Weighing the relevant issues: obesity in nursing homes

The obesity epidemic has touched all segments of society and every health care sector including the nursing home industry. Understanding the issues related to the care of obese nursing home residents is important in light of this epidemic. Such issues include the difficulties related to access to nursing homes, the structural preparedness of nursing homes to care for obese patients, and the potential for staff injuries. Policies regarding strategies to improve nursing home access for obese patients, mitigate disparities in quality of care and health outcomes owing to obesity, and better prepare for the growing obesity epidemic are needed.     

应对老龄化挑战探索“护理院”发展

上海在20世纪70年代就进入了老龄化社会，这对上海市域社会的发展带来了严峻挑战，大力发展老年护理事业迫在眉睫。对目前上海老年护理院的现状进行调研发现，上海在发展老年护理院方面存在若干瓶颈问题。通过对问题的形成原因加以剖析，并借鉴发达国家的有益经验，提出发展上海老年护理院的具体政策建议。     

The Effect of Care Setting on Elder Abuse: Results from a Michigan Survey

This study compares abuse rates for elders age 60 and older in three care settings: nursing home, paid home care, and assisted living. The results are based on a 2005 random-digit dial survey of relatives of, or those responsible for, a person in long-term care. Nursing homes have the highest rates of all types of abuse, although paid home care has a relatively high rate of verbal abuse and assisted living has an unexpected high rate of neglect. Even when adjusting for health conditions, care setting is a significant factor in both caretaking and neglect abuses. Moving from paid home care to nursing homes is shown to more than triple the odds of neglect. Furthermore, when computing abuse rates by care setting for persons with specified health conditions, nursing homes no longer have the highest abuse rates.     

Recent developments in institutional elder care in China: changing concepts and attitudes

This study examines recent developments in institutional care for Chinese elders and attitudinal changes toward institutional care in Tianjin, China. Based on studies in 12 elder home sites and survey interviews with 265 older residents, this study compares institutional differences between government and non-government-owned elder homes, and examines elders' evaluations of elder homes' quality and their level of willingness to stay in elder homes. Findings suggest that government-owned elder homes still enjoy institutional and bureaucratic privileges in funding, staffing, and insurance. Elders' overall evaluation of elder home quality was high. Elders' former living arrangement and financial ability were related to their willingness to stay in the elder home. The unfair competition between governmental and non-governmental elder homes is likely to hinder the development of elder home industry in the free-market system and foster a growing gap between the rich and poor elders in their capability and decisions in elder home care. As adult children become increasingly unavailable due to the one-child policy and geographic mobility, institutional care for aging parents is likely to become one of the major options for parent care.     

“It’s a Dignity Thing”: Nursing Home Care Workers’ Use of Emotions1

This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions—sometimes in ways consistent with organizational demands, and sometimes not—and they consistently found in their emotions a resource to manage the strains of their work lives.     

“When You First Get There,You Wear Red”: Youth Perceptions of Point and Level Systems in Group Home Care

Child welfare involved youth are frequently referred to group home care. One common intervention utilized in group home care is behavior management systems. This intervention is operationalized as points, token economies, and level systems. Grounded in social learning and behavioral theories, the objective is to reinforce-pro-social behaviors and to provide mild negative consequences for undesirable behaviors. However, little is known about how child-welfare involved youth perceive these kinds of interventions and whether they believe them to be effective. Focus groups were conducted with 40 young adults known to independent living services and formerly in group home placement. The qualitative findings reveal that while youth felt structure was needed, how it was operationalized in group homes was restrictive, non-normative, and non-individualized. Implications for social work practice and further research using an attachment perspective are discussed.     

Old-age homes and services: old and new approaches to aged care

Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.     

Assessing results of the Alameda project

This note assesses the Alameda Project, a successful experiment conducted in California and designed to restore foster children to their home or to provide alternative continuous care. The study is examined critically against research which indicates that the majority of foster children come from economically disadvantaged homes and that restoration to homes in which the environmental conditions are not adequately improved often results in the recurrence of problems or the development of new problems.     

Culture Change in Skilled Nursing: An Exploratory Comparison of a Traditional Home to a New Model

Abstract

The culture change movement has pushed for reform for more than two decades to align policy, the long-term care industry, and resident preferences with regard to care. Evidence from research indicates that culture change has the potential to improve quality in nursing homes. There is no one-size-fits-all way to implement culture change; however, there are key elements and associated concepts and models. A common thread is that they run counter to the medical model, typically found in nursing homes, where care is provided in a hospital-like setting according to the schedules and routines of physicians and staff with little resident input. This qualitative study looks for evidence of culture change in a traditional model of care compared to a newer culture change model, by describing the differences in practices associated with the medical model, person-centered care, and person-directed care between the two settings. Our results indicate that there is evidence of person-directed care in one model of culture change—the Green House home—but not in the traditional nursing home. Future studies should examine other culture change models to compare the differences in the utilization of person-directed care. This information will help to clarify the definitions and concepts of culture change, along with developing best practices for future culture change models.     

Developing Public Information on Nursing Home Quality

The need for greater public information about nursing home quality is growing. While there are problems in using existing administrative data on nursing home quality from federal certification surveys, it is probably more feasible to use such data than to conduct direct surveys of residents and their family members and friends. Administrative records could be used to provide greater information on quality than is currently reported by the Health Care Financing Administration. These records could also be used to develop a rating system for nursing homes based upon key quality indicators and administrative sanctions. This challenge is one that should be undertaken to ensure greater access to information on quality of care in nursing homes and to stimulate efforts by nursing homes to improve quality.     

