Relationship of Facility Characteristics and Presence of an Ombudsman to Missouri Long-Term Care Facility State Inspection Report Results

This study analyzes existing data describing general facility characteristics, the presence of an ombudsman in the facility, and the number of deficiencies/violations reported for long-term care facilities in the state of Missouri. The model that predicted the rate of deficiencies/violations best was one that included the following characteristics: “contained more than 50 beds” and “considered a Skilled Nursing facility.” Findings suggest that the characteristics that are significantly associated with fewer deficiencies are larger size (more than 50 beds) and being classified as Skilled Nursing. While those facilities that housed an ombudsman were found to have fewer deficiencies per bed in the general analysis, further investigation found this to be an artifact mostly due to the higher rate of ombudsmen at larger facilities.     

Nursing home administrators' views of their own and volunteer resident advocates' enhancement of long-term care

Volunteers perform much of the work of federally mandated state ombudsman programs which may include review of resident care in nursing facilities to protect against abuse and neglect. Although volunteers' activities may take place in the nursing facility, Nursing Home Administrators' (NHAs) views of their work are seldom studied. Data from questionnaires completed by 199 NHAs predicted enhancement (improvement) of long-term care by volunteer resident advocates. Administrators also described their advice for improvement of care. NHAs' perceptions of residents' pleasure and families' satisfaction with volunteers' visits were associated with enhancement of long-term care. Effectiveness attributed to volunteers' protection of rights and resolution of complaints was not related to perceived enhancement of long-term care. Answers to a number of remaining questions could enhance the efforts of volunteers in ombudsman programs, improve long-term care, and diminish opportunities for abuse.     

Assessing the efficacy of ombudsman services for the aged in long term care institutions

Long term care ombudsman programs are a recently established component within the gerontological services continuum. Public policy in this area is not yet well defined and there is a conspicuous absence of systematic studies assessing the effectiveness of such program efforts. This research reports on the accomplishments of an urban based, volunteer nursing home ombudsman program. Survey findings show moderate levels of goal attainment in the policy and social relations domains and more promising results in the organizational/managerial sphere. The relationship between perceptions of program success and varying ombudsman role behaviors is underscored.     

Use of court-appointed advocates to assist in permanency planning for minority children

Despite federal law on reuniting children in care with their families, minority children remain in dependency longer and are more likely to be placed in long-term foster care than white children. This article describes a program of volunteer, court-appointed advocates to assist in cases of abuse and neglect involving minority families, and an outcome study. Significantly fewer children were placed in long-term foster care and significantly more children were placed in adoptive families than in a comparison group of families.     

The retirement system in transition: the 2007 Retirement Confidence Survey

WORKERS SLOW TO SEE OR ADAPT TO A CHANGING U.S. RETIREMENT SYSTEM: The 17th annual wave of the Retirement Confidence Survey (RCS) suggests that American workers may be slow to recognize how the U.S. retirement system is changing, and those who are aware of these changes may not be adapting to them in ways that are likely to secure them a comfortable retirement. HALF OF WORKERS LESS CONFIDENT ABOUT PENSION BENEFITS: The RCS finds pension-plan changes by employers have left nearly half of workers less confident about the benefits they will receive from a traditional pension plan, but that those experiencing a decline in retirement benefits often fail to react constructively. Moreover, although Americans will rely increasingly on 401(k) retirement savings plans and other personal savings and investments to fund their retirement security, data suggest that many may not follow professional investment advice when it is offered to them. MANY WORKERS COUNTING ON BENEFITS THAT WON'T BE THERE: Many workers are counting on employer-provided benefits in retirement that are increasingly unavailable. Only 41 percent of workers indicate they or their spouse currently have a defined benefit pension plan, yet 62 percent say they are expecting to receive income from such a plan in retirement. Likewise, workers are as likely to expect as retirees are to receive retiree health insurance through an employer, even though the number of employers offering this benefit to future retirees is declining. MANY WORKERS UNLIKELY TO HEED INVESTMENT ADVICE EVEN IF THEY GET IT: More than half of workers indicate they would be likely to take advantage of professional investment advice offered by companies that manage employer-sponsored retirement plans. However, two-thirds of these workers say they would probably implement only some of the recommendations they receive and 1 in 10 think they would implement none of them. AMERICANS OVERESTIMATE LONG-TERM CARE COVERAGE: One-quarter of workers and more than one-third of retirees report they have long-term care insurance (separate from health insurance, Medicare, and Medicaid) to help pay for care they might need in a nursing home, assisted living facility, or at home. But only 10 percent of Americans age 65 and older are estimated to have had private long-term care insurance in 2002, suggesting that many are counting on coverage they do not actually have. MOST SAVINGS LEVELS ARE MODEST: Almost half of workers saving for retirement report total savings and investments (not including the value of their primary residence or any defined benefit plans) of less than $25,000. The majority of workers who have not put money aside for retirement have little in savings at all: Seven in 10 of these workers say their assets total less than $10,000. CONTINUED IGNORANCE ABOUT SOCIAL SECURITY COVERAGE: Despite the longstanding increase in the eligibility age for Social Security, only a small minority of workers are aware of the age at which they can receive full retirement benefits from Social Security without a reduction for early retirement.     

