首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 31 毫秒
1.
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.  相似文献   

2.
The primary objective of Government policy for the care of the elderly is to enable old people to live independent lives in the community for as long as possible. To facilitate this, recent policies have switched the emphasis away from long-term institutional care to the provision of care within the community. An integral aspect of this has been the provision of sheltered housing, with or without additional facilities and backed up by domiciliary and community services. This paper examines the contribution made by sheltered dwellings to the accomodation of the elderly in two areas of Wales, by comparing the characteristics of those resident in sheltered schemes with those residing in non-specialist accommodation.  相似文献   

3.
The role of ownership in the provision of nursing home care has long been a challenging issue for policy makers and researchers. Although much of the focus historically has been on differences between for-profit and not-for-profit facilities, this simple distinction has become less useful in recent years as companies have employed more complicated ownership and management structures. Using detailed ownership data from the state of Texas, we describe the evolution of nursing home corporate structures from 2000 to 2007, analyze the effect of these structures on quality of care and staffing in nursing homes, and discuss the policy implications of these changes.  相似文献   

4.
Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzhemier's disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five action towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands knowledge concerning state policies targeting people with dementia, imtroduces a reliable method of collecting state laws, and contributes to the advocacy effort made on behalf of persons with dementia.  相似文献   

5.
Abstract

Florida is a bellwether state in terms of the need for assisted living among elderly persons and has more than 2,000 of the nation's estimated 11,459 assisted living facilities (ALFs). The authors of this article surveyed 140 ALFs in Florida in order to examine the relationship of profit status to ownership of other facilities, willingness to serve low income groups, formal policies, and persons involved in decisions about resident retention. Significant differences were found between for-profit and non-profit facilities in terms of ownership of nursing homes and resident involvement in retention decisions. A discussion of how the profit motive and formal policies can impact residents concludes the article.  相似文献   

6.
Between 1999 and 2007, Florida implemented two initiatives combining legislative, regulatory, and reimbursement strategies to increase nurse staffing levels in nursing homes to improve quality of care. Despite a $40 million incentive package allocated for direct-care staffing, per-resident-day staffing increased only after legislative requirements mandated minimum nursing hours per resident day. Total Medicaid expenditures grew by $1.1 billion over the 8 years; per diem rates increased 65% to reimburse providers' costs. Registered nurses' hours decreased, while licensed nurses' and paraprofessionals' hours increased. This article describes the impact of staffing policy changes, includes stakeholders' views about approaches to achieve quality outcomes, and documents state policy implementation efforts. Seven lessons from the implementation of state nurse staffing standards to improve quality of care outcomes are also presented.  相似文献   

7.
Abstract

Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzheimer's disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five actions towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands knowledge concerning state policies targeting people with dementia, introduces a reliable method of collecting state laws, and contributes to the advocacy effort made on behalf of persons with dementia.  相似文献   

8.
Dramatic growth in Assisted Living (AL) has resulted in increasing research and policy interest. This analysis compares smaller and larger AL facilities in four states to determine whether extant measures of four key concepts, used to distinguish the AL sector, give advantage to larger facilities. Quantitative comparisons predominantly show differences favorable to larger facilities; qualitative information raises the prospect that current measures overlook beneficial aspects of smaller facilities. If small facilities are included under the AL banner. both policy provisions and quality assessment must be carefully crafted to avoid placing small homes in funding and oversight jeopardy as AL develops.  相似文献   

9.
There is evidence that staffing characteristics influence quality of care in nursing homes. Federal and state surveyors conduct inspections of homes to assess their compliance with regulatory standards, including requirements related to staffing. Deficiency citations are issued when these standards are not met. This article examines the relationship between operational, facility, and market characteristics and organizational performance measured as staffing-related deficiency citations. Online Survey Certification of Automated Records (OSCAR) data from 2000 through 2007 were used with multinomial logistic regression analyses to identify factors associated with deficiency citations for staffing. Chain members and facilities with poor quality of care were more likely to receive deficiency citations for staffing. Greater bed count and competition between nursing homes were associated with a decreased likelihood of deficiency citations for staffing. Staffing-related deficiencies within nursing homes vary according to various operational, facility, and market characteristics.  相似文献   

10.
Protection of children and youths after placement must be given increased emphasis because deinstitutionalized care is itself not harm-free and also because the needs of many children for care, control, and treatment are likely to be met in residential facilities for the foreseeable future. However, the diverse and often incompatible views of advocates and providers of child care about the issues affecting the protection of residents in institutions loom as obstacles to planning for the protection of children and youths after placement. Both of the extreme views of institutional abuse and neglect issues deny the need for child protection after placement. The first holds that since the child or youth is being protected and/or treated, no ongoing child protection is necessary. The other view holds that any child protection effort short of closing residential facilities is futile and therefore without merit. Underreporting of abuse or neglect is widespread; accountability of facilities for the protection of residents is, as a result, unevenly established. These conditions are attributable in part to the inadequate statutory base for protecting children in institutions. At the same time, because of the lack of a planned approach to protection within facilities, and between facilities and child protection agencies, residential facilities are likely to suffer negative public exposure when moderate or serious incidents of maltreatment become public. The absence of procedures for facilities themselves to recognize abuse and neglect invites exposure of incidents by staff and residents. The ad hoc manner in which incidents are managed by external agencies often inflicts unwarranted costs on the reputations of residential facilities that in many cases may have only one or two serious incidents a year. Finally, the use of "last resort" placements may be putting some children and youths into situations of unacceptable risk. Despite the existence of differing views in the residential care field, we have identified areas of agreement between the child protection agencies and residential facilities upon which public policy might build. The problem may not be so much that these attitudes exist, as that the states have not responded in a planned and credible way to the problem of institutional abuse and neglect. Nevertheless, development of a planned and credible approach must deal with these areas of difference if protection of children after placement is to be improved.  相似文献   

