Monitoring Quality of Care in Residential Care for the Elderly: The Information Challenge

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs.     

Housing Implications of Individual Budget Home Care Models for Older Renters: An Australian Case Study

Policies and programs relating to successful aging in place are premised on the fact that older people's housing is stable and suitable. Home-based aged care delivery models such as individual budgets aim to deliver increased service flexibility, choice, and control for consumers. Little attention has been paid to the consequences of such models for older renters, who often have less stable housing and restricted rights to modify their accommodation. This article reports on a project in Australia that explored the delivery and receipt of individual budget style models of home-based aged care services to older renters.     

In Search of a Future for Large-Scale Care Homes in Flanders

Housing for older people in Flanders evolves toward small-scale facilities and better quality of life. Ageing population strains the means to achieve this to the limit. The authors investigate whether and how Flemish large-scale facilities can adapt to meet contemporary and future requirements of housing for older people. By analyzing current tendencies, they depict what this housing should look like, both now and in the future. They then investigate how an existing large-scale care home could fit this picture by using design as a mode of knowledge production. They propose to redesign the site such that its actual evolution would be thoroughly redirected. Beyond the facility at issue, the study shows how Flemish large-scale facilities could develop to keep playing a role in the future. They should timely adapt their size with qualities of small-scale housing schemes, and integrate in the neighborhood.     

Activity Engagement in Residential Care Settings: Findings from the National Survey of Residential Care Facilities

Assisted living and similar residential care is an important source of care for elders, including those with dementia. Meaningful activities may help residents maintain function, improve self-esteem, and enhance quality of life. Using data from the 2010 National Survey of Residential Care Facilities, this study identifies the extent of resident engagement in different types of activities; examines the extent to which cognitive status, other resident characteristics, and residential care community characteristics relate to activity engagement; and, among cognitively impaired residents, assesses whether being in dementia-specific settings is associated with activity engagement. Compared with persons without cognitive impairment, those with severe cognitive impairment are less likely to go on outings (79% versus 36%) and talk with family and friends (85% versus 72%). Residents with mild to severe cognitive impairment have higher participation in leisure activities than other residents if they live in dementia-specific settings (73% higher) than those who do not.     

The Continuum of Care System

Abstract

The Continuum of Care System is a Decision Support System designed to assist social workers responsible for identifying and selecting alternative living arrangements for children unable to remain in their own families. The Continuum of Care System consists of two software packages called MATCH and PROFILE. MATCH produces a rank-ordered list of prospective placement alternatives by statistically comparing an individual child to groups of children previously admitted into different residential facilities. PROFILE summarizes the characteristics and problems of children at each facility in the system.     

Elder Mistreatment in U.S. Residential Care Facilities: The Scope of the Problem

Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.     

Elders' Decisions To Enter Assisted Living Facilities: A Grounded Theory Study

ABSTRACT

The purpose of this qualitative study was to develop a substantive theory of elders' decision-making process to relocate to an assisted living facility. The researchers interviewed a purposive sample of 28 elders who resided in assisted living facilities. The theory of elders' decisions to relocate to an assisted living facility is a story about elders weighing and balancing gains and losses to go to where the help is. Decision makers weigh and balance gains and losses before, during, and after relocating to an assisted living facility. Elders stay at their current residence if gains outweigh losses and they relocate if losses outweigh gains. Understanding the process of decision-making in this segment of the population may lead to the development of interventions that can promote positive relocation experiences among elders and increase the effectiveness of their decision-making behaviors.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

Family decision making in child welfare: challenges in developing a knowledge base for practice

Over the past two decades, engaging families in decision‐making has grown in popularity across child welfare systems internationally. The family group conference in particular has generated interest as a practice model that facilitates broader family engagement in care and protection. As the practice has flourished, research has been undertaken to strengthen the knowledge base and to support the introduction of family engagement strategies across jurisdictions. This paper examines the recent research relating to family engagement strategies in child welfare and explores the ways in which family involvement in decision‐making can be incorporated into emerging protective practices. Copyright © 2010 John Wiley & Sons, Ltd.     

