Effect of childlessness on nursing home and home health care use

This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: (1) Are the childless elderly at a greater risk of nursing home and home health care use? (2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? (3) Does having additional children beyond the first one have a significant effect on the use of these services? (4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old Survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed.     

Afraid to care; unable to care: A critical ethnography within a long-term care home

This paper describes the findings of a critical ethnographic research study conducted in an urban long-term care home. While our intention was to learn more about the culture of care, specifically as it relates to mental health care provision, the participants in the study consistently spoke with us about (what we have labeled as) a culture of compliance. In a context where new long-term care legislation is being implemented along with new, standardized resident assessment instruments, gaining a deeper understanding of the (un)intended consequences of government's efforts to ensure a high quality of care is of paramount importance. This research demonstrates how policy-driven structural mechanisms can (re)produce conditions that result in frontline staff being afraid and unable to care, and thus contributes to a better understanding of the lived experience of frontline long-term care staff who find that their caregiving responsibilities are displaced by caregiving accountabilities.     

Affective practices,care and bioscience: a study of two laboratories

Scientific knowledge‐making is not just a matter of experiments, modelling and fieldwork. It also involves affective, embodied and material practices (Wetherell, 2012) which can be understood together as ‘matters of care’ (Puig de la Bellacasa, 2011). In this paper we explore how affect spans and connects material, subjective and organizational practices, focusing in particular on the patterns of care we encountered in an observational study of two bioscience laboratories. We explore the preferred emotional subjectivities of each lab and their relation to material practice. We go on to consider flows and clots in the circulation of affect and their relation to care through an exploration of belonging and humour in the labs. We show how being a successful scientist or group of researchers involves a careful choreography of affect in relation to materials, colleagues and others to produce scientific results, subjects and workplaces. We end by considering how thinking with care troubles dominant constructions of scientific practice, successful scientific selves and collectives.     

Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Divided self models of the socioeconomic person: the metaeconomics approach

Microeconomics envisions a single decision-maker in a firm or household who is presumed to experience economic relationships only in markets. This theory is largely silent regarding the moral dimension, i.e., the nature of the invisible hand, and how it unconsciously affects the self acting in said markets. Amitai Etzioni, the founder of socioeconomics, offered the vision of the moral dimension as a component of the self. Metaeconomics operationalizes this vision by making explicit the Strict Father moral dimension in the invisible hand and recognizing interdependence of self when Nurturant Parent morality is operant. It builds upon a tripartite, multiple–self concept, with a mediating adult who balances the pleasures with the moral dimension in finding a satisfactory mix of self- and we-interests. By making this dimension explicit, metaeconomics reintegrates ethics and economics, includes values and community, and proposes the starting point for a common analytical engine for all socioeconomists.     

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.     

Defining the challenges of providing long-term care: the case of the nursing home industry's response to the AIDS epidemic

Acquired Immune Deficiency Syndrome (AIDS) is now viewed as a chronic disease requiring long-term management. As a result, more persons with AIDS (PWAs) are seeking long-term care in facilities that have primarily served the elderly. In some regions, however, the nursing home market into which PWAs may introduce new demand is a market already characterized by excess demand. In light of this, competition for limited long-term care resources may develop between the frail elderly and PWAs. The nursing home industry has raised many issues regarding the feasibility of admitting AIDS patients as residents, but little is known about how important these issues are in deciding admissions policy. How the industry perceives and resolves the concerns it has regarding delivery of care to PWAs can affect the overall long-term care system and thus affect the traditional users-the frail elderly. Knowing the concerns and preferences of the industry may help guide and anticipate future changes in the system. In this pilot study, a random sample of 250 nursing home administrators in the five highest AIDS-incidence areas in the United States was surveyed to determine (1) the industry's concerns and issues regarding AIDS care, (2) data regarding requests for admission by PWAs to nursing homes, and (3) data concerning the industry's preferred way of delivering AIDS care. Important admissions policy issues cited by the respondents included the ability to meet special care needs, costs of care, and inadequate reimbursement. The majority also believed the most appropriate methods of providing care were special care units for AIDS within nursing homes or dedicated HIV/AIDS nursing facilities.     

Meeting communication needs: topics of talk in the nursing home

Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.     

Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.     

Ergonomic constraints among nursing workers in the sectors of emergency care in two public hospitals in Brazil

The goal of this study was to comprehensively identify ergonomic constraints among nursing workers in two public hospitals in Brazil. We used a qualitative research design and conducted interviews, field observation and performed a subjective questionnaire with nurses of emergency care sectors. The Cronbach α technique was used to determine the internal consistency of the questionnaire. Based on this qualitative study, we identified some ergonomic constraints related to work environment, biomechanics/anthropometrics, work organization and work station (hospital direction).     

