Chapter 5 Impacts of Profit Status of Assisted Living Facilities

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.     

Oregon's Efforts to Reduce Elder Financial Exploitation

ABSTRACT

Several programs have been undertaken in Oregon to reduce financial abuse. They include the production of a multi-media training kit by the Oregon's Attorney General's Task Force with funding from the US Department of Justice, creation of an “Elder Financial Exploitation Prevention Program” that educates seniors “at the scene of the crime,” and distribution of devices to assist elders in ending unwamted phone calls and direct mail solicitations.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Mentoring for Gay and Lesbian Youth

Abstract

Coming to terms with one's sexual identity always has presented a challenge to gay and lesbian adolescents. Older gays and lesbians have useful knowledge to contribute to the younger generation, whose members usually lack role models of successful gay and lesbian adults. Mentoring programs that involve gay and lesbian youth and adults are an important, but overlooked resource for sexual minority youth.     

Chapter 2 Residents in Assisted Living Facilities and Visitation Patterns

Abstract

Resident visitation patterns within an assisted living facility provide insight into a resident's life satisfaction. This study investigated residents' perceptions of family and friend visitation. Thirty assisted living residents from Oklahoma participated in a comprehensive interview that included demographics, life satisfaction, visitation frequency, and perceptions of visitation patterns. A majority of the respondents (90%) perceived family and friend visitation as “important” to “very important” in their life. Visitation allows residents to reminisce with family members and friends, to fulfill the need to have outside contact, and to be reassured that they have not been forgotten. Results indicate residents do desire continued relationships with family and friends through visitation. Facilities should encourage activities involving outside members of a resident's support network and be aware of residents less visited, developing programs creating social contact and involvement.     

Resident and Family Perspectives on Assisted Living

Abstract

This research describes and compares the relative importance residents and family members place on attributes of the environment, the programs, and the policies of assisted living; describes their satisfaction with these features; and identifies factors associated with congruence between residents' and family members' ratings of importance and satisfaction. Both residents and their family members had high importance and satisfaction ratings. Family members gave the assisted living setting lower satisfaction ratings on all features than did residents. Congruence ranged from 34% to 71% for importance items and from 29% to 63% for satisfaction. Female residents, affectionate family relationships, and residing in an AL owned by a chain were positively associated with congruence on importance items, while resident and family education, resident income, and family involvement were negatively associated with congruence on importance items. For congruence on satisfaction items, having an affectionate relationship was positively associated and higher ADL dependency, more family involvement at the facility, and family members who viewed the facility as a safe place were negatively associated with congruence. This study makes a major stride forward because cognitively intact residents' perspectives are compared and contrasted with their own family members' perspectives, thus showing that residents and family members are two distinct groups, each with a unique set of preferences.     

Table of Contents

Senator Rockefeller Proposes Legislation to Regulate Methadone Maker of Vivitrol to Launch Financial Assistance Program for Patients The 8 Criteria for Methadone Take‐Home Doses Caron Tobacco Cessation Program Funded by Phillip Morris Future of Mass. Treatment Programs Depends on Alcohol Tax Breakdown of Governor's Proposed Budget Alcohol Taxes Proposed for Sports and Cities in Indiana Child Abuse/Neglect Increases Risk of Teen Binge Drinking: Study Briefly Noted State News Call for Applications Names in the News Coming up     

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration

Abstract

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration—the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQ Demonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool—the MDS—was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.     

Parallel Process Issues for Lesbian and Gay Adoptive Parents and Their Adopted Children

ABSTRACT

This article is a case study that examines the failures of the social welfare system in failing to prevent homelessness. This article chronicles one family's homeless experience and examines the social policies and programs that affected them. The authors make recommendations for further research and policy implementation for vulnerable populations.     

Quality of Life in Nursing Homes

Abstract

The Nursing Home Reform Act (NHRA) of 1987 established nursing home requirements and dually emphasized quality of care and quality of life outcomes. We researched elders' perceptions of quality of life in nursing homes using focus groups. Analysis revealed four major themes important to residents: generativity, spiritual well-being, homelike environment, and privacy. Themes were used to analyze the disparity between NHRA's goal of dual emphasis and the dominance of quality of care in the treatment of frail elders living in nursing homes. Policies and procedures must be developed that promote decisional control in everyday matters of an older person's life.     

Intergenerational Community Action and Youth Empowerment

Abstract

Empowerment theory can provide a useful framework for the design and evaluation of intergenerational community-building programs. Using an intervention research approach that draws heavily on empowerment theory, the author designed, facilitated, and evaluated an innovative model for intergenerational community engagement involving undergraduate students and older adult residents of an assisted living facility. This “Intergenerational Community Action Group” met at the assisted living facility throughout a school year to engage in group-building activities, to discuss and choose an issue of concern to them in the community, and to plan and implement an action project to address the issue. This article discusses the use of empowerment theory in intergenerational community action and similar programs, and reviews the empowerment outcomes for youth participants in the Intergenerational Community Action Group.     

