A Typology of Source of Information About the Continuing Care Retirement Community and Older Adults’ Living Arrangement

Abstract

A continuing care retirement community (CCRC) represents a residential alternative for older adults. It offers a variety of social and health care services to meet older adults’ needs and preferences. Using the theory of innovation as a theoretical basis, the overall goal of the study was to use the source of information about the CCRC as a potential predictor of the decision to move. In total, 76 older adults responded to a question about the source of information on the CCRC. Of these, 40 were CCRC residents and 36 were community dwellers, who expressed an interest in the CCRC but decided to remain in their community. Based on their responses, respondents were classified into one of five clusters (e.g., spouse, friends, children, nonhuman sources, mixed human and nonhuman sources). Those classified into the spouse or adult children as sources of information were more likely to live in a CCRC. Results show that information about the CCRC should be conveyed to additional members in the family, such as adult children, as they often take a major role in the decision to relocated. The findings have implications for administrators as they clearly point to potential sources of greater influence on older adults’ decision to relocate.     

A survey of mental health district structure and effectiveness

A national survey using a mailed questionnaire was undertaken to clarify issues of mental health district governance. CMHC, state hospital and district management and governance staff from 49 identified districts classified their districts on 20 types of decision authority and 14 measures of district effectiveness. Each respondent type thought their districts: (1) dealt with state money issues, seeking regional money, and coordinating/changing programs and services, and (2) effectively enhanced planning capabilities. Service providers did not find planning capabilities to be systematically related to specific decision authorities. CMHC management perceived less district control than district officials and, with state hospital management, perceived less effectiveness. District and CMHC officials see a direct relationship between district control and effectiveness. In a subsample of 11 districts each described by multiple respondent types, no item of authority or effectiveness was rated universally positive by all groups. District management subjectivity and legislative implications are discussed.     

Social work students’ professional and personal exposure to social work: an Australian experience

General career research suggests that many factors may influence how people select a career, including information about or exposure to the career. The focus of this paper is upon how exposure to a social worker personally (e.g. friend or family) or in a therapeutic capacity (e.g. received social work therapy) may influence the decision to become a social worker, when compared to other disciplines. The results showed that 63% of 64 social work students had personal and/or professional exposure to social work prior to making a career decision. When compared to other students (n?=?447) the social work students were significantly more likely to have accessed social work services (themselves or a family member). The influence of a friend who was a social worker and working with a social worker was noteworthy for mature-aged students. These results highlight that every interaction social workers have with the community provides valuable information about the profession and gives insight into social work as a career. Additionally, the results suggest that the increase in numbers of social workers and the influence of that exposure to a social worker have resulted in an increase in the use of social work services by students, and may continue to rise in the future.     

Evaluation in a down-loaded mental health system.

Speculation that policy and funding shifts in the nation's mental health system would negatively impact program evaluation services in community mental health centers (CMHC) is substantiated. Performance of program evaluation activities was investigated in 71 CMHCs in 15 states over a two-year period. Twenty-five percent of the centers reported cutbacks, including staff attrition and diminished funding devoted to evaluation functions. The majority of centers reported no changes, but many directors representing these centers also indicated that they had never fully developed a capacity for performing evaluations and would cease to devote attention to these activities without available funding. In some centers evaluation functions are being transferred to clinical administrators; integrated into quality assurance activities; performed "as needed' by external consultants; or ignored altogether. Many centers are developing or enhancing a computerized information system to improve internal efficiency and to meet state accountability requirements. The professional issues raised to these trends as well as their implications for federal and state policy are discussed.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Measuring the quality of health care

This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making and practice styles are being monitored by purchasers as new health care delivery systems are being formed. The American Medical Association found that 39 percent of surveyed physicians were subject to clinical profiling.     

The development and field testing of a vocational education evaluation model

Reported is the development and field testing of an evaluation model used to evaluate the vocational education programs at the Metropolitan Community Colleges (MCC) of Kansas City, Missouri which can be implemented on vocational programs at other institutions. The model evaluated a vocational program on the following six criteria: (1) program's relationship to job market profile; (2) program's level of community support; (3) program's success in meeting vocational aspirations of clientele; (4) program's success in terms of student performance; (5) program 's cost-effectiveness; and (6) program 's success in reaching the handicapped and disadvantaged. The evaluation model provides a strategy and a set of procedures for assessing the quality of existing vocational education programs of study at any post-secondary institution. The model can be easily and inexpensively implemented, thus providing a data base which is useful for administrative planning and decision making.     

