaching the point. I've done quite a lot, mainly because I'm a single parent with two dependent children.

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And it was when a friend of mine with MND died unexpectedly that it really hit home to me that if anything happened to me suddenly, that the children would probably - or friends - would have to make choices. I'm not saying I don't want treatment, because I wouldn't have had the PEG done if I was - all it really says is that if possible I don't want to be ventilated.

Because in the event of that happening it would then become a decision of my children if and when to turn that off. And that's something I don't want them to have to deal with. Even though I know deep down it might never happen, I'm just covering all the angles. And also if I lose everything and can only blink I may well be happy in that state. I don't know yet. I might be quite happy sitting watching Cliff [Richard] all day, and then again I might not. But people who know me will sense whether or not that is quality of life.

And if I'm going to get a chest infection repeatedly, then don't treat it, if all it's going to do is maybe prolong my life by another three weeks or a month. So that's really why I've done it. I've just made sure that there isn't - I've got something to fall back on. It can be changed at any time. And I've got a really excellent relationship with my GP and my neurologist, who both would know, I think, would know me well enough to know that it, the time's not yet. Because initially when I was doing it, it was, 'God, if I ever -' - I remember saying to my GP, 'You will give us the tablets now if I get a chest infection?

Just because I'm going to - I'm not saying, 'Kill me off'.

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But that's not the case at all. I'm not considering PEG-feeding. I'm not going to refuse artificial therapy, non-invasive ventilation, if that helps. It's just there as a - what I don't want is to be on a ventilator and kept alive. What do you feel about the, the debate about whether people should be given the, the choice of euthanasia?

The principal limitation to this study is reliance on observational data. Given the nearly universal prevalence of medical, mental, and substance abuse problems among the Respite patients, it is unlikely that selection of a particularly healthy subgroup of homeless individuals biased the results. Additionally, the analyses adjusted for measured confounds, some of which suggested that patients discharged to Respite were at higher readmission risk.

Comprehensive casemix adjustment and propensity scoring are important methodologic tools not previously applied to comparing interventions for the homeless. Given high hospital utilization by a growing homeless population, this study offers a methodological advance, and may lay the groundwork for a much-needed randomized trial of respite care in comparison to other care arrangements. It should be emphasized that the design of this particular study was driven by our interest in an easily measured outcome, hospital readmission.

The findings should spur further research, and lend impetus to recognition of this service. The authors acknowledge the kind assistance of Mr. These entities had no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. Professor Ash is associated with the company that licenses the software, used to implement Diagnostic Cost Group DCG -based casemix adjustment. Shwartz Michael, Boston University. National Center for Biotechnology Information , U. J Prev Interv Community. Author manuscript; available in PMC Jan 1.

Kertesz , Michael A. Posner , James J. Mullins , Shwartz Michael , and Arlene S. Author information Copyright and License information Disclaimer. See other articles in PMC that cite the published article. Abstract Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays.

Procedure In general, a decision to discharge a hospitalized patient to Respite involved the combined inputs of caregivers residents, attending physicians, nurses, case managers, Boston Health Care for the Homeless visiting staff, shelter personnel , the patient, and potential receiving facilities the Respite, shelters and Other Planned Care.

This permitted us to: Apply exclusions Of patients, 14 were hospitalized for childbirth mother and infant care is not available through Respite , 35 did not survive to hospital discharge, 41 had unplanned medical discharges against advice, and 3 records could not be found likely due to interval changes in identifiers.

Identify endpoints We then identified BMC readmissions within 90 days of hospital discharge. Measures One of three discharge dispositions was identified for each participant: Respite This category included persons referred to Respite up to one day after hospital discharge. Other Planned Care Non-Respite patients discharged to supervised recuperative care e. Data Analysis The primary unadjusted analysis compared day readmissions among persons discharged to Respite, Own Care i. Open in a separate window. Early Readmission Readmission by 90 days occurred among patients Contributor Information Stefan G.

Using diagnoses to describe populations and predict costs. Health Care Financing Review. The Urban Institute; Retrieved April 28, , from http: Rare outcomes, common treatments: Analytic strategies using propensity scores. Annals of Internal Medicine. The effects of respite care for homeless patients: American Journal of Public Health. Identification of factors associated with hospital readmission and development of a predictive model. Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. It takes a village: