Long-Term Care Administrators' Perceptions of the Ombudsman Program in the State of Missouri

The presence of a long-term care ombudsman in a long-term care or nursing facility helps prevent abusive or neglectful situations before they start. Almost all Missouri long-term care facility administrators responding to the survey reported that they were aware of the ombudsman program; however, only half currently house an ombudsman in their facility. Respondents aware of the program were significantly more likely to currently accommodate an ombudsman in their facility, and those managing larger facilities were significantly more likely to currently have an ombudsman present. Given the numerous changes in the long-term care system, the need for more ombudsman advocates in this setting is crucial.     

精神残疾群体的社会保障需求与供给:现状、问题与发展建议

精神残疾人多生活困难,构成社会最为弱势的群体。本文采用实地研究与文献研究的方法,对精神残疾人的社会保障需求与供给进行专门考察。研究发现,精神残疾群体的主要需求包括治疗、基本生活支持、康复、长期照护与监管以及社会参与。对此,我国政府已通过多项社会保障制度安排予以回应,基本满足了精神残疾人的基本生活与治疗需求,但还存在社区康复服务匮乏、替代性照护服务供给不足、就学、就业难等问题。基于以上发现,本文认为精神残疾人的基本生存权虽得到较好保障,但是对其发展权和参与权依然关注不足。原因在于当前精神残疾人社会保障存在三个不平衡:经济保障与服务保障发展的不平衡,医疗服务与社会服务发展的不平衡,以及卫健、民政、残联不同部门能力与投入的不平衡。针对这些问题,笔者对未来政策的完善提出了参考建议。     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Can Certified Care Workers Become Long-term Settlers?: Case Study of 49 Filipinos under the Japan–Philippines Economic Partnership Agreement

This article focuses on the first group of Filipino certified care worker (kaigo fukushishi) candidates who joined Japan's caregiving workforce under the Japan–Philippines economic partnership agreement (EPA) in 2009. The arrival of this group marked the start of the arrival of Filipinos specifically to work and study for 3 years in a designated care facility in order to take Japan's unique national board exam in 2013. Based on the follow-up research on 49 of the first group of 190 Filipino candidates, this study examines the lives of those passing the board exam who decided to remain and continue to work in Japan. Being able to transfer to various care facilities for better employment conditions, their quality of life in Japan has improved, while the issues regarding their residential status and reuniting with their family have yet to be resolved.     

Staff-resident interaction in the nursing home: An ethnographic study of socio-economic disparities and community contexts

In recent years, nursing home (NH) researchers have paid increasing attention to socio-economic and racial/ethnic disparities in quality of care. Although there is growing evidence of disparities in resident health outcomes, less is known about the ways in which these differences manifest in care processes from a qualitative perspective. This paper addresses this gap by comparing staff-resident interactions in two urban, non-profit NHs, including roughly 50 staff participants in each facility. The researcher conducted ethnographic observation in one facility serving a white, middle class community and another serving low-income Black and Hispanic clients from an underserved neighborhood. Grounded theory methods generated three categories of interaction—activating, relating, and attending—which were performed differently in the two NHs. In the more affluent facility, staff interacted with residents in a dynamic fashion, adapting to residents’ responses, and they were relatively well equipped with resident-specific information when responding to individual concerns. In the safety-net facility, staff interacted with residents in a one-directional, “didactic” fashion, providing instruction without a mechanism for adapting to residents’ responses, and they were not as well equipped with resident-specific information. These differences reflected disparities between the two facilities in staff communication skills, underscoring the importance of workforce development to enhance the quality of staff-resident interaction and promote resident-centered care. This study raises further questions about the role of neighborhood contexts in shaping organizational processes that influence quality of life for NH residents. Moreover, the study offers a unique contribution to the NH literature by generating a typology of styles of interaction that can be used to develop a conceptual framework for understanding staff-resident interaction in the nursing home. Such a framework can inform efforts to improve residents’ quality of life.     

Nursing home deficiency citations for safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

Nursing Home Deficiency Citations for Safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

Architectural Space in Respite and Intermediate Care: An Actor-Network Theory Analysis

This article presents an analysis of 2 short-term care facilities using actor-network theory with the aim of revealing performative processes in different networks in the buildings in use. The 2 facilities differed in architectural design, which was expected to influence their care model and organization. One facility was larger and accommodated 4 patients/residents in double rooms as well as permanent residents who stayed in single rooms. The other facility was smaller and accommodated only short-term care patients in single rooms. The study revealed that the latter facility received more care-demanding people than the other. The size and the type of patients/residents influenced the social environment. The larger facility was more busy and lively than the smaller one. However, the analysis did not show any difference in quality of care or ambiance. Both facilities were valued as either good or bad by different residents or staff members. The study concludes that therapeutic values and outcomes are defined and redefined in the ongoing performances of everyday interactions.     

