Preservation of self in the nursing home: Contradictory practices within two models of care

Researchers have identified several aspects of nursing home care that interfere with residents' preservation of self. This paper examines how different models of care shape residents' opportunities for preserving a sense of self, adult identity, and agency. Using ethnographic data, I analyze staff practices in two facilities that reflect the contrast between the home and hospital models of long-term care. Previous research on long-term care suggests that an informal, “home-like” approach to care creates more opportunities for residents to preserve a sense of self-identity, whereas a formal, “institutional” approach fosters depersonalizing practices that interfere with residents' psychosocial well-being. My research suggests, however, that both approaches can have contradictory effects on residents' preservation of self. I analyzed patterns of objectification and infantilization that emerged in the social interactions between residents and staff members, as well as practices that mitigated these patterns. This study highlights how a larger culture of ageism and stigma surrounding dependency can become embedded in micro-level practices and underscores the challenges of defining and implementing “good” care.     

COMMUNITY SERVICES AND OUT-MIGRATION

This paper investigates the relationship between changing community context and out-migration in one of today's poor countries, seeking to document the various mechanisms by which infrastructure affects the migratory behavior. We focus on the expansion of social and physical facilities and services near to rural people's homes, including transportation, new markets, employment, schools, health clinics, and mass media outlets such as movie halls. We draw upon detailed data from Nepal to estimate the hypothesized effects. The direct effects of expanding economic and human capital infrastructure are clearly negative, reducing out-migration. However, increased economic infrastructure is associated with a greater accumulation of human and social capital among respondents and their parents. Through these intervening mechanisms, economic and social infrastructure increased the odds of migrating out. These results reveal the often countervailing nature of short- and long-term effects of economic and social change and the complex pathways influencing migration outcomes.     

Migration Trends in the Kansas Ogallala Region and the Internal Colonial Dependency Model

Abstract The High Plains of the United States has been portrayed both as a place of despair and a region of renaissance. This study proposes that, within the Ogallala Aquifer portion of the High Plains, landscapes of decline and renaissance co-exist within the context of an internal colonial dependency model. While the notion of internal colonial dependency has been applied primarily to the central Appalachian region, an assessment of population change in the High Plains of western Kansas suggests some striking similarities with the population change expected in a region conforming to the internal colonial dependency metaphor. This study identifies a wide range of colonial dependent characteristics, as they apply to the High Plains, with a focus on migration. Demographic changes supporting a colonial influence include long-term population decline in most counties, high median age, high levels of channelized out-migration, even higher levels of channelized in-migration, in-migration flow origins that are concentrated in just four other Ogallala states, and a continued long-term trend of exporting the region'S most educated inhabitants.     

All kinds of potential: Women and out-migration in an Atlantic Canadian coastal community

Rural researchers have found that women leave rural communities at a higher rate than men. Rural education researchers have also found that young women are significantly more successful in formal education than their male counterparts. Few studies though attempt to explain why this is so. This work presents data and analysis from two studies of education and out-migration from a rural-coastal community in Nova Scotia Canada. The questions I investigate in this session are: (1) why are women more likely to leave rural communities? (2) how have contemporary change forces like globalization and network society influenced the gender balance regarding rural out-migration? and (3) how has young rural women's relative success in formal education related to their higher rates of out-migration? Given the recent concern about boy's education, I raise some critical questions about the parallel notion that girls are doing just fine.     

“Such Trivial Matters:” How staff account for restrictions of residents' influence in nursing homes

National policies emphasize older people's right to autonomy, yet nursing home residents often have restricted opportunities to make decisions about everyday matters. We use qualitative interview data to analyze staff members' explanations of actions that conflict with both social norms and national policies. Two types of problematic actions are discussed: restrictions of elderly residents' influence in decision making and neglect of residents' complaints. While staff members describe residents' influence as desirable, they simultaneously formulate accounts that justify their inability to live up to this ideal. Further, we demonstrate how certain complaints are “made trivial” when they are described and treated in specific ways by the staff. We argue that the accounts offered by staff members draw on an implicit folk logic, a logic in which residents are allowed to exercise influence only as long as it does not conflict with the efficient running of the institution as a whole.     

