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.     

Australian Approaches to Resident Classification and Quality Assurance in Residential Care

Summary

This paper begins with an account of the structure of Australia's residential long-term care program, which was divided into two distinct levels of hostel and nursing home care until 1997. In response to changed policy objectives, a number of measures were then taken to create an integrated residential care system. The main measures were the development of a single scale for classification of resident care need and associated funding to replace two previous separate scales, and the implementation of a new quality assurance system, which included new standards for buildings as well as revised standards for care. I give accounts of these measures and the extent to which they have achieved their intended outcomes before proposing some further developments that could see closer links among pre-admission assessment, resident classification, and quality assurance.     

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.     

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.     

Relationship of Facility Characteristics and Presence of an Ombudsman to Missouri Long-Term Care Facility State Inspection Report Results

This study analyzes existing data describing general facility characteristics, the presence of an ombudsman in the facility, and the number of deficiencies/violations reported for long-term care facilities in the state of Missouri. The model that predicted the rate of deficiencies/violations best was one that included the following characteristics: “contained more than 50 beds” and “considered a Skilled Nursing facility.” Findings suggest that the characteristics that are significantly associated with fewer deficiencies are larger size (more than 50 beds) and being classified as Skilled Nursing. While those facilities that housed an ombudsman were found to have fewer deficiencies per bed in the general analysis, further investigation found this to be an artifact mostly due to the higher rate of ombudsmen at larger facilities.     

Marital Quality Ten Years After the Transition to Parenthood: Implications of the Timing of Parenthood and the Division of Housework

Using a sample of 180 dual‐earner, nondivorced couples, this study explored how the timing of parenthood and the division of housework are related to husbands' and wives' marital quality during the childrearing years. Hypothesized to be “at risk” for negative marital evaluations were early first‐birth couples who divided tasks in a less‐traditional manner and delayed first‐birth couples who divided tasks in a traditional manner. Analyses revealed that husbands and wives in the “risk” groups evaluated their marriages more negatively, suggesting that congruence between behaviors, background, and attitudes is important for marital quality. In addition, early first‐birth couples evaluated their marriages more poorly than did the “on time” or “delayed” couples. Wives' gender‐typed attitudes emerged as a significant covariate in the analyses but did not account for the effects of the timing of parenthood and the timing of parenthood × the division of housework interactions.     

A Valued Relationship with Nature and Its Influence on the Use of Gardens by Older Adults Living in Residential Care

ABSTRACT

While there is growing interest in inclusion of gardens and outdoor spaces in residential care facilities for older adults, these spaces are often underutilized despite many identified, evidence-based benefits. A qualitative study of participant observations with behavior mapping, and individual and focus-group interviews, using a grounded theory methodology was used to understand value versus use of outdoor garden spaces. Individual and focus-group interviews were conducted with 32 residents from two facilities. Results revealed that views of nature are fundamentally important to resident well-being, that access to nature influences facility choice, and use of garden spaces is influenced by the way in which individuals prefer to enjoy nature.     

A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps both inside and outside the home. The majority of the caregivers had made home modifications that pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

Downshifting: An Exploration of Motivations,Quality of Life,and Environmental Practices

“Downshifting,” reducing work hours, thereby income, to increase leisure time, offers a possible individual‐level solution to the stress many experience from long working hours and work intensification. Recently, some have argued that an increase in leisure time with a reduction in income might also foster pro‐environmental lifestyles as has been demonstrated for the “voluntary simplicity” movement. Quantitative research on the relationship between downshifting and quality of life is scant, with equivocal results, and studies of the relationship between downshifting and environmental lifestyles are even more rare. Survey data from a western Canadian city reveal nonsignificant impacts of downshifting on two measures of quality of life (subjective well‐being and satisfaction with time use) as well as on sustainable transportation practices. However, downshifting is significantly associated with sustainable household practices. In order for downshifting to have more widespread positive effects, further structural changes in broader domains such as work culture, urban design, and support for families will be required.     

Motivational Style,Length of Residence,Voluntariness, and Gender as Influences on Adjustment to Long Term Care

Abstract

Seventy-five institutionalized older adults (Mage = 79.08, SD=9.73, 25 males, 50 females) varying by length of residence, gender, and motivational style (self determined vs. motivational) were queried to explore the impact of these variables on indicators of adjustment, i.e., health, life satisfaction, desired and expected control, self-esteem, ADLs, and positive/negative affect. MANCOVAs (controlling for social desirability) indicated self-determined motivational style to positively impact adjustment, as well as to interact (p <.05) with gender in this respect. Length of residence and gender each impacted ADLs, and motivational style also affected both desired/expected control and self-esteem, where those with higher self determined motivational styles had expectations for and desirability of control. Voluntariness of the decision to move generally positively impacted adjustment, but its impact was moderated by motivational style. Thus, persons who vary along motivational style, gender, voluntariness, and length of residence are likely to function in distinct ways in adjusting to being institutionalized.     

