The Quality Indicator Survey: Background,Implementation, and Widespread Change

The Quality Indicator Survey (QIS) is the most comprehensive regulatory change to the nursing home survey process since the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). In this article we describe the policy evolution that led to the QIS, summarize the QIS method and implementation, and profile the QIS survey results. Following over a decade of development, in 2007 the Centers for Medicare and Medicaid Services (CMS) began the national rollout of QIS. The intent was to improve consistency in the nursing home survey and to render the survey process more resident-centered and aligned with the intent of OBRA-87. We reviewed policy reports and firsthand accounts from the lead developer of the QIS methodology and leader of the national training contract for QIS. Changes in survey findings are profiled based on analysis of the publicly available Nursing Home Compare database from 2004 to 2010. Nineteen states implemented the QIS between 2007 and 2010, with nearly 20% of U.S. nursing homes receiving QIS surveys in 2010. Nursing homes surveyed with the QIS received more survey deficiencies on average than in the traditional survey; however, average numbers of deficiencies across states became more similar over the early implementation of QIS, with lower-than-average geographic areas experiencing increases and higher-than-average geographic areas experiencing decreases in survey deficiencies. The explicit and structured questioning of residents in the QIS is associated with increases in deficiencies related to choice, dignity, dental care, and nurse staffing. We describe ways in which the QIS affected the regulatory agencies, providers, and resident communities, although these effects are difficult to quantify. CMS's implementation of QIS is a significant step toward a more resident-centered, comprehensive, and consistent survey process. Substantial changes, however, are required not only among regulators but also among nursing homes. We argue that these new expectations and norms surrounding quality assessment and quality assurance are an important component of achieving culture change in U.S. nursing homes.     

Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts

In recent years, nursing home (NH) researchers have paid increasing attention to socio-economic and racial/ethnic disparities in quality of care. Although there is growing evidence of disparities in resident health outcomes, less is known about the ways in which these differences manifest in care processes from a qualitative perspective. This paper addresses this gap by comparing staff-resident interactions in two urban, non-profit NHs, including roughly 50 staff participants in each facility. The researcher conducted ethnographic observation in one facility serving a white, middle class community and another serving low-income Black and Hispanic clients from an underserved neighborhood. Grounded theory methods generated three categories of interaction—activating, relating, and attending—which were performed differently in the two NHs. In the more affluent facility, staff interacted with residents in a dynamic fashion, adapting to residents’ responses, and they were relatively well equipped with resident-specific information when responding to individual concerns. In the safety-net facility, staff interacted with residents in a one-directional, “didactic” fashion, providing instruction without a mechanism for adapting to residents’ responses, and they were not as well equipped with resident-specific information. These differences reflected disparities between the two facilities in staff communication skills, underscoring the importance of workforce development to enhance the quality of staff-resident interaction and promote resident-centered care. This study raises further questions about the role of neighborhood contexts in shaping organizational processes that influence quality of life for NH residents. Moreover, the study offers a unique contribution to the NH literature by generating a typology of styles of interaction that can be used to develop a conceptual framework for understanding staff-resident interaction in the nursing home. Such a framework can inform efforts to improve residents’ quality of life.     

Commentary: The Physician's Role in Nursing Home Quality of Care: Focus on Restraints

The physician can play an important role in managing high-risk nursing home residents without restraints and working with interdisciplinary care teams in comprehensive fall evaluations. A reduction or elimination of physical restraints can be measured for a facility over time, and it represents a relevant quality indicator of physician and facility interactions during the process of care. We discuss how the physician's role fits into this quality of care equation for nursing homes and its implications for new clinical, research, and policy directions for long-term care.     

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range?=?70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.     

The relocation of nursing home residents: An illustration of the advantages gained by planning a new program and designing an implementation evaluation together

This paper describes a collaboration between an evaluation team and the management and staff responsible for relocating nursing home residents to a new, state-of-the-art facility. Both the relocation plan and the implementation evaluation of this plan are detailed in order to illustrate the link between program planning and evaluation. I argue that combining program planning and implementation evaluation activities is of value to a wide range of organizations contemplating the development and implementation of a new program. Then I draw upon the research utilization literature to discuss how the collaborative relationship between the evaluation team and management contributed to the success of both program planning and program evaluation activities.     