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.     

The Effects of Organizational Policies on Resident Perceptions of Autonomy in Assisted Living

Abstract

This study examines the effects of organizational policies on resident perceptions of autonomy in assisted living. The sample included 412 residents in 59 facilities. Organizational policies were measured in terms of policies that foster resident choice and control in the facility. Resident autonomy was assessed according to resident perceptions of influence and independence. Hierarchical linear modeling was used to examine the effects of organizational policies on resident autonomy, controlling for facility size, ownership, and level of care. Higher levels of choice-enhancing policies were related to more favorable resident perceptions of autonomy. These findings suggest that allowing residents more choice in their daily routines may contribute to a greater resident autonomy.     

College Smoking Policies and Smoking Cessation Programs: Results of a Survey of College Health Center Directors

Abstract

College students' cigarette smoking rose dramatically during the 1990s. Little is known about what colleges do to address the problem. Health center directors at 393 4-year US colleges provided information (response rate: 65.1%) about college policies addressing smoking and the availability of smoking cessation programs. Of the health center directors surveyed, 85% considered students' smoking a problem; yet only 81% of colleges prohibit smoking in all public areas and only 27% ban smoking in all indoor areas, including students' rooms in dormitories and in private offices. More than 40% of the respondents reported that their schools did not offer smoking cessation programs and that the demand for existing program was low. Colleges need to do more to discourage student tobacco use. Recommended actions include campus-wide no-smoking policies that apply to student residences and identification of new ways of providing smoking prevention and cessation services.     

Geographic Migration Among Residents in Seniors Housing and Care Communities: Evidence From the Residents Financial Survey

ABSTRACT

Although the elderly as a while show relatively little geographic migration in the U.S., we were interested in the geographic migration patterns among a specific subset of elderly that we know have moved out of the traditional family home—those living in assisted living and independent living communities. We analyze data from the Residents Financial Survey, a survey of 2,617 residents in assisted living and independent living communities that asked about their previous living arrangement, where they lived before moving to their current community, and how their care needs were previously met. We find there is substantial migration among respondents. Using self-reported and community-reported location and zip code information, we calculated whether people moved across state lines and we computed the distance people moved between their previous location and their current community. While the median distance moved is less than 10 miles, 20% moved across state lines and 21% of the sample moved more than 100 miles, with the average distance moved among the sample being 165 to 190 miles. The evolution of living arrangements shows that there are strong correlations among respondents' current living arrangements, previous living arrangements, and their plan to move in the future.     

Housing Canada's Oldest-Old: Correlates of Their Residential Status

ABSTRACT

The authors examined determinants that contribute to keeping Canada's oldest-old (those 85 years and older) living in their own homes by focusing on determinants associated with living in certain types of homes. Multivariate logistic regression was done on a sample of 722 community dwellers aged 85 years and older from the 2001 Participation and Activity Limitation Survey. It was found that gender, marital status, and financial status determine residential status of the oldest-old and that high and low levels of mobility and instrumental activities of daily living foster community living. Previous findings suggest a trajectory of social exclusion (from house to apartment to facility). The current study shows the oldest old as socially stable, living in their homes. New policies to support their residential status and modifications to old policies are critical.     

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.     

Parent adoption and implementation of obesity prevention practices through building children's asking skills at family child care homes

BackgroundEarly childhood education programs provide a setting to reach children and parents to modify home environments to prevent obesity. The Healthy Opportunities for Physical Activity and Nutrition Home (HOP’N) Home project was a novel approach that linked Family Child Care Homes (FCCH) to home environments by developing children’s asking skills for healthful home environmental change through curricular activities.ObjectiveTo evaluate the feasibility of engaging parents in obesity prevention practices through building children's asking skills at FCCH.MethodsFCCHs (n = 5 settings) and children (n = 25; aged 3−5 years; female = 36 %; non-Hispanic white = 91 %; low socioeconomic status = 28 %; overweight/obese = 52 %) and parents (n = 25) participated in a pre-post cohort design. We assessed children's body mass index and self-report variables at three time points. HOP'N Home included continuous staff training, group time, dramatic play, meal prompts, songs, and home activities.ResultsFCCH providers implemented 83%–100% of intervention activities. All parents (100 %) adopted the program, most (87 %) returned completed homework activities to FCCHs, and over 90 % implemented changes in the home. Percent of overweight/obese children decreased from pre-intervention (50 %) to post-intervention (29 %,p = 0.06) and follow-up (38 %,p = 0.06).ConclusionsIt is feasible to build children's asking skills and pair this strategy with home activities to engage parents to prevent obesity.