A Stage of Migration Approach to Understanding Nursing Home Placement in Latino Families

ABSTRACT

This article introduces a dual application of Drachman and Ryan's stage of migration framework by applying the framework to an analysis of experiences of 25 nursing home residents with a prior history of migration from Cuba, the Dominican Republic, Ecuador, Mexico, and Puerto Rico. The stages of premigration and departure, transit, and resettlement are discussed in relation to research findings about the residents' earlier migration to the mainland United States and more recent move into a nursing home. Implications for social work practice with residents, families, and as members of interdisciplinary teams are addressed.     

Racial and Ethnic Differences in the Prevalence of Depressive Symptoms Among U.S. Nursing Home Residents

This study aimed to examine racial and ethnic differences in significant depressive symptoms among long-term nursing home residents. We analyzed the 2014 national Minimum Data Set linked to a nursing home file and estimated multivariable logistic regressions to determine the associations of race and ethnicities with significant depressive symptoms (score ≥ 10 on the 9-item Patient Health Questionnaire [PHQ-9] scale) and whether associations were explained by resident and nursing home covariates. Stratified analyses further determined independent associations in subgroups of residents. We found that the prevalence rate of PHQ-9 scores ≥ 10 was 8.8% among non-Hispanic White residents (n = 653,031) and 7.4%, 6.9%, and 6.6% among Black (n = 97,629), Hispanic (n = 39,752), and Asian (n = 16,636) residents, respectively. The reduced likelihoods of significant depressive symptoms for minority residents compared to non-Hispanic Whites persisted after sequential adjustments for resident and nursing home covariates, as well as in stratified analyses. The persistently lower rate of significant depressive symptoms among racial and ethnic minority residents suggests that training of nursing home caregivers for culturally sensitive depression screening is needed for improved symptom recognition among minority residents.     

Predictors of Nursing Home Admission: A Social Work Perspective

Abstract

Institutionalisation of geriatric patients is a growing trend in ageing societies, such as Singapore. Earlier studies focused on the sociodemographic profile and attributes of nursing home residents and applications, but neglected to address the predictors of nursing home admission from a social work perspective. The present retrospective study identifies independent risk factors that predispose a patient to a nursing home discharge from a general rehabilitation ward in a community hospital in Singapore, with a multidisciplinary emphasis on clinical intervention. Factor analysis results reinforced findings that functional impairment and dementia are consistent predictors of nursing home admission. Multivariate logistic regression analysis showed that positive predictors of nursing home admission include older age, length of hospital stay, low socioeconomic status, dementia, and functional disability. Social work interventions include early referrals to the medical social worker, so that options for social and family support can be explored prior to deciding to place patients in a nursing home. Other interventions include suitable family therapy and counselling for patients and their families.     

The Impact of the Social Environment on Nursing Home Residents

ABSTRACT

This study contrasted the experienced quality of life of residents living on one of two nursing home units: a unit for those considered socially intact and a unit combining residents who had moderately impaired cognition or physical function with those requiring skilled nursing or therapy. Qualitative interviews were held with residents of both units. The findings indicate that the social environment of each of the units played a fundamental role in the residents' quality of life. The social environment affected the residents' conceptions of self, their interactions with other residents and their interactions with the nursing staff. The article suggests the processes behind the social environment of each floor that may have resulted in different perceptions of the quality of life.     

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.     

Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents

We conducted a qualitative content analysis of barriers to nursing home admission for rural residents. Data came from semi-structured interviews with 23 rural hospital discharge planners across five states (Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin). From those, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions across four themes: loosen bureaucratic requirements, improve communication between facilities, increase rural long-term care capacity, and address underlying social determinants of health.     

Therapeutic Effects of an Outdoor Activity Program on Nursing Home Residents with Dementia

Abstract

Objective: The purpose of this one-year pilot study was to obtain preliminary information on the effects of an outdoor activity program, in comparison to an indoor activity program, on sleep and behavior in nursing home residents with dementia. Structured activity programs have been shown to improve dementia-related behavior problems, and there are some indications that improved behavior is associated with improved sleep. Previous research has shown that sleep disturbance is common in nursing home residents, and that limited exposure to light bright enough to entrain circadian rhythms contributes to their sleep problems. Thus, we expected to see improvements in behavior in both the outdoor and indoor activity groups, but improvements in sleep in the outdoor activity group only.

