Mom and Pop Versus the Big Boys: Adult Family Homes as Providers of Medicaid-Funded Residential Care

This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities.     

Determinants of the Rigor of State Protection Policies for Persons With Dementia in Assisted Living

Continued growth in the number of individuals with dementia residing in assisted living (AL) facilities raises concerns about their safety and protection. However, unlike federally regulated nursing facilities, AL facilities are state-regulated and there is a high degree of variation among policies designed to protect persons with dementia. Despite the important role these protection policies have in shaping the quality of life of persons with dementia residing in AL facilities, little is known about their formation. In this research, we examined the adoption of AL protection policies pertaining to staffing, the physical environment, and the use of chemical restraints. For each protection policy type, we modeled policy rigor using an innovative point-in-time approach, incorporating variables associated with state contextual, institutional, political, and external factors. We found that the rate of state AL protection policy adoptions remained steady over the study period, with staffing policies becoming less rigorous over time. Variables reflecting institutional policy making, including legislative professionalism and bureaucratic oversight, were associated with the rigor of state AL dementia protection policies. As we continue to evaluate the mechanisms contributing to the rigor of AL protection policies, it seems that organized advocacy efforts might expand their role in educating state policy makers about the importance of protecting persons with dementia residing in AL facilities and moving to advance appropriate policies.     

Profiles of refugee and non-refugee Palestinians from the West Bank and Gaza

Relying on demographic and labour surveys which the Palestinian Central Bureau of Statistics collected in 1995, this article investigates the profile of West Bank and Gaza refugees. Refugees are better educated and have higher fertility than non-refugee Palestinians, but the difference is small. However, they have a significantly lower participation rate, a higher unemployment rate and a higher incidence of arrests and work stoppage than the corresponding rates among non-refugee Palestinians. A smaller proportion of Palestinians commute to work into the Israeli labour market and refugees earn lower wages than non-refugees. Returns to investment in education are small for both groups. High fertility among refugees imposes a future challenge for policy makers in terms of resources required for the provision of appropriate education and health facilities. Employing future labour market entrants is another serious policy challenge.     

Abuse,neglect and exploitation in assisted living: an examination of long-term care ombudsman complaint data

Long-term care ombudsmen are advocates who empower and assist residents with complaints relating to quality of care and violations of resident rights in assisted living (AL) and skilled nursing facilities (SNF). Given that long-term care residents are vulnerable to elder abuse, neglect and exploitation (ANE), and existing gaps in the literature addressing ANE in AL, more research is needed to understand the prevalence of ANE in these communities. Ombudsman complaint data (n = 140,497 complaints) in 3,171 Texas long-term care facilities were analyzed using proportion Z tests. Findings showed that SNF had higher rates of ANE per resident. For both AL and SNF, verbal/psychological abuse was the most reported type of ANE and sexual abuse was the least reported. AL residents had disproportionately high rates of financial exploitation. We explored factors that may contribute to these findings and recommend strategies for preventing ANE.     

Architectural Space in Respite and Intermediate Care: An Actor-Network Theory Analysis

This article presents an analysis of 2 short-term care facilities using actor-network theory with the aim of revealing performative processes in different networks in the buildings in use. The 2 facilities differed in architectural design, which was expected to influence their care model and organization. One facility was larger and accommodated 4 patients/residents in double rooms as well as permanent residents who stayed in single rooms. The other facility was smaller and accommodated only short-term care patients in single rooms. The study revealed that the latter facility received more care-demanding people than the other. The size and the type of patients/residents influenced the social environment. The larger facility was more busy and lively than the smaller one. However, the analysis did not show any difference in quality of care or ambiance. Both facilities were valued as either good or bad by different residents or staff members. The study concludes that therapeutic values and outcomes are defined and redefined in the ongoing performances of everyday interactions.     

Effective components of interventions in juvenile justice facilities: How to take care of delinquent youths?

Therapeutic interventions support change in delinquent youths rather than rely on surveillance and deterrence. This article describes successful and concrete components for therapeutic interventions in juvenile justice facilities. The effectiveness of remedial measures to best address the sources of youths' delinquent behaviors and the performance of juvenile justice system are discussed first, and then two theoretical frameworks of rehabilitative models are described that are commonly used with delinquent youths. Finally, specific recommendations for enhancing treatment in juvenile justice facilities with regard to the content of interventions, social climate, and youth motivation to engage in treatment are described and explained in a way intended to help caregivers and practitioners, supervisors of juvenile justice facilities, and policy makers improve the daily life of youths placed in this kind of environment.     

