Patricia Hanrahan - Academia.edu (original) (raw)

Papers by Patricia Hanrahan

This article presents the background, development, and content of a manualized home-based family ... more This article presents the background, development, and content of a manualized home-based family intervention for ethnic minority families with a seriously mentally ill member. The development of this homelessness prevention intervention is based on the premise that the client's home can be one of the most effective venues for achieving long-term positive outcomes from mental health services. By observing the patient within the context of the home environment, staff can more accurately assess the family dynamics and encourage family members to fulfill more effective roles as caregivers. The agency within which this manualized intervention is implemented is an Integrated Services Agency (ISA) which serves the highest utilizers of the most costly mental health services in the public sector. Through effective case management and other interventions, the agency has been able to change the service utilization pattern from inpatient care, homelessness, and incarceration to community treatment within the framework of integrated comprehensive services. Ten salient points which have been significant to this agency's positive outcomes are discussed. We also provide a model for conceptualizing the strengths and burdens of the study population of low-SES African Americans and Latinos. We identified the strengths as the extended

Background: The PROUD Homelessness Prevention Project of Arapahoe House, Inc. in Denver, Colorado... more Background: The PROUD Homelessness Prevention Project of Arapahoe House, Inc. in Denver, Colorado uses a pair or dyad of case managers to address the individualized client needs of a target population characterized chiefly by chronic utilization of public detoxification services. The local political and economic contexts affecting this population include a recent increase in poverty and decreased housing available to seriously debilitated individuals. Created in 1992, PROUD has expanded its housing services to address homelessness more fully.

Oxford University Press eBooks, May 10, 2001

ABSTRACT

Journal of the American Geriatrics Society, Sep 1, 1997

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a ... more OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. DESIGN Two cohorts of hospice patients were studied longitudinally, each for 2 years. SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty-seven patients were enrolled in home hospice and institutional hospice settings. MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41 ' YO could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal,

Psychiatric Services, 2000

Psychiatric Services, Sep 1, 2001

Journal of the American Geriatrics Society, 1993

This study sought to determine the kind of health care that professional and family caregivers vi... more This study sought to determine the kind of health care that professional and family caregivers viewed as appropriate for end-stage dementia patients. Survey. All 819 physician members and 1,000 randomly selected non-physician members of the Gerontological Society of America and 500 families of demented relatives from the Alzheimer's Association. Respondents chose the appropriate level of care from five choices on a continuum from highly aggressive to palliative. The majority of physicians who cared for elders (61%), gerontologists from other professions (55%), and families (71%) chose palliative care only. Increased age of the respondent and experience with terminal care choices were associated with the choice of palliative care. The majority favored hospice care for patients with end-stage dementia. Professional and family members of demented individuals, especially if they have experience in terminal care decisions, strongly favor palliative care for end-stage dementia. These findings may be helpful to professionals and families dealing with these choices.

Schizophrenia Research, Dec 1, 1992

Repetitive dysfunctional behaviors (e.g., polydipsia, bulimia, hoarding, mannerisms) are frequent... more Repetitive dysfunctional behaviors (e.g., polydipsia, bulimia, hoarding, mannerisms) are frequently observed in chronically institutionalized schizophrenics, cause significant morbidity and are readily reproduced in animal models. The goal of this study was to assess the frequency and severity of these behaviors. Thirty-two chronic schizophrenics on an extended treatment unit were rated on the Elgin Behavioral Rating Scale, which includes eight repetitive behaviors and eight positive and negative symptoms. Fortyseven percent of the patients exhibited at least one severe, or 2 moderate, repetitive behaviors, while 63% exhibited at least one severe or 2 moderate positive or negative symptoms. The mean total score (i SD) on the eight repetitive behaviors (10.3 + 6.1) was about 2/3 that for the eight positive and negative symptoms (15.3k8.9, r=4.l, p= .OOOl). Interrater reliability for the repetitive behaviors was similar to that for the positive and negative symptoms. Repetitive behaviors were positively related to male gender, white race and total length of hospitalization. Repetitive dysfunctional behaviors are frequently observed and can be reliably rated in chronically institutionalized schizophrenics.

Springer eBooks, 1991

An increasing array of home care, community-based and institutional services has accompanied the ... more An increasing array of home care, community-based and institutional services has accompanied the increasing numbers of elderly and disabled persons in general, as well as those with posthospitalization home care needs. The extent and availability of services are limited, however, and for those who cannot pay for their own support, eligibility requirements may limit service usage. Most home and community services for the elderly are initiated through federal programs, which often contain targeting or limiting factors. Local community programs may have limits as well. The service system frequently changes due to political and economic realities, and eligibility may change due to alterations in the recipient’s needs and status. The result is a complex and confusing network that is difficult to use. In fact, elders and their families may often require considerable assistance in securing and utilizing services to which they are entitled.

American Journal of Hospice and Palliative Medicine, 1999

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a... more Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used—as opposed to our previous study, which only examined initial treatment plans. Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.

Hospice Journal, The, Sep 1, 1995

Hospice �are is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993)... more Hospice �are is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 per cent of hospice patients have a primary diagnosis of dementia (Han

American Journal of Psychiatry, 1992

The purpose of the study was to determine whether there are differences in clinical characteristi... more The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

Research on Aging, Mar 1, 1990

Before attempting to understand how a relatively new treatment modality such as adult day care (A... more Before attempting to understand how a relatively new treatment modality such as adult day care (ADC) works, it is useful to understand what it is. To this end, this article describes the structural characteristics of ADC centers and the characteristics of ADC users in the United States and across the four U.S. census regions. A 1986 national census survey of 1,347 ADC centers yielded 974 usable responses (72.3%). Findings indicated that there is great variability in characteristics of ADC across the country. In general, ADC's are well-staffed, well-linked to other agencies, and well-equipped. However, demand and enrollment appeared low. A need for improved oversight and staff in-service training was indicated for a substantial proportion of centers. These and other findings provide the most detailed and comprehensive national and regional descriptions of ADC available to date.