Methodology: A two-group (outdoor program, indoor program) two phase (baseline, intervention) design was used. Subjects were randomized to the outdoor or indoor program groups. Sleep and behavior disturbance were assessed over a 10-day period at baseline (usual activity conditions, which were expected to include little or no time spent outdoors) and at intervention (daily structured activity program offered outdoors or indoors). Sleep was assessed with wrist actigraphs with photocells, which also allowed for monitoring of light exposure. Behavior disturbance was assessed with the Cohen-Mansfield Agitation Inventory. Both activity programs were offered Monday-Friday over a 2 week period, included similar content and were offered by research project staff. The analytical approach emphasized primary changes between baseline and intervention measures of sleep and behavioral symptoms in the two activity groups. Because this was a pilot study, the significance level was set a priori at p< 0.10.

Findings: The outdoor activity group experienced significant improvements in maximum sleep duration. Both groups showed significant improvements in total sleep minutes. There also was a significant improvement in verbal agitation in the outdoor activity group.     

Moving to and Living in a Retirement Home

Abstract

Bad health combined witii deteriorating physical functions force many elderly people to move to a retirement home. The primary focus of this study was to investigate the resident's experience of safety and security. From a sample of 57 residents, 12 persons volunteered to participate in the interview. Data were analyzed with qualitative content analysis. The standard and design of the participant's previous home made mobility difficult and this affected their sense of security. This motivated them to move into an environment where they felt more secure. The environment at the retirement home was predominantly described as secure and safe. The finding shows that the participants felt that safety and security were more important than independence.     

The Presence of Memory-Enriched Environments for Cognitively Impaired Nursing Home Residents

Abstract

Enriched living environments that contain a wide array of personal memorabilia and memory-stimulating cues have the potential to support cognitive functioning. The purpose of this ethnographic research was to describe the care environments of older adults with cognitive impairment living in nursing homes (n?=?42), to evaluate the degree to which these environments contained memory-stimulating cues, and to understand the extent to which these environments were cognitively stimulating for older adults with dementia. Results indicated varying levels of enrichment both within and between homes, with nearly a quarter of the residents living in environments that contained no memory-enhancing stimuli.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Summerhouse Dialogues between Mobilier and Immobilier

Abstract

Addressing processes of cultural memory and mental appropriation in leisure architecture, this study relies on the fact that, in Denmark, summerhouses are often sold with furniture and objects representing the former owners and their ways of life. The theoretical starting point is formed by a discussion of Gaston Bachelard’s notion of “childhood home.” A menaced phenomenon in today’s urbanized reality, the childhood home and its mental values may indirectly be cultivated and reinterpreted by way of summerhouses. Buying a partly furnished summerhouse involves a joint encounter with immobilier (real estate) and mobilier (movables). In this way, a dialogue between the actual residents and a larger cultural history comes about. Built 1960/1971, the summerhouse studied here belongs to the author and his family. Archival and photographic experiments carried out after the acquisition in 1998 support reflections on space and life, now and in the previous history of the house.     

Interpreting Home in the Transnational Discourse

ABSTRACT

The aim of this article is to present a selection of primary findings culled from empirical data collected in Dublin with post-European Union enlargement Polish migrants as the cohort in study. One aspect of the project was to investigate how that group interpreted home since they have left Poland. Based on the outcomes of interviews with thirty-one informants, the narratives reveal a group of individuals who continuously contest social constraints and push the boundaries of previously held notions of migration, identity, and home. This article situates their aspirations, preferences, and practices within discourses of transnationalism, thereby connecting their migration experiences with a consciousness of feeling at home in the world. This article breaks up “home” as interpreted by the informants into three categories—centered home, sentimental home, and transportable home. The wide range of perspectives held by informants and the inability to clearly define their position with regard to the notion of “home” reinforces the hypothesis of this article that, for a transnational cohort, the meaning of home is contested. In relation to the wider international literature regarding concepts of home, this article makes a contribution to the deepening scope of migration research in Ireland.     

