Impact of Regulation and Financing on Small Board-and-Care Homes in Maryland

ABSTRACT

States use forms of regulation in small board-and-care homes to control quality; however, quality varies in spite of these efforts. This study of 94 small facilities compared quality of care measures in homes regulated by a state-administered program with those in nonregulated homes. It also compared homes on those variables using average payment for services as the independent variable. Results indicate that higher payments for services had a greater impact on quality than did participation in a regulatory program. Adequate funding may be key to maintaining reasonable quality in these homes.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Detouring Nursing Home Entrants

Under the Omnibus Budget Reconciliation Bill of 1981, states can apply for waivers to underwrite nonmedical home care services for Medicaid clients who would otherwise enter nursing homes. Ideally, subsidized home services should improve the quality of life for older people, relieve the demand on nursing homes, and reduce overall Medicaid expenditures; yet in Rhode Island the program has served few people. This discussion proposes reasons for the minor impact of "waiver channeling."     

The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Race and gender differences in the distribution of home and community-based services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Church suppers,pony tails and mentors: Developing a program for street kids

Increasing number of teens are leaving their homes to live on the street, and communities are often confused as to how best to provide services for them. This article describes one community's response to this and the lessons learned. The program, its development, the services and the communication with other agencies are described.This research was funded in part by grants from the Juvenile Justice Delinquency Prevention Funds.Ms. Roloff is affiliated with the program, Crosswalk.     

State “Technical Assistance Programs” for Nursing Home Quality Improvement: Variations and Potential Implications

To improve nursing home quality, many states have developed “technical assistance programs” that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.     

Separation and loss: Assessing the impacts on foster parent retention

Foster family homes are utilized as the primary substitute care arrangement for over one-quarter million dependent children annually in the United States. An unsuccessful retention of foster family homes permeates the country's foster care system, thus requiring a determination of the major factors which contribute to foster parent retention or loss. To this end, a comparative census survey of a statewide foster parent population was conducted. When respondents from currently licensed homes were compared with those previously licensed on factors pertaining to the separation and loss experience, significant differences were found in two major dimensions: (1) training and (2) agency services and supports. Both dimensions were indicated to be viable factors of foster parent retention.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

A review of private residential care in Hong Kong: implications for policy and practice

Hong Kong government policy encourages and facilitates families to care for their older members as long as possible by providing families and their older relatives with community support services. Residential care for the elderly is viewed as a last resort. Due to the inadequate supply of community support services, the long period of care required, and the gradual breakdown of values of filial support, families may increasingly give up their caring roles and seek residential care for their dependent elderly relatives. A shortfall in subsidized residential care may lead to needy elderly persons' being cared for in private residential facilities. The demand for private residential care is projected to increase, despite criticism about the standard of care provided. Although an Ordinance, a Regulation, and a Code of Practice for residential care homes are in place to control, monitor, and upgrade private residential care in Hong Kong, problems remain that put the elderly at risk of receiving substandard services. These include the existence of substandard private aged care homes operating either with or without a license; the provision of substandard "places" to the elderly under the government's "bought place" scheme and "enhanced bought place" scheme; ineffective inspection; a lack of grading to indicate the quality of private aged care homes; and a general neglect of the quality of care. We provide recommendations to address these concerns. This requires paying attention to both the quality of care, as well as to the physical environment of homes.     

The role of housing in the transition process of youth and young adults: a twenty-year perspective

Lighthouse Youth Services in Cincinnati, Ohio, began placing foster youth, ages sixteen to eighteen, in individual apartments and other living arrangements in 1981 as a way of preparing them for life after foster care. The program has assisted over thirteen hundred youth and their children using scattered-site apartments, shared homes, roommate situations, host homes, and subsidized housing. The agency works with referring agencies to develop a transition plan one youth at a time and allows youth to move along a continuum of housing options depending on their level of functioning and behavior. Aftercare services assist youth for years after they leave custody. This chapter includes some case studies and summarizes the author's observations from running the program for the past twenty years.     

“Dirty” research in “real” places: A practitioner's guide to program evaluation in the human services

Traditional models of evaluation have often fallen short of their potential for improving services to clients. Using illustrations from a study of client turnover in group homes for troubled youth, this paper discusses practical ways to increase the impact of program evaluation in human service settings.     

Race and Gender Differences in the Distribution of Home and Community-Based Services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and commnunity characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services– whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black womcn to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homcs are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

A study of performance indicators and Ofsted ratings in English child protection services

This paper presents new findings from a study of performance measures for children in need and child protection services in England. National datasets and census returns from 152 local authorities over a 13-year period were combined in order to analyse trends and correlations in quality indicators. The study also explored the relationship between these measures and inspection ratings from the Office for Standards in Education, Children's Services and Skills (Ofsted), with a particular focus on services rated as inadequate. The available quality measures mainly focused on the timeliness of work processes, but these did not seem to affect outcomes in the form of re-referral rates. However, re-referrals were higher in local authorities with a tendency to close cases quickly and in those with high rates of agency workers. A small number of indicators were able to predict an inadequate Ofsted rating in 2012 and 2013. Changes in performance measures in the year following an inadequate Ofsted rating may suggest greater use of protective interventions compared with similarly performing local authorities. Implications are considered for performance measurement, management and inspection in the field of child protection.     

Linking structure, process, and outcome to improve group home services for foster youth in California

The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service were studied: structure, process, and client outcomes, specifically residents' increase in developmental assets leading to the ability to transition successfully to independent living by the age of 18 years. Data were collected at 32 group homes from 127 residents and 72 staff members using three questionnaires. Both structural and process aspects of services influenced residents' satisfaction with services. However, only the process of care predicted changes in residents' developmental assets. State-level regulatory agencies learned from these results that auditing only structural aspects of services was not sufficient to promote effective services. Further, one structure item and two process items were identified as less consistently occurring in the group homes: timely distribution of clothing allowances, healthy communication between staff and youth, and staff support of regular exercise for the residents. Focusing on these aspects of service first should promote more change in outcomes and satisfaction for foster youth residing in group homes.     

Old-age homes and services: old and new approaches to aged care

Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.     

Old-Age Homes and Services

Summary

Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve non-aged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.     

A parent aide program: record keeping, outcomes, and costs

As the use of parent aides grows, it is important that plans for developing and administering the services be carefully drawn to enhance the service. The record-keeping system described here evolved in direct response to program objectives and has helped maintain those objectives. It should be emphasized that although the procedures involved appear time consuming and perhaps troublesome, they play an important part in saving program time overall and making an effective service available to as many clients as possible. When the costs of parent aides are compared with those of other services, the results show that the time-limited, goal-oriented focus of this program allows effective services to be delivered economically.