Stock investors’ preference for short-term vs. long-term bonuses

Bonuses in the finance sector may be based on too short time intervals for environmental and social factors to be taken into account in investment decisions. We report two experiments to investigate whether investors prefer short-term to long-term bonuses. In Experiment 1 employing 27 undergraduates, preferences were measured for four short-term certain bonuses, evenly distributed across a time interval, and one certain long-term bonus at the end of the time interval. A majority chose the short-term bonuses, and in order for the long-term bonus to be equally preferred it had to be about 40% higher than the four added short-term bonuses. Experiment 2 employing another 36 undergraduates introduced outcome uncertainty that more accurately reflects the choices stock investors face. The participants again choose between a long-term bonus and four distributed short-term bonuses. It was shown that uncertainty made more participants prefer the long-term bonus to the added short-term bonuses than when the outcome was certain. A smaller increase of the long-term bonus of about 20% was now required to make it equally attractive as the four added short-term bonuses.     

Village Facilities and Social Place Attachment in the Rural Netherlands

Economies of scale and increased mobility have led to the closure of many village facilities. Most residents do not rely on locally available facilities anymore for their primary function. However, facilities are also meeting places. A decline in facilities may therefore negatively influence residents' social place attachment. This article examines which facilities impact residents' social place attachment. It also explores whether different facilities impact the social place attachment of different groups of residents differently. In our analyses, we make a distinction between rural areas near and away from urban areas. Based on structural equation modeling, we conclude that in rural areas, both near and away from cities, cafés and supermarkets may well matter for residents' social attachment. In contrast to common expectations, community centers, primary schools, and sports facilities were not shown to enhance social place attachment. Considering the increasing self‐reliance of local communities, these findings raise doubts about the use of public services to revitalize local communities.     

Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order

Using ethnographic data collected from a Swedish nursing home, this article analyzes residents' everyday or subtle influence attempts relative to the maintenance of institutional routines. Residents' efforts to carve out some autonomy or fulfill personal preferences in everyday matters could be categorized as (1) disruptions, (2) disturbances, or (3) “good matches” relative to ongoing and up-coming nursing home routines. Striking disruptions were often fruitless, while attempts rendered as disturbances were typically postponed or modified. In general, the outcomes of residents' maneuvers were shaped by brief and situational negotiations of whether (and how) temporary exemptions from the institutional order were deemed accountable or not by the staff. Although the staff sometimes arranged situations in which residents were given some defined or symbolic decision-making authority, the findings of this study show how an inflexible local routine culture can constitute a constraining and only occasionally porous framework for residents' self constructions and everyday life.     

President Bush's major post-Katrina speeches: Enhancing image repair discourse theory applied to the public sector

When Hurricane Katrina swept the Gulf Coast, President Bush's newly formed Department of Homeland Security received its first test and failed. In Katrina's aftermath, Bush not only had to manage one of the nation's worst natural disasters, but also had to quell political backlash about the federal government's response to Katrina. This study examines: (a) how Bush presented the federal response to Katrina in his speeches; (b) how Bush responded to the public's criticism in his speeches; and (c) how effective Bush's speeches were in repairing his tarnished image.     

From Collective Memory to Collective Imagination: Time,Place, and Urban Redevelopment

This article is about a place that does not exist, yet. It is about residents' perceptions of redevelopment plans involving the reconstruction of a defunct neighborhood firehouse. Interviews revealed the residents' “collective imagination” as they actively envisioned potential future outcomes for a firehouse‐turned–community center. When asked about the needs of the community, interviewees discussed the current conditions of their neighborhood (the present), its history (the past), and how they would like to see it change (the future). This corresponds well with George Herbert Mead's ideas about temporality. I argue that connecting the identity of a place to a sociological understanding of time (especially Mead's) is a necessary step for gaining a better understanding of the subjective side of urbanization and ultimately creating a better vernacular knowledge base for urban redevelopment plans.     