Perceptions of Financial Well-Being among American Women in Diverse Families

This study investigated the financial well-being of American women using data from a nationwide web survey of 368 women between the ages of 30 and 65 with household incomes of at least $40,000. Specifically, we examined perceptions of financial well-being among women with and without children who lived in different family forms including marriage, cohabitation, stepfamilies, as well as women who were single. The majority of women reported they had conservative buying behaviors, desired financial independence, had a somewhat negative view of their current financial situation, had worries about retirement and their financial futures, and considered long-term care insurance a necessity. Women in nontraditional families (single mothers, cohabitors, and stepfamilies) had significantly greater worries about their financial futures than women in first marriages. Single mothers were less likely to say that they had their financial house in order and were more likely to express concern that their money would not last through retirement. Cohabiting women were significantly more likely to express fears about becoming a burden. All three groups were more likely than women in first marriages to agree that long-term care insurance is a necessity. Women who were older, were more educated, had higher income, and who contributed more money to the household income had more positive perceptions of their financial situation.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

The influence of financial incentives and racial status on the use of post-hospital care

This study examines the influence of financial incentives and the racial status of the patient on the use of extended care following an episode of hospitalization. Post-hospital care (PHC) is defined as the services provided by a skilled nursing facility (SNF) or intermediate care facility (ICF) following discharge. The focus of the analysis is on the use or nonuse of PHC, the presence or absence of a delay in transfer to an ICF or SNF and, limited to those who experienced a postponement, the length of the delayed discharge. After controlling for multiple factors, the results indicate that Medicare beneficiaries were more likely to use PHC, less likely to experience a delay in discharge, and used fewer days of prolonged care. Medicaid recipients and uninsured patients experienced reduced access to PHC. The results also indicated that the access of Native Americans and Americans to PHC was impeded.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Placement stability for children in out-of-home care: a longitudinal analysis

This study examines the number of placement moves experienced over an eight-year period by 5,557 children in one state who first entered out-of-home care between birth and age six. This group comprised 28% of all young children who entered care during this period. Nearly 30% of children in kinship care and 52% of children in nonrelative care experienced placement instability (defined as three or more moves after the first year in care). Children in kinship care, regardless of age, had fewer placement moves than those in nonkinship care. A multivariate analysis found that children who had more than one placement move during their first year of care were more likely to experience placement instability in long-term out-of-home care than if they did not move or were moved only once during their first year in care.     

A Survey of Grass Roots Advocacy Organizations for Nursing Home Residents

The aim of this study was to examine the role that grass roots advocacy organizations play in safeguarding nursing home residents. The article (1) describes citizen groups with respect to functions, structure, permanence, and assessment procedures; (2) examines the relationship between the grass roots groups and the official ombudsman programs; and (3) identifies distinctive models of citizen organizations. The findings suggest that these organizations provide supplemental manpower to the official ombudsman programs by increasing their capacity to carry out their oversight duties, circumventing political roadblocks and overcoming bureaucratic intertia, and improving program performance through their scrutiny, criticism, or presence as an alternative.     