Developing public information on nursing home quality

The need for greater public information about nursing home quality is growing. While there are problems in using existing administrative data on nursing home quality from federal certification surveys, it is probably more feasible to use such data than to conduct direct surveys of residents and their family members and friends. Administrative records could be used to provide greater information on quality than is currently reported by the Health Care Financing Administration. These records could also be used to develop a rating system for nursing homes based upon key quality indicators and administrative sanctions. This challenge is one that should be undertaken to ensure greater access to information on quality of care in nursing homes and to stimulate efforts by nursing homes to improve quality.     

Conflicts and contestations. Rural populations’ perspectives on the second homes phenomenon

In response to demands to restructure and diversify their economies, many rural communities have welcomed the expanding phenomenon of second homes. However, while the second home owners bring new resources to the host communities, the literature also suggests that large second home populations in rural communities provide fertile ground for a number of economic, social and cultural conflicts and contestations. The present paper analyses the views of the local rural populations on the second home phenomenon, with particular attention to variation in these views, both within and between the rural communities (municipalities). The analysis uses material from the survey City, countryside, second homes 2008, which was conducted among a large-scale and representative sample of the population in Norwegian rural second home municipalities. The first section of the paper addresses the rural populations’ stance towards the second home phenomenon, both in general and as it unfolds in their own vicinity. Results show generally positive views on second home development; however, the analysis identifies a substantial minority which is negative to the second home expansion. Nevertheless, the second section shows that even those rurals who are negative towards further developments of second homes largely report harmonious social relationships with the second home population that is already present. Third, the paper presents and discusses a multivariate logistic regression model to analyse how different segments of the rural population vary in their views on second home phenomena. Here, results suggest differences at both micro and macro levels: the local rural elites, in particular those with direct economic interests in the second home sector, are most positive towards further development. On the municipality level, resistance towards second homes is stronger in municipalities with a high density of second homes. Nevertheless, a high growth rate in the number of second homes, due to high investments, seems to increase local support.     

Women Caring for Our Aging in Place Seniors Will Lose Out because of U.S. Immigration Policies

Most older people experiencing chronic health problems, physical disabilities, and memory losses are still able to age in place in their own homes. However, they often need help from others to enjoy healthy, active, and independent lives. They turn mostly to family members, mainly women and usually their daughters, daughters-in-law or wives. But caring for frail elders has become more demanding and complex, and these family members often feel physically and emotionally overwhelmed and burnt out. They concede that they cannot do it alone. Others find it more difficult to hold full-or even part-time jobs. Hiring home (direct) care workers to assist their loved ones can be an effective solution to ease their caregiving responsibilities. However, these personal care aides, home health aides, and nursing assistants are already in short supply. Moreover, going forward the aging of the baby boomer population will result in an even greater demand for their services even as these jobs are often unattractive to American-born workers and turnover is high. This country’s immigration policies will make it even more difficult for women caring for older persons to hire these workers. Over 25 percent of home care workers are low-skilled immigrants or foreign-born. However, the Trump administration’s policies reduce the number of immigrants entering the U.S. and specifically choke off the various pathways that enable low-skilled persons to be hirable in the home care sector. Female caregivers seeking relief from their caregiving responsibilities will lose out unless we remove these immigration barriers.     

Communes of elderly people: Between independence and colonization

While it is generally assumed that elderly people want to live alone, at least as long as they are physically able, this is not always the case. Not only has the rapid growth of communes of elderly people in the Netherlands attracted international attention, it has also become a social policy issue. The government and institutional care providers tend to see them as informal homes for the aged, whereas the elderly who are involved in this see the communes as positive alternatives to traditional ideas on aging. In a theoretical interpretation it is shown that both the communes and the different reactions to them represent in a nutshell important developments concerning aging and the position of the aged in Western society, as well as major trends in the modernization process.     

Aging in Place at Home Through Environmental Support of Physical Activity: An Interdisciplinary Conceptual Framework and Analysis

This article presents a conceptual framework to link issues of health, services, physical activity, and environment to help older adults age in place in their own homes, which may reduce the demands on society to provide institutional long-term care. Using environments to promote physical activity has received attention by researchers, but its impact on aging-in-place at home has been largely ignored. This article interprets and synthesizes existing studies on aging-in-place in relation to health and services, contributions of physical activity to health and service accessibility, and environmental support of physical activity. The conceptual framework can serve as the core construct to address gaps in previous research and as a tool to refine practical targets for policies and interventions aimed at promoting healthy aging.     

Transfer of learning: concept and process

This article will present findings from a doctoral study exploring the impact of 'SVQ Care: Promoting Independence (level III)' within children's homes. The study focuses on the extent to which SVQs enhance practice and their function within a 'learning society'. A total of 30 staff were selected from seven children's homes in two different local authority social work departments in Scotland. Each member of staff was interviewed on four separate occasions over a period of 9 months. Interviews were structured using a combination of repertory grids and questions. Particular focus was given to the assessment process, the extent to which SVQs enhance practice and the learning experiences of staff. The findings suggest that there are considerable deficiencies both in terms of the SVQ format and the way in which children's homes are structured for the assessment of competence. Rather than address the history of failure within residential care, it appears that SVQs have enabled the status quo to be maintained whilst creating an 'illusion' of change within a learning society.     

Nursing home ownership: an historical analysis

The need to care for dependent elderly in the United States has been a constant since colonial times. Today, as in the earliest days, most care is provided at home by family members. Personal and health services outside the home are sometimes provided by nursing homes. The nursing home industry is large, dominated by private, for-profit ownership, and receives much of its income from public funds. Why are nursing homes publicly funded? Why are nursing homes privately rather than publicly owned? Why is ownership for-profit or proprietary rather than not-for-profit or voluntary? The answers to these questions are found in the history of social policies in the United States.     

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.     

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.