Distribution and Utilization of Home- and Community-Based Long-Term Care Services for the Elderly in North Carolina

ABSTRACT

Provision of home- and community-based long-term care is a growing concern at the national, state, and local levels. As more persons grow old, the need for these services is expected to rise. This analysis examines the distribution and utilization of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilization among the elderly. Great variability was found in number of elderly utilizing the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilized the programs. Multivariate modeling for associations to service utilization was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilization. Percent of persons 85 years or older and the ratio of institutionalized long-term care beds were negatively associated with utilization. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.     

Civic Community in Small‐Town America: How Civic Welfare Is Influenced by Local Capitalism and Civic Engagement*

Abstract The aims of this paper are twofold: first, to gain a fuller understanding of factors that foster community cohesion and contribute to the residents' social and economic well‐being; and, second, to move beyond previous research that used larger spatial units such as states, counties, or aggregates of counties and to focus instead on American small towns (population 2,500–20,000). The data on small towns are drawn from public‐use files and from confidential microdata from various economic censuses. From these sources we construct measures of locally oriented firms, self‐employment, business establishments that serve as gathering places, and associations. The local capitalism and civic engagement variables generally perform as hypothesized; in some cases they are related quite strongly to civic welfare outcomes such as income levels, poverty rates, and nonmigration rates. We discuss the advantages and disadvantages of working with place‐level data and suggest some strategies for subsequent work on small towns and other incorporated places.     

Wildfire Perception and Community Change

Given increasing political and financial commitments to wildfire preparedness, risk policy demands that risk identification, assessment, and mitigation activities are balanced among diverse resident groups. Essential for this is the understanding of residents' perceptions of wildfire risks. This study compares wildfire‐risk perceptions of Pennsylvania residents with those of Minnesotans living in natural‐amenity‐rich communities. Natural‐amenity‐driven migration shifts land‐use patterns and social conditions, making it important to understand if and how such changes affect residents' perceptions of wildfire. Key informant interviews suggest land use and contrasting values associated with sociodemographic shifts were intertwined with wildfire‐risk awareness, concern, and mitigation. In both study areas, local social interactions were impaired by geospatial and sociocultural barriers related to land use and population change. Barriers included perceived threats to quality of life, conflicting needs for economic development, and homes built in isolated locations. As a result, residents did not agree on community‐wide notions of wildfire risk and response. Further, residents' ideas about the potential for a wildfire disaster did not correspond to those of risk managers. Although some places were attempting to overcome these challenges, many informants said their communities were overwhelmed with the effects of change. Finding common notions of wildfire risk is critical precisely because resident participation is crucial to hazard management. In these localities, rural community development can facilitate capacities to address wildfire risk in the context of landscape and social change.     

The Impact of the Social Environment on Nursing Home Residents

ABSTRACT

This study contrasted the experienced quality of life of residents living on one of two nursing home units: a unit for those considered socially intact and a unit combining residents who had moderately impaired cognition or physical function with those requiring skilled nursing or therapy. Qualitative interviews were held with residents of both units. The findings indicate that the social environment of each of the units played a fundamental role in the residents' quality of life. The social environment affected the residents' conceptions of self, their interactions with other residents and their interactions with the nursing staff. The article suggests the processes behind the social environment of each floor that may have resulted in different perceptions of the quality of life.     

The meaning of nursing-home: ‘Waiting to go up to St. Peter,OK! Waiting house,sad but true’ — An Australian perspective

BackgroundThis article is derived from a larger Australian research study using multiple qualitative methods to investigate truth-telling in aged-care.AimTo analyse and discuss findings associated with residents', personal care assistants' (personal carer, enrolled nurse) and the registered nurses' perceptions about the nursing-home. The thesis is that the health of the resident in a nursing-home is directly linked to care provision that encourages autonomy.MethodsResearch participants' personal journals, group discussions, follow-up in-depth discussions and the author's field journal across five nursing-homes.ResultsThe nursing-home is described as endowed with suspicious awareness and mutual pretence, overloaded with tasks, short of staff and starved of time with little engagement with the residents.DiscussionResidency that claims to have as its primary focus ‘the resident’ ought to take seriously the residents' health and therefore the residents' autonomy. However, the nursing-home, as described here, fails to adequately understand this link.     

