Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Resource Dependence and Community Well‐Being in Rural Canada*

Abstract The well‐being of residents of resource dependent communities is a question of traditional interest to rural sociologists. The label “resource dependent” obscures how this relationship may vary between particular resource industries, regions, or indicators of well‐being. Few analyses have compared the relationship between well‐being and resource dependence across different industries, nor tested competing theories about the relationship between resource dependence and well‐being. Our paper presents an overview of the relationship between resource dependence—agriculture, fisheries, mining, energy, forestry—and human well‐being in Canada. Analysis of 1996 Statistics Canada data revealed a great deal of variation in the effect of “resource” dependence on indicators of well‐being (e.g., human capital, unemployment, income): some industries exhibit fairly positive outcomes (e.g., agriculture), others more negative outcomes (e.g., fishing). Consistent with analyses conducted in the United States, these relationships vary by region, suggesting the need for models that incorporate the particulars of place and industry.     

Using a Box–Cox transformation in the analysis of longitudinal data with incomplete responses

We analyse longitudinal data on CD4 cell counts from patients who participated in clinical trials that compared two therapeutic treatments: zidovudine and didanosine. The investigators were interested in modelling the CD4 cell count as a function of treatment, age at base-line and disease stage at base-line. Serious concerns can be raised about the normality assumption of CD4 cell counts that is implicit in many methods and therefore an analysis may have to start with a transformation. Instead of assuming that we know the transformation (e.g. logarithmic) that makes the outcome normal and linearly related to the covariates, we estimate the transformation, by using maximum likelihood, within the Box–Cox family. There has been considerable work on the Box–Cox transformation for univariate regression models. Here, we discuss the Box–Cox transformation for longitudinal regression models when the outcome can be missing over time, and we also implement a maximization method for the likelihood, assumming that the missing data are missing at random.     

THE DISTRIBUTION SECTOR AND THE DEVELOPMENT PROCESS: ARE THERE PATTERNS? YES

Using an increasing returns specification for distribution, an inverted U pattern between the share of distribution in gross domestic product and the level of development is shown to arise. A cross-section time-series data set is constructed and merged with one used to analyze the service sector. In contrast to the rising pattern found for services, an average time-series relation that exhibits an inverted U pattern is established. The empirical results are robust, for example, to choice of functional form and country and time period coverage. A similar pattern is found in the average cross-section (country) relation between distribution and development.     

Nichts genaues weiss man nicht!?

What do voters really know about party platforms and how do they perceive the contents? Are there any relationships between party election platforms and electoral behavior? Despite of much research on parties, there are hardly any answers to these questions. If political parties devise programmes in order to influence political attitudes or electoral behavior, it will be necessary that these programmes are read by people. But it seems to be unclear if and how people do so. This article shows clearly that voters don’t know much about party manifestoes. Still, programmes are more important for voters than many people believe. Programmes are also an important factor for electoral behavior. But there is still a lack of data to get evident results.     

Time and Postmodernism

In this essay we discuss changes in the cultural meaning and significance of time in postmodernism. We begin by examining the experience of time and space in the Middle Ages and its radical alteration following the Renaissance. After a relatively brief period of optimism during the Enlightenment regarding the scientific control over time and space, a new crisis beginning in the mid‐nineteenth century emphasized the increasing disjuncture between external, objective notions of time and the way time was experienced subjectively. We argue that the current literature on time and post‐modernity is best understood in this context, where earlier disequilibriating effects brought about by modern technologies are exacerbated by new developments in transportation and communications technology. Here we discuss the particular effects on topics of interest to social scientists such as changes in notions of personal identity and the effacement of historical time. We conclude with a call for more empirically grounded work on questions concerning time in postmodernism. We lament the paucity of concrete data as well as the excess of useless polemics and recommend several researchers already conducting work in this field.