The Timing of Leaving the Parental Home and Its Linkages to Other Life Course Events in Turkey

Abstract

This study employs the data of the 2003 Turkish Demographic and Health Survey to study the timing of leaving the parental home and the links between home leaving and other life course events (entry into labour force, family formation, and first birth) for three groups of home-leavers: early, on-time, and late. Results of the study suggest that the majority of the home-leavers are late home-leavers in Turkey. This pattern of parental home leaving observed in Turkey resembles the pattern which can found today in Mediterranean and Southern European countries. The median age at home leaving is found to be 24.4 years. In terms of gender differentials, the study implies that the timing of leaving the parental home for males (27.2 years) markedly differs from the timing of leaving the parental home for females (21.6 years). Results also imply the sequence of life-course events for males in Turkey: entry into labour force, marriage, the birth of first child, and home leaving. On the other hand, timing of home leaving for females was found to be in line with the timing of family formation. However, the home leaving experiencing by females does not mean a real home leaving in the context of Turkey; it is just a shifting from their own parental home to their husbands' parental home.     

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration

Abstract

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration—the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQ Demonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool—the MDS—was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.     

The Meaning of Queer Home

Abstract

This article positions two proto-queer texts together in order to demonstrate how the development of American “queer subjectivity” arose as a discernible discursive and embodied notion related to “home.” Written before the arrival of the queer category, Audre Lorde’s Zami: A New Spelling of My Name (The Crossing Press, Freedom, CA, 1982) and Leslie Feinberg’s Stone Butch Blues (Alyson Press, Los Angeles, CA, 2003, original work published 1993) concentrate upon the home as a site conditioned by twin concerns that would become central to queer politics: “the home” as narrative metaphor and homes as real-world shelters. Queering the home stretches and scrambles the home category (“dyke bar as home,” “Black lesbian sisterhood as home,” “body as home”) while insisting upon self-defined, material structures of protection and comfort for queers. The article performs a “reading through skin” of queer scholarship and of sociological data. It argues that these queer-emergent texts helped establish notions of “queer home” via exploring metaphoric and empirical axes related to domestic space.     

Family Members' Reports of Non-Staff Abuse in Michigan Nursing Homes

Recent research showed that mistreatment of nursing home residents by other residents may be highly prevalent. The present study examined the issue from family members' perspectives. The data came from the 2005 and 2007 random-digit dial telephone surveys of Michigan households with a family member in long-term care. Based on family members' reports, about 10% of nursing home residents aged 60 and over were abused by non-staff in nursing homes (e.g., other residents and visitors) during the past 12 months. Family members were more likely to report non-staff abuse when the nursing home residents were younger, were female, had behavior problems, and had greater level of physical functioning. Family members who reported staff abuse were four times more likely to also report non-staff abuse.     

My Room,My Home,My Self

Abstract

The material culture of home cannot be supplanted in its entirety when moving into an aged care facility. When the time comes, the decision of what to take and what to leave behind is not simple. This article presents the balance between practical and emotional considerations in the choice and presence of personal objects in the rooms of residents. Intersubjective relationships between material objects in the room and the people who enter that space is viewed through a narrative lens. In this way, it is the materiality of the room-as-home for the self, which is key. Three major themes relating to the objects in the room of the older person were found to be: 1. Safety, 2. Family, and 3. Home. These themes emerged from ethnographic research in an aged care setting. Participants included residents, their families, care staff, and management of the facility. The article contributes to understandings of material objects as carriers of identity and meaning in an aged care facility.     

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

Abstract

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons.

This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva.

Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Low skeletal muscle mass index is associated with function and nutritional status in residents in a Turkish nursing home

Introduction: To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home.

Methods: Male residents aged?>60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m², skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m²) were calculated. The participants were regarded as having low SMMI if they had SMMI?<9.2?kg/m² according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded.

Results: One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1?±?6.7 years with mean ADL score of 8.9?±?2.0 and IADL score of 8.7?±?4.6. One hundred twelve (71%) residents were aged?>70 years. Thirty-five men (23%) had low SMMI in group aged?>60 years, and twenty-eight subjects (25%) in the group aged?>70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1?±?3.4 versus 19.6?±?2.5, p?=?0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6?±?2.7 versus 27.1?±?4.1, p70 years (8.1?±?2.6 versus 9.1?±?1.6, p?=?0.014). In regression analyses, the only factor associated with better functional status was the lower age (p?=?0.04) while the only factor associated with better nutrition was higher SMMI (p?=?0.01).

Conclusions: Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.