The effects of conflict,quality, and time on small group information use and behavior in evaluative decision making situations

Graduate students simulated school board members making decisions about educational programs. Situation contexts within the program evaluation reports were varied by conflict (high, low), quality (high, low), and time (long, short). Analyses of Variance (ANOVA) of the qualitative measures m the 2 × 2 × 2 factorial design indicated significant results at the .01 level. The quality of decisions affect support for program continuation. Interactions of conflict and quality affected need for more information and more time in decision making. A conflict and time interaction affected preference to talk to other board members. Changes in situational contexts affected information need and use in small, decision making groups.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Training Needs of Administrators in the Nonprofit Sector: What Are They and How Should We Address Them?

In increasing numbers, academic programs across the country are exploring how they can best meet the needs of nonprofit organizations. To better support the debate and decision‐making processes of such programs, the author contributes information on training drawn from nearly six hundred nonprofit administrators, exploring variables that may influence the needs and examining the format for training most desired by those administrators.     

Synthesizing the interests of consumers, citizens, and administrators in gathering client feedback

In a large metropolitan county's mental health system program evaluators involved consumer representatives, advisory board, and administrators in a client feedback study. The evaluators presented the groups with a “menu” of possible questions, and members of each group selected items where it would be particularly useful to know the opinions of clients. The groups did not agree about the kinds of questions that were desirable. The evaluators created a survey instrument that included high-priority items from each group. The survey was completed by 205 outpatients in three sites. Clients expressed a nearunanimous opinion about some questions, while on other issues there was no client consensus. In human service systems where decision making is shared by people with potentially conflicting interests, the authors recommend polling groups of decision-makers and then uniting their interests in a study of client feedback.     

Worum geht es, wenn es um nichts geht?

Rational choice theories appear to have difficulties when it comes to explain behaviour in so called ‘low cost, low benefit’ situations. As a consequence, low cost situations are sometimes regarded as a serious problem of the rational choice paradigm as a whole. We demonstrate that, quite to the contrary, theories of rational action are perfectly well suited to understand the logic of low cost situations. The costs of information and decision making on the part of the actor and the clarity of incentive or cost structures on the part of the situation prove to be the central variables. Since there is a close link between low cost situations and certain collective good problems, the role of these variables is discussed with regard to the production of collective goods. In adapting an established model of routine based decision making, we show how the threshold of a low cost situation can be determined analytically.     

Oral health in long-term care: The implications of organizational culture

When an investigation designed to compare extant models of delivering oral health and dental services to the institutionalized elderly revealed that structural variables explained very little of the difference between effective and ineffective programs, secondary analytic techniques were employed to consider alternative explanations. The original study was a program evaluation based on a comparative case study of 12 long-term care (LTC) facilities. Data for each case included interviews with administrators, care providers, family members, and residents, administrative documentation, and clinical measures of oral health from the residents. The secondary analysis revealed the mechanisms through which the organizational context of each facility influenced the effectiveness of the oral health services. In addition, it revealed how administrative and leadership issues influenced the quality of care.     

Influences on registered nurses' decision‐making in cases of suspected child abuse

This paper reports on the factors influencing decision‐making for a group of 10 South Australian community nurses in cases of suspected child abuse. Each nurse participated in a structured interview. The data were organized into themes, using the computer program NUD*IST. Factors having an impact on the nurses' decisions to report included: the type of suspected abuse, making moral judgements and decision‐making, the consequences of reporting, and the impact versus the outcomes of reporting. Most significantly, the community nurses based many of their decisions on their estimation of the kind of intervention likely to be undertaken by children's protection services. Copyright © 2002 John Wiley & Sons, Ltd.     