Enhancing the Quality of Care in Residential and Nursing Homes: More than Just a Professional Responsibility

ABSTRACT

This article highlights a range of issues considered essential to improving the quality of care received by older people in residential and nursing home settings. It is argued that improving such care represents a societal as well as a professional responsibility and that remedial action is needed at a number of levels. Five ‘routes’ to achieving quality are outlined, and it is suggested that these are not simply alternatives but that each requires attention if genuine progress is to be made.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

State of public relations education in the United States: 2006 report on a national survey of executives and academics

A survey of 312 public relations executives and educators examined how well practitioners and instructors perceive public relations students to be prepared for the practice, the content and value of public relations curricula and, the future of public relations education in the United States. Results are largely consistent with those from a slightly smaller 1998 survey, suggesting that the views of both groups are consistent over time and providing the first two data points in what it is hoped will develop into a longitudinal line of research addressing public relations education. Judgments regarding the desired characteristics among job applicants and essential curriculum content were extremely similar between the practitioner and educator groups with both wanting more emphasis on research, ethics and strategic planning as the field moves from a low-paid technical emphasis toward a much better paid strategic planning and research emphasis.     

Giving the community a voice: Lessons learned from a comprehensive survey in an urban neighborhood

Weinland Park, an urban neighborhood adjacent to The Ohio State University, has been targeted for revitalization following several decades of disinvestment. The goal of these efforts is to develop holistic solutions that break the cycle of poverty. Such an undertaking requires collecting baseline data to understand community needs, inform programming, and guide revitalization efforts. This paper describes the development and implementation of the Weinland Park Evaluation Project (WPEP) – a collaborative and comprehensive neighborhood survey and needs assessment. Using the RE-AIM framework as a conceptual model, the paper describes how the WPEP was designed to meet short-, medium-, and long-term community needs. In addition, it offers lessons learned as a guide for researchers designing neighborhood surveys and conducting community assessments. An Appendix A includes indicators measured via the survey tool.     

Demystifying the use of mail survey in developing countries: a case of Nepal

ABSTRACT

The mail survey is a popular data collection tool in developed countries, but little is known about its use and efficacy in developing countries. Grounded on social exchange and diffusion of innovations theories, this study sought to ascertain whether the mail survey works in Nepal – one of the developing countries, by looking at how long respondents take to respond to mail surveys, and what the determinants are of the response time. A mail survey was conducted in June–September 2012 among 863 village animal health workers. Analysis of the data derived from 500 usable surveys shows that if properly planned and executed, the mail survey will perfectly work in developing countries as well. However, response period greatly varied by respondent’s home region, program sponsor, income groups, but not by gender, age, and education. The paper concludes by outlining suggestions to improve the mail survey.     

Sense of home in a transnational social space: New Zealanders in London

In this article, I explore the ways in which ‘middling’ migrant New Zealanders living in London and New Zealand discuss and identify with home. For these multi‐local individuals, the discursive and material aspects of New Zealand as home form a framework for their everyday life as migrants living in London. Interpretation of the interviews using thematic and narrative analyses works through a conceptualization of home, migration, and identity as interdependent, through three interrelated themes: the symbolic or political nature of home; the importance of family and familiarity for a sense of home; and the role of physical material objects and places. Participants in this study see New Zealand as their home, yet by being away from home they gain new perspectives on home. In London, they engage with or resist a collective imaginary of New Zealand as home that is both self‐perpetuated and externally imposed, and which both reveals and conceals ideas about individual and group identity and community. On returning from London, the idealistic and sometimes simplistic visions of New Zealand as home that structure their lives in London are often disrupted by the more complex yet more mundane version of home and self with which they are confronted.     

The influence of donors on cross class social movements: same sex marriage and trans rights campaigns in New York State

ABSTRACT

New York State’s largest gay rights organization, the Empire State Pride Agenda (ESPA), won significant legislative victories, including the legalization of same sex marriage in 2011. Yet ESPA was never able to mount comparable efforts for its long-standing commitment to transgender rights before disbanding in 2015, despite the fact that marriage equality was less widely supported than transgender rights in ESPA’s own public opinion polling. In-depth interviews reveal that ESPA was constrained by the class and personal interests of its affluent major donors, mainly high-income gay white men. The organization’s abrupt closure provided an unusual opportunity to research the often secret topic of major donor influence, as frustrated former staff were willing to be frank in interviews. ESPA was only able to successfully campaign on issues that were especially compelling for these donors, and was forced to close when its legislative agenda diverged from their interests. This case suggests class interests and access to resources shape the causal impact of collective identities on social movement dynamics.     

