Sexual abuse of nursing home residents

1. A new subgroup of rape victims resides in nursing homes. 2. Nursing home victims can suffer both compounded and silent rape trauma. 3. Innovative therapies are needed for treating elder rape trauma.     

Cross-state variation in conceptions of quality of nursing facility long-term care for the elderly

We address two issues in this exploratory study. First, to what degree do variables prominent in explaining cross-state variation in the generosity of other public assistance programs also help to explain the resources states devote to nursing facility long-term care for the elderly, a service supported largely by states' Medicaid programs? Second, to what degree do the resources that states commit to this purpose influence the quality of state nursing facility processes and, in turn, translate into state nursing facility residents' quality-of-life outcomes? We find unusual features to the pattern of factors explaining state resource levels. We also find surprises in relations among the three aspects of quality, but overall, raising resource adequacy improves nursing facility process quality, which, in turn, bolsters nursing facility residents' quality-of-life outcomes. We close with suggestions for further improvement.     

Mental disorders among non-elderly nursing home residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

The impact of the social environment on nursing home residents

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.     

Developing and testing a satisfaction survey for nursing home residents: the Ohio Experience

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data--a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.     

Courtesy Stigma and the ADA

Abstract

A seldom-discussed element of the Americans with Disabilities Act (ADA) of 1990 provides a degree of employment protection to the relatives and close associates of persons with disabilities, if these relatives or associates have been subject to adverse employment action because of this relationship. This paper describes this “third-party discrimination,” and analyzes important court cases related to it.     

Sources of stress reported by daughters of nursing home residents

The accounts of 31 daughters (M = 48.2 years) who had a parent living in a nursing home were examined. Data from 7 focus group discussions that explored the stressful experiences daughters encountered in providing care to their parents were content-analyzed. Eight major stressor themes were identified: sense of responsibility, losses, role change, conflicting perceptions of parent's ability, realization of own vulnerabilities, facing the unknown, lack of family support, and lack of appropriate facility care. The results shed light on the kinds of stressors these daughters faced and point to the influence that prior family and caregiving histories may have on the daughters' present experience.     

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.     

Identifying the barriers and challenges to voting by residents in nursing homes and assisted living settings

To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29%+/-28, range 0-100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems. Nearly two-thirds of facilities indicated they assessed residents' voting capacity before the election. However, methods differed and may have disenfranchised residents who were actually competent to vote. Current procedures in many facilities fail to protect voting rights. These data suggest that rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' rights and reasonable accommodations.     

Using group process to educate staff and manage aggressive behavior of nursing home residents

1. Group process can be an effective tool to cope with aggressive behaviors of nursing home residents. 2. Staff education in and commitment to group process are essential. 3. Peer pressure, therapeutic confrontation, and a supportive environment empower residents and staff to cope constructively with negative behaviors.     

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.     

Relatedness,autonomy, and competence in the caring relationship: The perspective of nursing home residents

Based on self-determination theory and person-environment congruence models, this study investigated the importance and experiences of relatedness, autonomy, and competence in the caring relationship from the perspective of residents of somatic nursing homes. Furthermore, discrepancies between the attached importance and the fulfillment of these three needs, as well as the role of resident age, health and cognition were explored.Structured questionnaires and semi-structured interview questions were used with 75 recently admitted somatic nursing home residents. The results show that relatedness was considered as more important than autonomy and competence, on average, but there also was large variation between residents in the importance attached to these three needs (n = 75). A subgroup that was asked about relatedness, autonomy, and competence in the caring relationship (n = 35) experienced rather high fulfillment of these needs, although the semi-structured interview questions revealed more nuances. In addition, discrepancies existed between the importance and the fulfillment of the needs for a considerable group of residents in this subgroup. Subjective health and cognitive functioning were correlated with the evaluation of relatedness, autonomy, and competence in the caring relationship.It is concluded that, in nursing homes, the focus should be on the match between individual preferences and actual support of relatedness, autonomy, and competence.This involves asking residents for personal preferences and facilitating caregivers in taking these into account during daily caregiving.     

An overview of the national EEOC ADA research project

The authors outline the development and scope of the National EEOC ADA Research Project which resulted from a cooperative agreement between the Equal Employment Opportunity Commission and Virginia Commonwealth University. Research questions, the EEOC database, extraction of study data, limitations of the data, the organization of research teams, and the contents of this special issue of WORK are described.     

Workplace discrimination and disfigurement: the national EEOC ADA research project

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with disfigurement is documented. Key dimensions of workplace discrimination involving Americans with disfigurement and persons with missing limbs are compared and contrasted. Specifically, the researchers examine demographic characteristics of Charging Parties; the industry designation, location and size of Respondents/employers; the discrimination Issue (i.e., type of adverse action) alleged to occur; and the legal outcome or Resolution of these allegations. Charging Parties with disfigurement who are female or between 30 and 39 years of age are more likely to encounter employment discrimination than their counterparts with missing limbs. Harassment and Non-wage Benefits are the Issues that emerge in higher proportion. Allegations derived from persons with disfigurement are more common in among mid-size employers, those located in the South, or those in Retail or Service industries. Following investigation, allegations derived from persons with disfigurement are less likely to have Merit Resolutions than those brought by Charging Parties with missing limbs.     

'We Won't Go Back': the ADA on the grass roots level

The Americans with Disabilities Act (ADA) is a civil rights statute protecting people from discrimination based on a disability in both the private and the public sectors. Using interviews with grass roots persons with disabilities across the USA-many of whom are experienced activists-and using other sources this article describes the reaction of the disability community in the United States to the passage of the ADA and its impact. Largely people with disabilities feel empowered by the ADA. However, a strong amount of cynicism is also found at the grass roots level regarding it. A revealing example of the empowerment felt by people with disabilities is the conflict in New York City over a proposal for non-accessible public toilets. Other reactions and developments are discussed including the possibility of the repeal or weakening of the ADA. A fundamental change occurred in the US with the passage of the ADA and the disability community will not allow that change to be undone.