We've Looked at Care from Both Sides Now: The Effects of Alternative Evaluation Strategies on Study Conclusions

This study uses two studies about the role of managed-care programs in serving Medicaid long-term care clients in Florida to illustrate how different research designs can reach divergent conclusions. Two reports from different groups using essentially the same database to assess the impact of managed care on a group of older Medicaid clients served by a Nursing Home Diversion Program reached different conclusions. The report from Florida's Office of Program Policy Analysis and Government Accountability concluded that the Diversion program saved money, whereas the report from the Florida Policy Exchange Center on Aging at the University of South Florida reached basically the opposite conclusion. Both agreed that the capitation rate was too high. How the policy questions are framed and analyzed can affect the conclusions reached. A variety of factors can influence the apparent effects of programmatic interventions. Evaluations must take relevant confounding variables into account.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

Persuasion: An experimental study of team decision making

This paper studies persuasion within teams and investigates why teams commonly take, by some measures, better decisions than individuals. The analysis is based on data from electronic communication within teams of two players. Thanks to the experimental design, changes of an individual’s decision can be attributed to the content of the team partner’s message. The results for knowledge-related and strategic problems show that individuals’ decisions change upon receiving more informative and sophisticated arguments and remain the same otherwise. This individual behavior is an essential part of the information aggregation in teams and can explain the advantage of teams in decision making and in games.     

Making Decisions about Parental Mental Health: An Exploratory Study of Community Mental Health Team Staff

Adult mental health problems can impact on parents, and research highlights that their children are at higher risk of developing mental health problems. In extreme cases, mental health problems are associated with a risk of fatal child abuse. Despite this, there are few studies exploring clinical decision‐making by adult mental health professionals.

‘In extreme cases, mental health problems are associated with a risk of fatal child abuse’

This study used qualitative methods to explore Community Mental Health Team (CMHT) workers' experiences of decision‐making in the interface between mental health and child welfare. Workers were interviewed about their experiences of clinical decision‐making regarding child welfare. Interviews and accounts were analysed using Interpretative Phenomenological Analysis. Influences on decision‐making were explored and triangulated with the accounts of Named Nurses for Child Protection. The findings revealed that CMHT participants were aware of their responsibilities towards children, but a complex synthesis of factors impacted on their sense‐making about risk and welfare. Three superordinate themes emerged: the tensions of working across systems; trying to balance the perceptions and feelings involved in sense‐making; and the role that interpersonal dynamics play in the understanding and management of risk. This paper focuses in particular on perceptions and feelings. Copyright © 2011 John Wiley & Sons, Ltd.

‘A complex synthesis of factors impacted on their sense‐making about risk and welfare’

Citing Literature

Number of times cited according to CrossRef: 8

• Natalie Elizabeth Anderson, Julia Slark, Merryn Gott, Unlocking intuition and expertise: using interpretative phenomenological analysis to explore clinical decision making, Journal of Research in Nursing, 10.1177/1744987118809528, 24 , 1-2, (88-101), (2019). Crossref
• Phillip Tchernegovski, Andrea E. Reupert, Darryl J. Maybery, How do Australian adult mental health clinicians manage the challenges of working with parental mental illness? A phenomenological study, Child & Family Social Work, 10.1111/cfs.12426, 23 , 3, (381-389), (2017). Wiley Online Library
• Maria Afzelius, Lars Plantin, Margareta Östman, Children of Parents With Serious Mental Illness: The Perspective of Social Workers, Practice, 10.1080/09503153.2016.1260705, 29 , 4, (293-310), (2016). Crossref
• Louise Everitt, Caroline Homer, Jennifer Fenwick, Working with Vulnerable Pregnant Women Who Are At Risk of Having their Babies Removed by the Child Protection Agency in New South Wales, Australia, Child Abuse Review, 10.1002/car.2432, 26 , 5, (351-363), (2016). Wiley Online Library
• Joe Duffy, Gavin Davidson, Damien Kavanagh, Applying the recovery approach to the interface between mental health and child protection services, Child Care in Practice, 10.1080/13575279.2015.1064358, 22 , 1, (35-49), (2015). Crossref
• Peter Sidebotham, What did you do at Work Today, Daddy?, Child Abuse Review, 10.1002/car.2357, 23 , 5, (307-310), (2014). Wiley Online Library
• Peter Sidebotham, Rethinking Filicide, Child Abuse Review, 10.1002/car.2303, 22 , 5, (305-310), (2013). Wiley Online Library
• Jane V. Appleton, Peter Sidebotham, Child Protection and Mental Health, Child Abuse Review, 10.1002/car.2220, 21 , 3, (153-156), (2012). Wiley Online Library

Volume 21 , Issue 3 May/June 2012

Pages 173-189     

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.     