Scale direction effects in agree/disagree and item-specific questions: a comparison of question formats

The effect of the response scale direction on response behavior is a well-known phenomenon in survey research. While there are several approaches to explaining how such response order effects occur, the literature reports mixed evidence. Furthermore, different question formats seem to vary in their susceptibility to these effects. We therefore investigate the occurrence of response order effects in Agree/Disagree (A/D) and Item-Specific (IS) questions. We conducted an experiment among n = 930 students in which we varied the scale direction (decremental vs. incremental) within A/D and IS questions and asked respondents to evaluate the questionnaires. The results reveal response order effects within the A/D but not within the IS question format. Furthermore, respondent’s evaluations suggest that completion of the IS questionnaires requires more consideration than the completion of the A/D questionnaires. Altogether, our findings indicate that IS questions are more robust against response order effects than A/D questions.     

Money management and views of civil partnership in same‐sex couples: results from a UK survey of non‐heterosexuals

Recent legislation in the UK has extended many of the legal and financial rights and responsibilities of heterosexual marriage to same‐sex couples who register their partnerships. Prior to the Civil Partnership Act (2004) however, little was known about financial arrangements in same‐sex couples, nor the extent to which these mirrored those of married or cohabiting heterosexuals. This paper reports the findings from the first large‐scale survey in the UK to investigate finances and civil partnership beliefs in a convenience sample of non‐heterosexuals: 510 individuals, of whom 386 were currently in a same‐sex relationship, participated in the survey. Our findings showed less merging of finances (such as in pooling, allowance, and whole wage systems) than is typical in heterosexual married couples. The results of a series of multinomial logistic regression analyses showed that rating CP as more important, and having both names on the mortgage, significantly reduced the odds of independent (ie, separate) management of finances. Participants were almost unanimous in their endorsement of CP as a form of legal recognition, with a large majority saying that they would also consider it for themselves.     

Patterns of organisational innovation: comparison of western and eastern countries in Europe

West European (WE) countries perform better in innovation than their counterparts in Central and Eastern Europe (CEE). In this paper organisational innovation (OI) patterns in CEE compared to WE are studied. The paper exploits the Community Innovation Survey 2008, 2010 and 2012 and uses this firm-level innovation data from 12 countries. The authors introduce a novel approach, which elucidates seven types of OI patterns based on an intensity of firms’ engagement in OI. According to this notation most companies in WE were found to be complex internal innovators or complex innovators. In CEE, the largest share of companies in this period were exclusively work management-oriented. This picture remains the same throughout the three waves of the survey. The differences in OI can largely be explained through the differences in the background variables of the companies or through other innovation types, so if CEE and WE companies converge in these terms, much of the difference in OI also disappears. Nevertheless, there is also a part of the divergence which can be related to the societal level through path dependent developments in these countries.     

The potential for international and transnational public service advertising in public spaces in American and Chinese global cities: Conclusions from a 2010 survey of advertisements in subways in Beijing,New York,Shanghai and Washington,DC

Can we construct transnational or international public service advertising to counterbalance the proliferation of transnational commercial advertising? As an important first step in exploring the possibility of such an application of shared media public diplomacy among nations, this paper describes a complete survey of commercial and public service advertisements collected from the public spaces of subway systems in American and Chinese cities in 2010 – New York, Washington, DC, Shanghai and Beijing – to reveal the range of themes of commercial and public service ads in these spaces. The study reveals first that analogous commercial and public service ads are ubiquitous in the public spaces of both Chinese and American cities. Second, many of the themes that might appear in international or transnational public service ads are already being portrayed in ads created by local or national governments or NGOs, although these themes are portrayed in ads created by different sets of actors in China and in the US: government actors and a few international NGOs in Chinese cities, and governments, corporations and non-profit organizations in the case of American cities. Finally, the survey reveals that in all four cities there are many commercial advertisements that appeal to the identity of a transnational consumer, but that there are almost no public service ads that appeal to the identity of a transnational citizen: merely local or national ones who can solve such public problems as global warming, education, and health issues.     

Landing in a rural village: home and belonging from the perspectives of unaccompanied young refugees

This article explores how unaccompanied young refugees living in a rural village in Sweden make sense of home and belonging. From a post-structuralist approach, belonging and home are understood as ongoing processes that are negotiated with others, and via processes of othering and racialisation. This article demonstrates that the form of housing available, together with experiences of social exclusion in the village, may contribute to othering and thus challenge their feelings of home and belonging. However, they do construct some kinds of belonging and feelings of home based on social relationships and places that they have access to.