Sexual abuse of nursing home residents

1. A new subgroup of rape victims resides in nursing homes. 2. Nursing home victims can suffer both compounded and silent rape trauma. 3. Innovative therapies are needed for treating elder rape trauma.     

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.     

The abuse of children in out of home care

SUMMARY: One of the major paradoxes in child protective services in the United States is that children removed from their homes on protective orders and placed in foster and group care face continued abuse. These children are reported at two to three times the rates of children living with their families. Investigations are performed by the very system that marks placements. In the US, some recommend resolving these problems by withdrawing from the active protection of children in care. Others hold that because children are in the care and custody of the state, and demand a higher standard of care, specialised prevention, identification. reporting and investigation initiatives are necessary to ensure their safety. This has important implications for other countries, especially the United Kingdom with its recent spate of inquiries into abuse in residential care.     

Nursing home ownership: an historical analysis

The need to care for dependent elderly in the United States has been a constant since colonial times. Today, as in the earliest days, most care is provided at home by family members. Personal and health services outside the home are sometimes provided by nursing homes. The nursing home industry is large, dominated by private, for-profit ownership, and receives much of its income from public funds. Why are nursing homes publicly funded? Why are nursing homes privately rather than publicly owned? Why is ownership for-profit or proprietary rather than not-for-profit or voluntary? The answers to these questions are found in the history of social policies in the United States.     

Specialist police units and the joint investigation of child abuse

The last ten years have witnessed a significant shift in the police response to investigations of child abuse. One of the most ‘visible’ manifestations of this shift has been the establishment of specialist units where children can be interviewed, medical examinations conducted and, in some cases, overnight accommodation made available to children and their non-abusive carers. The history of these units in Scotland is summarized in this article, together with a brief outline of their remit and some of the current issues facing them. A closer examination of the way in which Scottish units have responded to the issue of joint child abuse investigations with social workers is made, drawing on evidence from research conducted in Scotland.     

Child sexual abuse suspicions: treatment considerations during investigation

This article addresses what, if any, psychotherapeutic interventions should be provided to meet the emotional and clinical needs of alleged child victims of sexual abuse while they await judicial determinations from the family, dependency, or criminal courts. The discussion emphasizes that to minimize iatrogenic outcomes, professionals involved in sexual abuse allegation cases should carefully establish and maintain professional role boundaries and take on only one role in a case. Professional roles may include an investigative forensic interviewer, court appointed forensic evaluator, and therapist. Special attention is given to complex issues that arise in child custody cases with allegations of child sexual abuse in family court.     

Physical abuse after child protective services investigation and adolescent substance use

The longitudinal pathways connecting physical abuse and substance use in child welfare-involved adolescents, a population with multiple risk factors for substance use problems, remain unclear. This study examined the relation between self-reported physical abuse among adolescents investigated by Child Protective Services (CPS) and later substance use, with a particular focus on exposure to physical abuse after CPS investigation as a potential contributing factor to this relation. Using data from the first National Survey of Child and Adolescent Well-being (NSCAW-I), a path analysis was conducted on a sample of 1079 adolescents aged 11–15 years who had recently been investigated by CPS. At baseline and 18-month follow-up, youths self-reported past-year physical abuse using the Parent-Child Conflicts Tactic Scale and past 30-day substance use frequency. At baseline, youths self-reported current internalizing and externalizing problems to the Youth Self Report. Path analysis revealed no significant relation between physical abuse at baseline and substance use at 18 months. Physical abuse at baseline was associated with higher levels of concurrent substance use and externalizing problems, which in turn predicted higher substance use at 18 months. Furthermore, physical abuse and externalizing problems at baseline predicted physical abuse at 18 months, which in turn was related to higher substance use at 18 months. The findings suggest that physical abuse after CPS investigation contributes to the development of adolescent substance use behaviors. Results indicate a need for innovative efforts to prevent physical abuse after CPS investigation, as well as assessment and treatment of substance use and externalizing problems at the point of investigation, to reduce future substance use in child welfare-involved adolescents.     

Nursing home admissions and long-stay conversions among persons with and without serious mental illness

The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.     

Nursing home administrators' views of volunteers' work in an ombudsman program

This research investigated nursing home administrators' (NHAs) perceptions of visits of volunteers in an ombudsman program in relation to effectiveness and satisfaction. Unlike placements of other volunteers made at the behest of organizations, visits of volunteer advocates, which may be mandated and include evaluative assessments of care, usually do not occur at the invitation of NHAs. Yet, outcomes for administrators are not often studied. Despite research showing stress attributed to interaction with state agencies, questionnaire data from 196 NHAs indicated that more contact between volunteers and NHAs was associated with perceptions of greater effectiveness and satisfaction. Those who found visits infrequent and with little impact rated the work of volunteers as less effective and were less satisfied. Qualitative data describe unexpected benefits of visits that were internal and external to the facilities.     

Shame and guilt in men exposed to childhood sexual abuse: a qualitative investigation

This study examined the experiences of shame and guilt in adult males sexually abused as children. Seven participants attending a service for male sexual abuse completed measures of shame, guilt, dissociation, and childhood trauma history and subsequently participated in a focus group. All participants experienced childhood sexual abuse in the "severe" range and showed elevated scores for shame, guilt, and dissociation. Four superordinate themes with associated subordinate themes emerged: (a) self-as-shame (foundations of self-as-shame, fear of exposure, temporary antidote: connection), (b) pervasiveness and power of doubt and denial (from others, from self, consequences of incredulity), (c) uncontrollability (of problems after disclosure, of rage, of intrusions and emotional pain), and (d) dissociation. Results are discussed with reference to the existing literature and the emerging "self-as-shame" construct, which appeared to encapsulate participants' view of themselves.     

Nursing home satisfaction,biography, and the life worlds of psychiatrically disabled residents

The stereotype of nursing home life as a uniformly dismal experience is pervasive in American culture, but this examination of the attitudes of psychiatrically disabled residents calls this generality into question. Residents in this study exemplified a range of opinions about the nursing home — some were clearly satisfied or dissatisfied, but most were ambivalent. In this paper, I explore the relationship between nursing home satisfaction and individual interpretive activity through the biographies of three residents. I find that how residents made sense of their lives was powerfully linked to their perspectives on nursing home residence. In particular, satisfaction was linked to how each resident viewed his or her illness, institutionalization, and life purpose. Understanding the phenomenological contributors to the meaning of nursing home life is essential to appreciating how it is that residents in the same environment can have vastly different outlooks on their surroundings.     

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.     

皖江城市带调研报告

2007年7月12日到18日,由中宣部原副部长朱厚泽、国家开发银行顾问史善新带队的中国城市科学研究会皖江城市带调研组到安徽安庆、池州、铜陵、芜湖、马鞍山进行了调研,调研组成员有中国城市科学研究会秘书长顾文选、中国人民大学教授叶裕民、山西省城市科学研究会理事长曹昌智、天津市城市科学研究会副会长王明浩、国务院发展研究中心战略发展研究部研究室主任刘勇、国家发改委宏观经济研究院国土经济研究所研究员史育龙、中国城市规划设计研究院区域所教授级城市规划师张文奇等。安徽省建设厅厅长倪虹对此次调研给予了具体指导,副厅长吴晓勤、安徽省规划院副院长胡厚国等同志参与了具体调研。调研后,调研组也提出了调研总报告,调研组成员均撰写了调研报告,其中王明浩撰写的《皖江城市带发展析疑》已于本刊2007年11期先期发表。现本刊将调研组总报告及部分调研组成员的调研报告予以发表。