Collaboration for community-based wildlife management

Perhaps as remarkable as the general upsurge in public interest in wildlife over the last 30 years is the trend toward greater community-based wildlife management since the late 1980s. This paper discusses the challenges and opportunities at the local, community scale of collaboration for wildlife management. We explain how collaborative activity between the professional wildlife manager and community stakeholders can lead to improved identification of human-wildlife interactions and better understanding of wildlife-related impacts that are of primary management concern in the community. Community-based collaborative decision making can also effectively result in the specification of management actions that are acceptable to a community. Furthermore, agency-community collaboration can lead to co-management that goes beyond stakeholder input or involvement in decision making about management objectives and actions, and includes appropriate sharing of responsibility for implementation and evaluation. A growing role for the wildlife agency in such situations is facilitating the development of local capacity by filling information and process needs so that individuals and groups in a community can participate effectively in collaborative efforts appropriate to the necessary level of agency-community engagement. This opportunity for the wildlife profession promises to be rewarding and have lasting positive influence on communities for the benefit of wildlife management. However, most agencies cannot address every issue at a community level. Public wildlife managers need guidelines for judgment about when to engage in community-based wildlife management. They need to assess various risks associated with not engaging in a particular issue and to prioritize the potential situations where various degrees of community engagement may be desirable. This paper highlights these intriguing challenges and opportunities associated with community-based wildlife management. An erratum to this article is available at .     

Demographic and Organizational Variables That Affect Southeastern College and University Student Health Promotion

Abstract

This study examined the relationship between demographic and organizational variables and college student health promotion efforts. Two hundred and forty-one college administrators from 14 southern states were surveyed to determine factors that may affect college student health promotion programming. Enrollment, tuition, affiliation, and highest degree offered were the demographic variables that were examined. The organizational variables were goals, control, motivation, interaction, and decision making. The methods of gathering information regarding student health problems, the kinds of health promotion programs offered, the methods of publicizing the programs, and the extent of student participation in health promotion programs were the dependent variables.

The statistical tests for the effects of the demographic and organizational variables on student health promotion efforts indicate that a relationship does exist. Combined multiple regression analysis equations that include all of the organizational variables demonstrated graphically the effects of interaction among the independent organizational variables and the dependent variables. These combined equations were better predictors of student health promotion programs and services than any of the organizational variables taken separately. Future studies of the factors that affect student participation in health promotion programs, the extent of student participation, and the effects of a student participation should be conducted.     

Citizen participation in neighborhood health centers for the poor: the politics of reform organizational change, 1965-77

Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.     

Variables Affecting Readiness to Benefit From Career Interventions

This article identifies and briefly describes the broad range of variables that may influence clients’ readiness to benefit from career interventions. The article also discusses consequences of low readiness for effective use of career interventions and addresses implications for practice as well as for future research. Variables contributing to low readiness for effective use of career interventions include personal characteristics and circumstances; knowledge of self, options, and decision making; and prior experience with career interventions. Consequences of low readiness for using career interventions include premature disengagement, negative perception of skills and interests, selective acquisition of incomplete information, premature choice foreclosure, protracted exploration, dependent decision‐making style, and poor evaluation of options.     

Career Counseling From the Counselee Perspective: Analysis of Feedback Questionnaires

The effectiveness of career counseling as perceived by counselees was measured using evaluation questionnaires. The results showed that 75% of the respondents rated the career counseling they received as satisfactory. A systematic difference was found between satisfaction with counseling as a result of the enhancement of the counselees' personal understanding and satisfaction as a result of the assistance they perceived in decision making. Respondents were more positive concerning their gains in self-understanding than about the help they felt they were given in arriving at a career decision. On the average, counselees rated discussions with the counselor as more important in counseling than were objective tests, interest inventories or vocational information. Respondents who reported that counseling helped them in both their personal and career problems were more satisfied than those who reported being helped solely in either their personal problems or their career decisions. The theoretical and practical implications of these results for career counseling are discussed.     

Evaluation of diagnostic procedures : A review of the issues

The expensive proliferation of new diagnostic medical technologies necessitates their rigorous evaluation. Diagnosis seeks to improve health outcomes by providing better information to guide treatment decisions. Evaluation may focus on various links in the management of patients by investigating (1) how diagnostic technologies affect the the information available to the physician, (2) how improved Information affects treatment decisions, and (3) how altered treatment decision affect health outcomes. For diagnostic procedures that do improve health outcomes, the gain in health status should be weighed against potential cost increases. This comparison may be made using risk-benefit and cost-effectiveness analyses. Experience in evaluating diagnostic technologies has shown the importance of (1) estimating effect size, (2) randomizing, (3) blinding, (4) enhancing external validity, (5) accounting for patient characteristics, and (6) reflecting patient values. Errors in adopting new diagnostic procedures may be reduced through better coordination of development, evaluation, and dissemination. This requires (1) improved evaluative decision making, (2) restraint among potential users, and (3) accelerated evaluation.