The development of a CAHPS instrument for Nursing Home Residents (NHCAHPS)

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.     

WORKING CARERS OF OLDER ADULTS

Juggling work and care presents particular challenges to carers and employers. Employers are increasingly under pressure, both from within organizations and from recent government legislation and policy, to develop family-friendly policies to support informal carers in the workplace. Yet existing ‘family-friendly’ schemes and services are still primarily designed for working parents of young children and rarely address the needs of employees who care for older or disabled adults. This paper reports on a study which investigated how working carers and managers in two public sector organizations — a Social Services Department (SSD) and a National Health Service (NHS) Trust — combined their work and caring responsibilities. A multi-method approach was adopted consisting of five phases. First, a profile of the two organizations was established, followed by a short screening questionnaire to all employees to identify who was caring for an older adult over the age of 60. Third, a lengthier postal survey was sent to the 365 carers who had indicated a willingness to participate further. In the fourth and fifth phases, carers and managers were interviewed in depth about their experiences. This paper reports briefly on the survey, but then concentrates in particular on what was said in the interviews about what helps and hinders working carers of older adults. Despite the existence of policies to support carers, our findings suggest that these were far less important than informal support from colleagues and a sympathetic manager in the workplace. Commuting distance between work, home and the older person also posed difficulties for carers, along with inflexible schedules and work overload. Employers are urged to explore these issues further if they are serious about recruiting and retaining employees, and developing the work – life balance agenda to meet the needs of those caring for older and disabled adults.     

The vertical network organization as a specific governance structure: what are the challenges for incomplete contracts theories and what are the theoretical implications for the boundaries of the (hub-) firm?

Departing from the seminal question that Coase raised in his 1937 work, this article discusses and assesses incomplete contracts theories’ analyses of the firm’s boundaries—notably transaction cost theory and the modern theory of property rights—by investigating the case of the vertical network organization (VNO). We perform a theoretical characterization and analysis of the functioning rules of the VNO to shed light on intra-network incentive provisions and coordination mechanisms. Our findings cast doubt on the role that hold-up considerations on the firm’s boundaries play and allow us to question forms of power within the VNO. Finally, we focus on the theoretical implications of the emergence of the VNO. The legal nature of the firm does not match the economic definition of the VNO, which tends to treat the firm as a specific governance structure.     

The place of South African philosophy in the future of South African philosophy

The title of my paper reads like an oxymoron if not downright confusion. However, it is not meant to be an oxymoron and it does not betray my private confusion. It is deliberate and perhaps a bit political. These two words “South Africa” rightly conjure up an image of things that are either in the south of Africa or things that are African in the south. I find the first image deserving of attention for my purposes. Juxtaposing the concerns of academic philosophy in South Africa (the country) alongside the ordinary reference of the term South Africa (and resultant expectations), I seek to argue that the practice of philosophy in South Africa does not sufficiently show South African characteristics. I specifically argue that the practice of philosophy in South Africa is far removed from the place in which it operates. While there are historical reasons to explain this state of affairs, the future of philosophy in this place can only be secured by an active renunciation of the status quo accompanied by a deliberate responsiveness to the philosophical needs of South Africa. It is incumbent on the dominant philosophers to make this renunciation and foster deliberate responsiveness.     

Skills Laboratories and the New Social Work Degree: One Small Step Towards Best Practice? Service Users' and Carers' Perspectives

The new social work degree has a strong emphasis upon the development of communication skills and upon the requirement for Higher Education Institutions (HEIs) to assess students' safety and readiness to practise. The GSCC grants to HEIs to develop skills labs to help with this skills development have been widely welcomed, but not enough work has been done fully to evaluate the effectiveness of such skills labs. There has been some previous evidence to suggest that such projects may even be counter‐productive. This article explores the way in which Staffordshire University has called upon its service user/carer group and a team of practice assessors to work with the academic tutor to devise and carry out a programme of skills training in a skills lab environment for first year students on the new degree. An initial evaluation of this project shows encouraging results for this ‘work in progress’, even though it is still early days.     

Causes of Poverty in Old Age,Not a Structural Failing?

The failures of many nations in Africa to include programs on aging into their national and developmental agendas have put more elderly people in the region at risk of poverty. Adult children are in many cases hampered from providing financial support to elderly parents due to waves of economic difficulties in many of the countries. The views of 36 elderly Nigerians were sought on causes of poverty in old age through key informant interviews. Despite awareness of structural causes, the results point to the direction of belief that individuals also have significant roles in determining their own economic fate in old age.     

Social pensions and policy learning: The case of southern Africa

In the last decade and particularly since the publication of the Millennium Development Goals, social pensions have captured the interest of those concerned with the well-being of older people across that large part of the world where formal, contributions-financed, old-age benefit systems cover only a minority of the population. International organizations have turned their attention to such schemes and some see them as having a valuable role to play. However, information about what they are and how they work, and about their efficacy in meeting the objectives set for them, is still limited. Learning has been taking place not only in the international organizations but also in the region where they are most prominent – southern Africa. Such learning should be encouraged and the International Social Security Association has a part to play in this learning process.     

A note on the paper, “Ranking irregularities when evaluating alternatives by using some ELECTRE methods”, by Wang and Triantaphyllou,Omega (2008)

The paper by Wang and Triantaphyllou [Ranking irregularities when evaluating alternatives by using some ELECTRE methods. Omega, 2008; 36(1): 45–63] (W & T) pinpoints in an interesting way some limitations of ELECTRE II and III methods. The objective of this note is to draw the attention of the reader to a different philosophy of interpreting the results of ELECTRE methods from the one provided by the authors, particularly the different interpretations of the results reported.