11.
This paper seeks to contribute to the critique of mainstream development discourse by conveying the ideas and issues raised by rural South African women. Building upon feminist and post-colonial discourses, this paper shifts the epistemological location of knowing to the women affected by development programmes and policies. Based upon interviews and discussions with over 600 women in rural communities, we offer a brief characterization of the South African context of rural women's lives, followed by rural women's comments about development, their daily struggles, and empowerment. Rural women's comments reveal a conception of development that is tied to their localized problem-solving skills and opportunities. Their response to the absence of development opportunities within their communities is to forge a space where they can negotiate between institutional spheres of power in order to address their needs. We argue that traditional development approaches overlook the space, or interstice, rural African women occupy between the modern state and traditional authority. For persons interested in development issues, rural women's experiences direct our attention to the in-between spaces as potential sites of empowerment.  相似文献   

12.
This article explores a key question in political sociology: Can post‐communist policy‐making be described with classical theories of the Western state or do we need a theory of the specificity of the post‐communist state? In so doing, we consider Janine Wedel's clique theory, concerned with informal social actors and processes in post‐communist transition. We conducted a case study of drug reimbursement policy in Poland, using 109 stakeholder interviews, official documents and media coverage. Drawing on ‘sensitizing concepts’ from Wedel's theory, especially the notion of ‘deniability’, we developed an explanation of why Poland's reimbursement policy combined suboptimal outcomes, procedural irregularities with limited accountability of key stakeholders. We argue that deniability was created through four main mechanisms: (1) blurred boundaries between different types of state authority allowing for the dispersion of blame for controversial policy decisions; (2) bridging different sectors by ‘institutional nomads’, who often escaped existing conflicts of interest regulations; (3) institutional nomads’ ‘flexible’ methods of influence premised on managing roles and representations; and (4) coordination of resources and influence by elite cliques monopolizing exclusive policy expertise. Overall, the greatest power over drug reimbursement was often associated with lowest accountability. We suggest, therefore, that the clique theory can be generalized from its home domain of explanation in foreign aid and privatizations to more technologically advanced policies in Poland and other post‐communist countries. This conclusion is not identical, however, with arguing the uniqueness of the post‐communist state. Rather, we show potential for using Wedel's account to analyse policy‐making in Western democracies and indicate scope for its possible integration with the classical theories of the state.  相似文献   

13.
This article critically reviews theories of migration policy according to two criteria: methodological rigor and explanatory plausibility. It finds that political economy accounts are theoretically robust, but at the price of oversimplification. Neo‐institutional theories offer more sophisticated accounts, but fall short on a number of methodological and explanatory counts. As an alternative, this article suggests a theory focusing on the functional imperatives of the state in the area of migration, which shape its responses to societal interests and institutional structures.  相似文献   

14.
Examining the immigration policy changes undertaken by Socialist President Francois Mitterand between May 1981 and September 1982, this discussion provides backgroung information for the study of immigration policy reform in France, discusses the institutional and historical contexts within which recent policy changes have occurred, and examines the initial measures taken, the new immigration legislation adopted in October 1981, the "Exceptional Regularization" carried out in 1981-82, and various other immigration measures announced during the period under study. The discussion also identifies some of the problems which arose and are likely to arise as a result of the new policies. The French government has historically taken great pains to track the movement of both foreigners and natives within its territory. All citizens are issued a national identity card, and all foreigners residing in the country for longer than 3 months must obtain a residence permit from their local prefecture of police. The entry of some 347 million people annually into France must contribute to the problem of exercising strict control at entry. French measures to enforce immigration laws within its borders have not prevented the development of clandestine immigration nor the employment of undocumented foreigners. French law requires that all employers and employees contribute to the system of the Securite Sociale and to a variety of other government programs providing social and economic assistance to workers and their families. The year 1932 marks the date of the first French laws limiting immigration. On July 5, 1974 the French government closed the country's borders to immigration and have not reopened them since. Following that date a more severe attitude towards clandestine immigration became evident. Despite the anti-immigration policies of the 1974-81 period the number of foreigners residing in France did not diminish. 3 basic goals guided the new government in the development of its policies: to limit the entry of new foreigners; to end the precariousness which has characterized the existence of many immigrant families in France; and to examine immigration problems through bilateral negotiation with various sending countries. The immigration policy developed and carried out by the Mitterand administration during its first 15 months in office expressed an attitude of generosity towards established immigrants and external rigor vis-a-vis new immigration. The generosity of the new government is evident in the limitations placed on expulsion and detention, the guarantee of due process of law and all job-related rights for undocumented foreigners, the reaffirmation of family reunification, easier access to "privileged" immigrant status, the extension of the right of employment to foreign students and to Polish and Lebanese refugees, and new legislation guaranteeing the right of association to immigrants. The government's desire to control immigration more effectively is evident in the tightening of control at France's borders and in the substantial increases in sanctions against employers of clandestine workers.  相似文献   