Sex Differences in Post-Coital Behaviors in Long- and Short-Term Mating: An Evolutionary Perspective

Few empirical studies have been devoted to exploring behaviors occurring immediately following sexual intercourse. Therefore, this study conducts an exploratory investigation of various post-coital behaviors that the authors propose may reflect the divergent adaptive reproductive strategies of each sex as understood from an evolutionary perspective. An online questionnaire was administered to 170 individuals examining sex differences in post-coital compared to pre-coital activities related to pair-bonding with long-term mates, as well as a variety of common post-coital activities comparing short- and long-term mating contexts. It was found that females were more likely than males to initiate and place greater importance on several behaviors related to intimacy and bonding following sex with long-term partners. Males were more likely to initiate kissing before sex, and females after sex. Intimate talk and kissing were rated by both sexes as more important before intercourse with a long-term partner, whereas cuddling and professing one's love was rated more important after sex. In a second set of more specific post-coital behaviors, females were more likely to engage in post-coital behaviors related to bonding with both short- and long-term partners, whereas males were more likely to engage in ones that were extrinsically rewarding or increased the likelihood of further coital acts.     

The Seniors' Outdoor Survey (SOS Tool): A Proposed Weighting and Scoring Framework to Assess Outdoor Environments in Residential Care Settings

Spending time outdoors offers substantial health benefits for older adults. However, in long-term care settings, outdoor areas may fail to adequately support elderly residents' needs and preferences. The Seniors' Outdoor Survey (SOS Tool) was recently developed to help users evaluate outdoor areas and indoor–outdoor connections in residential facilities for seniors, by rating 60 environmental features on a 1–7 scale. This article proposes a weighting strategy to approximate the relative importance of different items on the tool, according to their potential level of support for resident usage and preferences. A standardized scoring system will allow multiple stakeholders to apply the results to research, design, construction, and renovation projects.     

Community Relations and Risk Communication: A Longitudinal Study of the Impact of Emergency Response Messages

This study replicates and extends Heath and Abel's (1996) quasi-longitudinal analysis of the long-term impact of risk communication and emergency response measures. This study confirms and disconfirms some of the 1996 Heath and Abel conclusions. We found that because concern remains high that risk events are likely to occur and harm community safety, citizens are willing to become knowledgeable of emergency response measures. Such knowledge gives citizens a greater sense of control, which may translate into trust for industry and city emergency response experts. Support for the industry is increased by effective improvements in its operations. Long-term, community-relations programs may empower citizens with knowledge of what to do in the event an emergency occurs.     

Potential for the Abuse of Medication for the Elderly in Residential and Nursing Homes in the UK

ABSTRACT

Abuse of the medication prescribed to the elderly living in long-stay care homes may be perpetrated by a minority of unscrupulous doctors, pharmacists, or home staff caring for the residents. Disorganised practices and homes, poor communications, and sloppy professional practices may create opportunities for over-dosing, errors, fraud, or theft. This article describes the circumstances leading to the potential abuse of elderly residents' medication, and the measures that may be taken to avoid or minimise such abuse from occurring.     

A metahistorical information theory of social change: the theory

Abstract

A new yin-yang metahistorical approach that we call sociohistory is created to explore the possibilities of tracking and explaining social change. For this purpose, a frame of reference is created using Social Viable Systems theory to harness Sorokin's sociocultural dynamics. Epistemological content is enhanced by Frieden's new constructivist information theory called Extreme Physical Information. Its aim is to provide a scientific framework for the metahistory. The coupling of these theories has the potential for explaining and possibly predicting long-term, large-scale or short-term, small-scale sociocultural events. This new theory should be seen as emerging from the convergence of the approaches by Sorokin, Yolles and Frieden.