Gender differences and equality issues in Europe: critical aspects of gender mainstreaming policies

Gender mainstreaming is the major global strategy for the promotion of gender equality. Clear intergovernmental mandates for gender mainstreaming have been developed for all the major areas of work of the United Nations and the European Commission, including disarmament, poverty reduction, macro-economics, health, education and trade. The evaluation of equal opportunities mainly focuses on qualification measures for unemployed women and improvements in childcare facilities, and on consideration of gender mainstreaming in other policy areas as well as macro-economic effects on employment and unemployment of women. It is evident that the promotion of qualification measures and childcare facilities increases the activity rate of women, although there remain doubts about the quality and sustainability of many measures and the impact on families. In particular this article focuses on the relation between gender mainstreaming and equality issues to examine whether and how the debate on the topic is a real way to improve equality without missing gender differences and women's rights.     

The closer the sportier? Children��s sports activity and their distance to sports facilities

We investigate whether the distance between the next sports facilities and children’s homes matter for their sports activities inside and outside of sports clubs. Our analysis is based on a large and informative cross-section of individual data on children and their families, the so-called German Health Interview and Examination Survey for Children and Adolescents data. We use a semiparametric econometric method to investigate this relationship empirically. Our results suggest that while the distance does not matter in larger towns and cities, it does matter in smaller towns and in particular on the countryside.     

Work-to-Family and Family-to-Work Spillover: The Implications of Childcare Policy and Maximum Work-Hour Legislation

This paper addresses the relationship between individual-level work-to-family and family-to-work spillover and two country-level policy measures: childcare policy and maximum work hour legislation. Coupling Gornick and Meyers?? (Families that work: policies for reconciling parenthood and employment, 2003) policy measures with individual-level data (N?=?7,895) from the 2002 International Social Survey Programme, the authors analyze whether men and women in countries with stronger childcare policies and maximum work-hour legislation exhibit work-to-family and family-to-work spillover. The authors find that neither childcare policy nor maximum work-hour legislation is significantly associated with work-to-family spillover. Stronger childcare policy is associated with lower family-to-work spillover for women, especially for women with young children. Maximum-hour legislation is associated with greater family-to-work spillover for women, with a significantly larger effect for mothers of young children.     

Parental monetary investments in children: A focus on China

In 1979, China began the one child per couple policy throughout the country. In spite of the controversial issues of voluntary participation, the one-child policy has substantially reduced Chinese population growth. How might the policy affect parents' investiment in their children? This article attempts to study paretns' monetary investment in their children in four provinces of China using two-stage least squares procedure based on a survey of 4,000 Chinese children collected in 1990. This study shows that (a) the more children there are in a family, the less the parents invest in each of them; (b) parents seem to treat boys and girls differently; (c) although parents in rural areas invest less in absolute yuan terms, they invest a larger share of their income in their children than do their urban counterparts; (d) the presence of grandparent(s) seems to increase parents' monetary investment in their children; and (e) sibling structure is an important determinant in parents' investment decisions. Last, but not least, it is necessary to use different measures of parents' monetary investment to reveal a more complete and less biased picture of parental investment in children.     

Project scale and private sector environmental decision making: Factors affecting investments in small- and large-scale brownfield projects

The past decade has seen substantial policy effort directed at promoting the reclamation and reuse of urban brownfields or potentially contaminated properties. This paper is based on interviews with developers and lenders involved in redevelopment efforts. Findings indicate that effective policies and programs need to be framed within an understanding of the different needs of smaller and larger redevelopments. While market forces were equally significant inducements for both types of projects, important needs of small developers were not met. Overall, they were less likely to receive government subsidies, had greater difficulty accessing private capital, and lacked information about processes associated with remediation. Developers of large projects were more likely to benefit from public financing and were able to mobilize a network of supportive organizations to help them manage barriers to project completion. Additional findings suggest problems with legal mechanisms intended to promote brownfields cleanup in the course of redevelopment. While lender financing and public involvement of large projects encouraged environmentally responsible behaviors, self-financing of small redevelopments permitted some developers to skirt environmental requirements and avoid cleanup altogether. The paper ends with a discussion of the value of placing greater public emphasis on small projects and offers suggestions for policies to address their needs.     

Young People,Social Exclusion and Inter‐Generational Tension in a Rural Somerset Town

This article seeks to explore how the myth of the ‘rural idyll’ can be detrimental to those who currently experience some of the greatest social exclusion in rural areas — children and young people. The research explores the views and experiences of the young residents of a small town in the south‐west of England (n = 157, ages 12–18 years). The results suggest that rural policy and practice have failed to meet the needs of young people, contributing to their social exclusion in rural communities. Community engagement, facilities and youth consultation are discussed in the context of policy and practice.     