15.
Cultural policy has traditionally had close ties with the construction of the society as a nation state, which has been marked by its built-in tendency towards cultural homogenisation. Post-World War II, multicultural societies pose profound challenges to these traditional forms of cultural policy. Although, in the last decades, western democracies have been designing cultural diversity plans, this does not mean that governmental policies have successfully been translated in institutional practice. In the Netherlands, mainly established cultural institutions have failed to integrate diversity into their core business. Yet, there have been a few exceptions that continue to make attempts to adapt their programmes to address new populations. In this article, we use Parekh’s view of a multiculturalism that reconciles unity and diversity, as a heuristic device that allows us to explore and examine the bottom-up diversity policies and practices of two Amsterdam-based cultural institutions: Paradiso and De Meervaart.  相似文献   

16.
Family caregivers are the cornerstone of the long-term supports and services infrastructure in the United States, yet they often contend with many challenges related to this role. Public policy has been slow to change, leaving many caregivers vulnerable to health and economic consequences. Using models of policy making, we identify barriers to advancing policies that support family caregivers and overcome policy drift. We draw on discussions from the California Task Force on Family Caregiving as it prepares state policy recommendations. Identified strategies include identification of caregivers in health care and workplace settings to promote political consciousness raising, collecting and reporting on data that frame caregiving as a policy problem, borrowing policies and language from overlapping fields to emulate their policy successes, and presenting supportive caregiver policies as solutions to other policy problems. By presenting specific strategic approaches to advance caregiving policies, we provide tools to address the growing gap between caregiver needs and policy responses.  相似文献   

17.
Although social media use has grown dramatically, program policies have not kept pace. Some programs now state that student social media activities have led to professional conduct reviews and may violate ethical standards. This article reviews current social media policies and conceptualizes their key elements. A review of current social media policies is reported, pointing to the need for further policy development. Six domains of a social media policy are identified: understanding social media, ethical and legal obligations, implications of one’s personal and professional online presence, institutional obligations to the program and agency, productivity implications, and possible consequences for violations of the policy. A model social media policy is detailed, and unresolved issues are identified.  相似文献   

18.
Contextual entrepreneurship and mixed embeddedness approach alike emphasize the importance of the political-institutional embeddedness next to social embeddedness along with further contexts for migrant entrepreneurship, yet the aspect of international migration policies as an important institutional framework has been somewhat neglected. This paper introduces the case of political-institutional embeddedness of migrant entrepreneurship in Japan from an international migration policy perspective, discussing embeddedness of migrant entrepreneurs and their support institutions from a multi-scalar perspective. By analysing the migration policy context of migrant entrepreneurship at different policy levels, that is, national, regional and urban scales, it demonstrates the analytical value of differentiating policies along these scales and also their inter-connectedness, conceptually proposing the inter- and trans-scalarity of these policy contexts. By bringing issues of migration regimes and particularly the East Asian developmental state as a lens to analyse migrant entrepreneurship, it brings further approaches in comparatively analysing different entrepreneurial contexts for future research.  相似文献   

19.
Twenty-two states have implemented state Employment Nondiscrimination Acts (ENDAs) making sexual orientation discrimination illegal, and Congress has repeatedly considered a federal ENDA. However, we know very little about the impact of existing ENDAs and the likely impact of future ENDAs. I describe the implementation of ENDAs and highlight their shortcomings relative to federal employment nondiscrimination law. Despite their shortcomings, I show that state ENDAs decrease wage differentials by roughly 20 % for behaviorally gay men. ENDAs appear to reduce this wage differential by reducing the portion of wage differentials typically associated with discrimination. These results inform a contemporary policy debate over the necessity and impact of expanded protection from discrimination for gay men. (JEL J1, J3, J7)  相似文献   

20.
Until recently, migrant health policies have been overlooked as a topic of policy analysis. Although interest in the issue has developed in parallel with the progressive acknowledgement of the presence of unhealthy migrants and the transformation of welfare states and policy dynamics in Europe, studies on migrant health policies have often focused on the state as a unique unit of observation while hindering the role played by other institutional and non‐institutional actors taking part in the migrant health multi‐level governance. This contribution will bridge this gap, deconstructing the various actors and levels involved in migrant health policymaking from a multi‐level perspective. By critically reviewing migrant health policy research and discussing it with the new MIPEX Health Strand, this contribution suggests a more encompassing perspective in the analysis of migrant health policies and processes, looking at the different players at stake in this multifaceted policy field.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号