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.     

Denied Citizens of Turkey: Experiences of Discrimination Among LGBT Individuals in Employment,Housing and Health Care

The purpose of this article is to explore experiences of discrimination against lesbian, gay, bisexual and trans (LGBT) individuals in three domains of social policies: employment, housing and health care — domains in which LGBT individuals are not openly recognized as equal citizens and anti‐discrimination legislation is absent in Turkey. Drawing on qualitative content analysis of the data collected from 14 focus group interviews with 139 LGBT individuals conducted in ten provinces of Turkey in the first half of 2014, this article sheds light on diverse forms of discrimination facing LGBT individuals in employment, housing and health care in a largely under‐researched country. The article concludes that the contemporary understanding of Turkish citizenship and its practice are rooted in heterosexist universalism that does not recognize LGBTs as equal citizens, which, in turn, leads to systematic breaches of LGBTs' social rights in employment, housing and health care. The article shows that even strong and universalistic social policies fail to serve LGBTs on an equal footing with other citizens unless equal citizenship rights of LGBTs and anti‐discrimination principles are recognized and realized.     

Reimagining Nursing Homes: The Art of the Possible

Long-term care (LTC) needs to be reconceptualized. The current efforts to reinvent the nursing home perpetuate a flawed model of care. The heritage of the nursing home as the dominant model for LTC needs to be reexamined. The basic LTC building blocks—housing, services, and medical care—can be combined in various ways to meet consumers' needs and preferences. We need innovative solutions that can offer reasonable service while recognizing the value of acceptable risk taking. Modest personal care should not come at the price of surrendering one's autonomy.     

Differentiation Levels of College Students: Effects on Vocational Identity and Career Decision Making

This study assessed the effects of differentiation levels on the career development of college students. Participants were 231 college students who completed the Differentiation of Self Inventory (Skowron & Friedlander, 1998 ), My Vocational Situation (Holland, Daiger, & Power, 1980 ), the Career Decision Profile (CDP; Jones & Lohmann, 1998 ), and demographic questions. The results supported the hypotheses that higher levels of the various components of differentiation would predict higher levels of vocational identity and fewer difficulties with career decision making. In particular, lower levels of emotional cutoff and emotional reactivity and higher levels of “I position” predicted higher levels of vocational identity and career decision making. Results suggest a more complicated picture for fusion, with higher levels being predictive of lower levels of decisiveness but not significantly related to vocational identity. Implications of the results for career counselors are provided.     

The Erickson Life Study: A Five-Year Examination of a Screening Tool in a Continuing Care Retirement Community

Continuing care retirement communities are an increasingly popular housing choice for older adults. The purpose of this study is to evaluate the validity of an entrance tool to predict transitions over a 5-year time period. A sample of 261 participants was recruited. A discriminant analysis revealed that baseline scores correctly classified the Year 5 status of 71.3% of the cases, with 69.6% of those who experienced a change in status classified correctly. The use of the tool potentially provides the staff an objective means for pinpointing the areas where services may be required for the residents’ well-being.     

Building Bridges into the Community: Social Capital in a Volunteering Project for Care Leavers

Volunteering to address poor life outcomes often experienced by care leavers is emphasised in UK policy. Although volunteering is credited with the ability to generate social capital, there is limited research on the impact of volunteering on the social capital of care leavers. This article re‐examines data from an evaluation of a volunteering project for care leavers. It explores in what ways young people's participation in the project constitutes social capital. The findings support the importance of regular face‐to‐face contact and co‐production for young people to become creators of their own social capital.