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1 <br /> . - <br /> 1 <br /> fields (such as !career ladders and competitive pay scales. ) are <br /> increased. <br /> Most referrals to in-home services occur through discharge <br /> planners in acute care hospitals or from physicians. According to a <br /> 1981 Inspector General' s report. many of these doctors and discharge <br /> planners know liIttle about community in-home services. According to <br /> the same study, physicians were minimally involved in planning home <br /> health care and in determining the services to be provided. <br /> fmmitx_mosLecigort12 <br /> As noted above, the primary sources of care and assistance for <br /> most older persons are family and friends. Caring for functionally <br /> impaired, chronically ill persons in the home can be vary difficult and <br /> exhausting for family members. Yet, families often do not know where <br /> to find the help they need. Outreach and support services to families, <br /> including consumer education about sources of support, training in the <br /> provision of care, and respite services would help families provide <br /> better quality care for their older members and, by increasing <br /> families abilities to cope with the demands involved, may reduce their <br /> need to turn to more expensive, higher levels of care. Family members <br /> could be trained1to train each other in the provision of care, making <br /> such a system anieconomical one to develop and operate. <br /> REMUtUDAIIRN3.201LIBERMIND_IUE-HOMISIQUAE_CABE <br /> Recommendation 14: Increase the emphasis on geriatric and <br /> gerontological care skills-training for all <br /> health related personnel, including <br /> physicians, nurses, social workers, and other <br /> hands-on providers of care. Provide funding <br /> as needed for such training. <br /> Recommendation 15: Strengthen discharge planning in hospitals and <br /> other institutions so that it begins at time <br /> of admission and involves sufficient knowledge <br /> of the home situation so that an appropriate <br /> plan will be developed. <br /> Recommendation 16: Provide outreach and support <br /> servicessincluding such services as consumer <br /> education, training in the provision of care, <br /> and respite services, for families with <br /> dependent elderly. <br /> 13 <br />