Questions I now ask: Spirituality in the liminal environment of assisted living

This article analyzes, through two case studies, how elders in a secular, urban, assisted living facility (ALF), use their spirituality to manage change and loss, and to answer questions concerning the meaning of life and death. This article asks: how does personal spirituality help elders deal with the liminal environment of assisted living in the latter stage of life?This article is based on research that explored the cultural construction of dying and death in long-term care facilities. In-depth interviews were conducted with 22 residents living in an ALF. We offer case studies concerning elders' lived experience of spirituality in order to demonstrate the significance of individual and cohort history and the elder's embeddedness in the culture of assisted living.A key finding of this paper is that elders' spirituality becomes both miniaturized and expanded in the assisted living environment. The miniaturization mirrors the diminishment of their physical world. The expansion reflects the need for a belief system expanded enough to contain the questions asked in this place, at this time of life.     

A New Kind of AIDS: Adapting to the Success of Protease Inhibitors in an AIDS Care Organization

Using a case study analysis of Heath House, a Santa Barbara residential care facility for People Living With HIV/AIDS, this paper examines the effects of protease inhibitors on the life of an AIDS care organization. The case of Heath House reveals that when care providers are committed to static conceptualizations of an epidemic and its victims, and have defined the value of their work in relationship to these conceptualizations, new technologies threaten organizational identity and stability. While prior research on goal displacement has emphasized the process by which an organization's members lose sight of their original goals to achieve greater efficiency or legitimacy, this study offers an example of the process by which members adhere to original goals and ideologies, even when change becomes necessary for organizational survival. This article examines tensions between residents and staff at Heath House that occurred when the very institutional culture that allowed it to thrive became anachronistic as AIDS changed. I explore problems of internal dissent and external problems of legitimacy.     

Culture Change in Aged-Care Facilities: A Café's Contribution to Transforming the Physical and Social Environment

Objective: To discuss the potential of a café on the premises of an aged-care facility as a vehicle for culture change. Method: Secondary analysis of primary qualitative data that explored the value of a café in an aged-care facility, compared with culture-change principles established from a literature review. Results: Secondary analysis established congruence between culture-change principles and the themes established in the primary qualitative data. A café, in one aged-care facility, has facilitated the following dimensions of culture change for residents: individualized care, facilitation of meaningful relationships, opportunities for participation in life roles, and creation of a sense of belonging. Conclusion: Culture change can be achieved through environmental innovations, such as a café, where food and dining maximize social opportunities and create a homelike environment that facilitates continuation of residents' identity.     

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.     

Nursing home administrators' views of their own and volunteer resident advocates' enhancement of long-term care

Volunteers perform much of the work of federally mandated state ombudsman programs which may include review of resident care in nursing facilities to protect against abuse and neglect. Although volunteers' activities may take place in the nursing facility, Nursing Home Administrators' (NHAs) views of their work are seldom studied. Data from questionnaires completed by 199 NHAs predicted enhancement (improvement) of long-term care by volunteer resident advocates. Administrators also described their advice for improvement of care. NHAs' perceptions of residents' pleasure and families' satisfaction with volunteers' visits were associated with enhancement of long-term care. Effectiveness attributed to volunteers' protection of rights and resolution of complaints was not related to perceived enhancement of long-term care. Answers to a number of remaining questions could enhance the efforts of volunteers in ombudsman programs, improve long-term care, and diminish opportunities for abuse.     

Two lives in transition: Agency and context for assisted living residents

This research uses data on two “focal case” individuals residing in one residential care/assisted living (RC/AL) facility, collected as part of a larger ethnographic study exploring later-life transitions, including those leading to the moves into housing and care settings. In-depth examination of the 10-year transition histories of these two women highlights the major erosion of autonomy with advancing frailty, illness, and relocation into supportive housing. A second major theme is that an understanding of the contemporary events and challenges for these two individuals is substantially enhanced by nesting them within the temporal context of earlier life events, including personal relationships, social events, and preferences. Individual history, elicited from resident, family, staff and professional views, serves to contextualize current choices and reactions to key events. As researchers, adding this temporal context moves our understanding of their identities well beyond a simplistic snapshot view as “resident” in AL.     

