Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change

Components of nursing home (NH) culture change include resident-centeredness, empowerment, and home likeness, but practices reflective of these components may be found in both traditional and “culture change” NHs. We use mixed methods to examine the presence of culture change practices in the context of an NH’s payer sources. Qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation. Findings indicate that heightened coordination of Medicare and Medicaid could influence NH implementation of reform practices.     

Rethinking certification theory and the educational development of the United States and Germany

This essay places work certification at the center of all modern educational regimes. I sketch the growth of the education, training, and certification systems of the United States and Germany in new ways, highlighting the role of their highly divergent certification regimes in shaping them. Whereas Germany's education and training system, anchored in the economy through employers’ associations and unions, accords well with human capital models, American practice, governed primarily by academic interests divorced from the economy, fits much better with credentialist theory. I consider how the absence of meaningful work certification at the secondary level in the US negatively affects educational justice and has encouraged the creation of a costly, inegalitarian system of higher education. Finally, I conclude with an assessment of human capital, signaling, control, and credentialist theories of certification, one that finds them all to some degree wanting.