Nearby Nature and Long-Term Care Facility Residents

Abstract

As the population in North America continues to age, long-term care facilities for housing the elderly are likely to become even more important. Because one of the primary foci of these facilities is on sustaining and enhancing quality of life while eventually helping patients and families cope with the dying process, both the physical and social environments are critical to the facilities' success and the users' well-being. Healing, or restorative gardens and other designed green spaces have been suggested by many academics and practitioners as important components of these environments, yet there has been relatively little systematic research on the use and benefits of nature in this context. Do elderly residents of long-term care facilities benefit from access to outdoor areas? What are the design characteristics that are most important for this unique population?

Forty elderly residents of three different urban long-term care facilities were interviewed about the importance of outdoor green spaces and views within the facility, their use of the facility's outdoor spaces, benefits they derive from those spaces, and barriers to using the spaces. Facilities differed both in terms of the amount of nature in their outdoor spaces and in the design of, scale of, and access to those spaces. Results show that overall residents place a high value on access to green spaces and derive a number of benefits from these spaces, yet they spend relatively little time in these settings. Barriers to greater use of outdoor spaces included physical limitations, lack of staff assistance, and design issues. Implications for the value of nature spaces in long-term care facilities are discussed, along with specific design recommendations.     

Client Disclosure of Lesbianism:

Three hundred lesbian women were recruited through a snowball design survey. Discriminant analysis was used to differntiate those who disclosed their sexual orientation to their health care provider from those who did not. Disclosers had a greater number of friends to whom they disclosed, were less likely to currently drink alcoholic beverages, were more likely to have obtained a physical examination in Alaska in the previous five years, were older, and had seen more mental health counselors than nondisclosers. The model accounted for 20.91 percent of the variance in disclosure to health care providers. A majority of the respondents who disclosed (65.32%#37;) reported no perceived difference in health care provided following disclosure of sexual orientation.     

Are baby boomers who care for their older parents planning for their own future long-term care needs?

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

The closing of a social HMO: a case study

A social health maintenance organization (SHMO) integrates acute and long-term care and provides an extended-care benefit for elderly who are at risk of institutionalization. This article reports findings from a case study of the termination of the Group Health SHMO in Minnesota. Interviews were conducted with social workers and at-risk elderly who had been receiving long-term care through the SHMO. The case study examines the post-SHMO transition and the process of replacing SHMO care coordination and longterm care services. Most of the elderly and their caregivers indicated they were "losing ground"--that is, they were paying more or getting less care. Some were paying more for less care. Because they tended to switch to private-pay arrangements and to rely more on informal care, it appears that their care system became much less stable after the closing of the SHMO.     

What Happens to Foster Kids: Educational Experiences of a Random Sample of Foster Care Youth and a Matched Group of Non-Foster Care Youth

Older youth often “age out” of foster care when they reach 18 or 21. Then what happens to them? How do their educational experiences during and after high school compare with children raised in intact families? This study used existing longitudinal data from 1980 through 1986 to investigate the high school and post high school experiences of a group of foster care youth and a matched group of youth living with at least one parent. The results were unequivocal: the foster youth dropped out of high school at a much higher rate and were significantly less likely to have completed a GED. The foster care high school graduates received significantly less financial assistance for education from their parents or guardians. Foster youth reported more discipline problems in school and experienced more educational disruption due to changing schools. They were significantly less likely to be in a college preparatory high school track. The adults in the lives of the foster care youth were less likely to monitor homework. These findings have important implications for child welfare policy and practice.     

The Long-Term Care Ombudsman Program and Complaints of Abuse and Neglect:

This historical summary demonstrates that concern about elder abuse and neglect in long-term care facilities has played a vital role in the development and expansion of the Long-Term Care Ombudsman Program (LTCOP). Some 15 years after the Older Americans Act mandated ombudsman services in all nursing homes, the 1989-1990 state LTCOP reports were analyzed for information about abuse and neglect of elders in nursing homes nationwide. Following a brief review of the nursing home abuse literature, this paper reports on the findings from the 1989-90 reports about complaints of abuse and neglect and their implications for future research.     

Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders’ Views of Policy Implementation

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.