Quality of life in the Fourth Age: exercise experiences of nursing home residents

Life in the Fourth Age has been typified as a time of continued functional decline and reduced quality of life. Exercise might positively affect this experience. This study explored the exercise experiences of nursing home residents age 86-99 years who participated in a 6-month exercise intervention. An interpretive phenomenological approach was adopted. Twenty-one interviews were held with 14 residents at baseline and 7 residents at follow-up. Although their expectations were initially conservative, by the end of the intervention participants noted improved quality of life through better mobility, decreased fear of falling, and feelings of achievement and success. They valued the program as an opportunity to do something for themselves, to add something to their weekly routine, to meet other people, and to be more active generally. The professionalism of the exercise instructor appears to have been critical, balancing principles of safe and effective practice with the need to ensure that participants had fun in a supportive environment.     

Designing home care benefits: the range of options and experience

This article presents a framework identifying important home care benefit design decisions and reviews existing designs that have been adopted in practice. Four basic designs were identified, based on a review of 55 home care benefits drawn from public programs in the United States and foreign countries, and from private long-term care insurance policies in the United States. Three of these designs-service entitlements, managed-service benefits, and cash disability allowances--have each been adopted by public programs in the United States and abroad, and by private insurance policies in the United States. A fourth design--individualized cash benefits--has been adopted in only one experimental program. The designs observed in practice are remarkably varied, providing evidence that many alternative designs are feasible. Experimentation, particularly with cash disability allowances, is needed to determine the relative costs and benefits of various designs.     

Care management and social work: A case study of the role of social work in hospital discharge to residential or nursing home care

The role of social work with vulnerable adults has changed markedly in many countries, including England and Wales following the 1990 NHS and Community Care Act. The basis for this paper is a small qualitative study of the social work role in helping people entering residential or nursing care in the independent sector following an emergency hospital admission in England (Phillips and Waterson 1997). This double transition is an under-researched area (Bywaters 1993; Downs and Crossan 1999). Furthermore, the literature on hospital discharge to date relates to developing policy objectives (Department of Health 1989, 1992, 1994a) or a critique of them (Pearson 1994; Cresswell 1994; Nazarko 1994) or the impact on practice, highlighting issues of inter-disciplinary cooperation (Rachman 1993; Higgins et al. 1994; Davies and Connolly 1995a; Clark et al. 1997; Healey et al. 1999). Until very recently, there has been much less about the users and carers perspective of the effects on the social work role in this area (Hardy et al. 1999; Henton et al. 1999; MacDonald 1999; Chesterman et al. 2001; Hellstrom and Hallberg 2001). The research findings review the core tasks of care management and point to a devaluing of the 'social' dimension, which had previously been the mainstay of hospital social work, and which is precisely what users and carers continue to value. Whilst this paper is written from a UK perspective, and focuses on a small study of an atypical area of work, this finding raises issues of wider interest to those concerned with the health and social care of vulnerable adults in a range of transnational contexts. It raises fundamental questions about the nature of contemporary European social work.     

Nonprofit and for-profit home care in Israel: clients' assessments

Clients' assessments of differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly were studied. No significant differences were found between nonprofit and for-profit providers with respect to organizational efficiency; speed of placement and replacement of home care workers; responsiveness to clients' complaints; and supervision of care plans, schedules, and service delivery. Systematic differences were found, however, in clients' perceptions of workers employed by nonprofit versus for-profit service providers. The differences related to the home care workers' adaptation to clients' needs and wants; how well workers delivered services; and how satisfied clients were with the services received. Indications are that the relatively high efficiency of nonprofit organizations can largely be attributed to the performance of their home care workers.     

Chain reaction: an exploratory study of nursing home bankruptcy in California

This paper reports on an exploratory study of nursing home bankruptcy. From state and industry data regarding nearly 1,000 California facilities, it was possible to identify 155 homes in five chains (multi-facility organizations) that were operating in bankruptcy in 2000. When compared with facilities in non-bankrupt chains, while the bankrupt chain facilities had significantly worse financial liquidity, higher administrative costs, and higher payables to related parties, they also had more Medicare residents, fewer Medicaid residents, better solvency, and were located in less competitive county markets and in areas with higher Medicaid reimbursement rates. These findings indicate that, rather than facility characteristics and local market factors, strategic decisions taken at the corporate (chain) level are the major determinants of nursing facility bankruptcy status.