Reproductions of global security: accounting for the private security household

ABSTRACT

This article shows how private security households exist at the nexus of two foundational logics of contemporary warfare—militarism and neoliberalism. The celebration of neoliberalism and normalization of militarism allow the private security industry to draw upon the labor of eager contractors and their supportive spouses. This article develops a feminist analysis of the role of the private security household in global security assemblages. In what ways are households connected to the outsourcing of security work to Private Military and Security Companies (PMSCs), and how are these connections gendered? Through interviews with female spouses of former UK Special Air Services soldiers, now private security contractors, we demonstrate how the household is both silenced and yet indispensable to how PMSCs operate and how liberal states conduct war. These spouses supported the transition from military service to private security work, managed the household, and planned their careers or sacrificed them to accommodate their husband’s security work. Their gendered labor was conditioned by former military life but animated by neoliberal market logics. For the most part, the women we interviewed normalized the militarized values of their husband’s work and celebrated the freedom and financial rewards this type of security work brought.     

Struggling to do the right thing: stories from people living with Alzheimer's disease

The information presented in this article is meant not to provide answers, but rather to provoke thought about questions related to ethical decision making in people with Alzheimer's disease. Post (1995) suggested that: among the several most urgent questions of our time is whether human beings have in place the moral and ethical signposts that can point toward a future in which those who are so forgetful will be treated with dignity. (p. 1) Because American society places a high value on rationality and productivity, the life of people with Alzheimer's disease may be equated with hopelessness and uselessness. Thus, health care professionals have a moral obligation to rethink the assumptions that underlie their definitions of quality of life. We cannot know what should be done unless we learn to listen to the life stories of our patients and their families. Perhaps Sherry's comment best reflects how, even with devastating changes in a loved one's sense of identity, one can find ways to respect a new level of relationship: I still feel that he's [Sherry's husband] a human being, and I've tried to ensure that he has a quality of life. When I go visit him, sometimes he slips in and out of being normal. I would always hope that he's still treated with the dignity that he should have as a human being.... I guess what I'm saying is that, even though it seems weird,...there's still a human being in there sometimes, I guess there really is, and it's important to remember that. I can enjoy my husband a lot more now [that he's being cared for in a facility] than I could when I had him 24 hours a day. That was a nerve-wracking experience, especially when there were behavior problems.... He's still the love of my life.     

On the edge: Balancing health, participation, and autonomy to maintain active independent living in two retirement facilities

This study examines how independent living residents in Continuing Care Retirement Communities (CCRCs) work to maintain a healthy, active community. Specifically, this paper elucidates how independent living residents, who have high status in CCRCs but also face transitions to more advanced care, manage their daily lives to build a positive sense of community against the backdrop of potential health and social declines. The researcher supplemented four years of observation in one CCRC and two years of observation in another with qualitative interviews with thirty residents from both facilities. Results indicated that shared sentiments contrasting the active social world in independent living with other living units, norms of mutual support balanced with autonomy, social participation as a source of belonging (or isolation), and definitions of deviance surrounding functional health and manners framed residents' understandings of daily life by reaffirming independent living residents' privileged status in each facility.     

Continuing Care Retirement Communities' Response to Residents Aging in Place:

While many administrators of continuing care retirement communities continue to insist that their facilities are for independent residents only, their resident populations are becoming older and frailer, aging-in-place. This paper describes Part 1 of a two part study examining how the C.E.O.s at nineteen Wisconsin C.C.R.C.s responded to a survey about changing characteristics of their resident populations, and how their facility was responding to these changes.     

Chapter 3 Residential Care Facilities for the Elderly

Abstract

Residential Care Facilities for the Elderly (RCFEs), known as board and care homes, are licensed in California and many other states for non-medical care in the community. RCFEs are examined here to provide illustrative issues in the definition of types of long-term residential care. The research examines physical functioning, social supports, and course of residential placement for 109 RCFE residents (mean age 84 years). A significant portion of the residents had personal assistance needs not usually provided at the RCFE level (75% assistance with medication, 52% used walking aids, 29% assistance in bathing). Additionally, a third of the residents had restricted social supports and social activity. Residents report declines in functioning and support as reasons for moving to residential care. Length of residence in the facility (range less than a year to 15 years) was not related to physical functioning or social activity. These findings do not support “aging in place,” within the facility, as the rationale for increased need for assistance in residential care. Implications include the need to maintain the social model of residential care ample for the majority of residents while assuring the availability of a higher need for assistance of a significant portion of the residential care population.