Assessing Performance Budgeting at OMB: The Influence of Politics, Performance, and Program Size

This article investigates the impact of performance, as measuredby the OMB performance budgeting initiative called PerformanceAssessment Rating Tool (PART), on recommendations in the President'sbudget. In a multivariate analysis using data from the FY 2005budget, with appropriate controls for the political contentof programs, we find that the PART scores have a statisticallysignificant impact on budget decisions within OMB. We find thatPART scores have a larger impact on small and medium sized programsthan on large programs. We also find that the "results" componentof PART scores has a smaller impact on budget decisions thanthe "program purpose" component, a finding which tends to contradictthe goal of performance budgeting to redirect resources to programsthat produce results. The relative unimportance of the "results"component may be due to the lack of good outcome measures formost programs in PART.     

How consistent are class size effects?

Thus far researchers have focused on computing average differences in student achievement between smaller and larger classes. In this study, the author focus on the distribution of the small class effects at the school level and compute the inconsistency of the small class effects across schools. The author use data from Project STAR to estimate small class effects for each school on mathematics and reading scores from kindergarten through third grade. Then, all school estimates were combined to calculate an overall weighted average. The results revealed that a large proportion of the school-specific small class effects are positive, while a smaller proportion of the estimates are negative. Although students benefit considerably from being in small classes in many schools, in other schools being in small classes is either not beneficial or is a disadvantage. Small class effects were inconsistent and varied significantly across schools in all grades indicating a small class by school interaction.     

Impact of legislation requiring moped and motorbike riders to wear helmets

In 1992, a package of measures was adopted by the city of Barcelona to obligate riders of motorcycles with a power capacity inferior to 125 cc to use helmets, until then only compulsory for larger motorcycles. Interrupted time series analyses with the use of a control group is used to investigate the effect of these measures on the number of serious injuries and number of deaths. The results indicate a significant decrease in the number of serious cases in the treated group—smaller motorcycles and mopeds—a decrease which does not occur in the control group —larger motorcycles. The impact of the adopted measures is abrupt and permanent but the change in riders helmet wearing habits has not been influenced so much by the media campaign as by the coming into force of the legislation with the potential application of sanctions.     

Impact of regulation and financing on small board-and-care homes in Maryland

States use forms of regulation in small board-and-care homes to control quality; however, quality varies in spite of these efforts. This study of 94 small facilities compared quality of care measures in homes regulated by a state-administered program with those in nonregulated homes. It also compared homes on those variables using average payment for services as the independent variable. Results indicate that higher payments for services had a greater impact on quality than did participation in a regulatory program. Adequate funding may be key to maintaining reasonable quality in these homes.     

Off-farm labour decision of Canadian farm operators: Urbanization effects and rural labour market linkages

Understanding the factors affecting off-farm labour decisions of census-farm operators has significant implications for rural development and farm income support policy. We examine the off-farm labour decisions of Canadian farm operators using micro-level data from the 2001 Census of Agriculture combined with community level data from the 2001 Census of Population. While confirming some of the findings of previous research with respect to the effects of human capital and farm characteristics on off-farm work participation, this study shows the differential impact of those variables for operators of smaller and larger holdings. Family, community and regional characteristics appear more relevant in determining the joint decision to work off-farm and operate a smaller holding, compared to the decision to work off-farm and operate a larger farm. Results suggest that, once other factors are accounted for, proximity to urban centres does not have a positive effect on the joint decisions to participate in off-farm work and to operate a holding. This joint decision, in fact, is more related to the dynamics of the local labour market. A major implication of these findings is that while urban centers might represent an engine of growth for overall rural income through employment opportunities for the non-farm workforce, the non-farm income of farm operators is more likely to be affected by policy initiatives that address directly the dynamics of labour markets in the community where the operator lives.     

Nicotine addiction and substance use disorder treatment: The Philadelphia story

The Philadelphia Department of Behavioral Health and its leadership have a well‐deserved reputation for pioneering recovery‐oriented systems of care. Effective Jan. 1, 2019, the agency initiated an aggressive policy to address the problem of nicotine addiction among those receiving substance use disorder (SUD) services in contracted facilities. The policy covers nine detox facilities, 32 short‐term rehabilitation programs, 31 long‐term rehabilitation programs and eight halfway houses.