It Attacked My Change: An Exploratory Study with Young Adults on the Impact of Divorce and Their Adjustment Processes During Adolescence

Semistructured interviews were conducted with 2 female students, 21 and 24 years old. The participants experienced parental divorce during early adolescence (12 years old). This research examined the participants’ own views on the impact of parental divorce and their adjustment processes. The majority of participants’ narratives indicated that they had experienced negative effects of parental divorce. Results suggested that their adjustment was a long process in which mothers, peers, and psychologists had an important role in their coping process. Divorce and associated events were found to have a direct impact on participants’ development of identity, emotions, intimate relationships, father–child relationships, and views about forming their own families. The results were discussed in relation to the previous literature. Additionally, areas for psychotherapeutic emphasis are presented.     

A Cost Comparison of Congregate Housing and Long Term Care Facilities for Elderly Residents with Comparable Support Needs in 1985 and 1990

No abstract available for this article.     

An Interview with Dr. Cornelius Foley: Humor,Palliative Care and Hospice

Dr. Cornelius Foley, a geriatrician, is Director of Parker Jewish Institute, New Hyde Park, New York. Dr. Foley discussed the use of humor in his work in a hospice and palliative care environment with Dr. Kathleen Monahan.     

Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Prior Placements of Youth Admitted to Therapeutic Foster Care and Residential Treatment Centers: The Odyssey Project Population

Two samples of youth in the child welfare system were compared—youth entering residential treatment centers (RTCs) and youth entering therapeutic foster care (TFC). Three questions were addressed: (1) Where were youth living prior to the current placement? (2) Had youth been treated in other systems of care? (3) How many prior placements did youth have? Time 1 data of the national “Odyssey Project” developed by the Child Welfare League of America were used. The^.measure utilized was the child and family characteristics form (CFC). Results revealed that youth admitted to RTCs were more likely to be entering from other systems of care and stepping down to the RTC while youth entering TFCs were more likely to be entering from within the child welfare system and stepping up to a higher level of care. The results have implications for improving clinical practice and for the development of a cross-system perspective on serving troubled youth.     

Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan

Abstract

Objective: We investigated the effects of testosterone replacement therapy (TRT) on nocturia and general health among men with hypogonadism and nocturia.

Methods: From our previous EARTH study population, 64 patients with a clinical diagnosis of nocturia (two or more times per one night) and hypogonadism, comprising the TRT group (n?=?31) and controls (n?=?33), were included in this analysis. The TRT group was administered 250?mg of testosterone enanthate as an intramuscular injection every 4 weeks for 6 months. All patients responded to the following questionnaires: International Prostatic Symptoms Score (IPSS), Aging Male Symptoms (AMS) score and Short Form-36 health survey at baseline and 6-month visit. These categories were compared based on changes from baseline to the 6-month visit between TRT and control groups.

Results: At the 6-month visit, the TRT group had a significant decrease in IPSS question no. 7 and AMS question no. 4, whereas no significant changes were observed in the control group. Additionally, role limitation because of health program, vitality and mental health domains were significantly improved in the TRT group.

Conclusions: Six-month TRT may improve nocturia, sleep conditions and quality of life among men with hypogonadism and nocturia.     

Child Care Arrangements,Division of Household Labor and Other Employment Based Familial Predictors of Marital Adjustment Among Husbands of Employed Females in Pakistan

The primary purpose of the current study was to investigate the influence of division of household labor, child care arrangements, wife’s financial contribution, work-schedule of wife, perception of wife employment and wife’s work preference were contributing to marital adjustment of husbands of working married women. Additionally, it explored the role of wife’s financial contribution, perception of wife’s employment and wife’s work preference in formation of marital adjustment among husbands of working women. The data were collected through a self-structured questionnaire from 283 husbands of employed married women with one year of marital duration and at least one child. The data were collected from the city of Gujrat, province of Punjab, Pakistan. Factor analysis was run for reliability and validity analysis was executed to examine the validity of the existing scales used in the current study. Multiple linear regression analysis was used for model fit. Division of household labor, child care arrangements, wife’s financial contributions, wife’s work-schedule, the perception of wife’s employment, and wife’s work preferences contributed to the marital adjustment of husbands of working married women. Our results seemed to reflect fluctuating dimensions of gender role ideologies among families. Incorporating new predictors of marital adjustment into literature of marriage and family has been a sociological significance of the current study.