Unlicensed care homes in the United States: a clandestine sector of long-term care

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 17 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies, and practices that might influence UCH prevalence are discussed.     

Profiles of African American College Students’ Alcohol Use and Sexual Behaviors: Associations With Stress,Racial Discrimination,and Social Support

Though studies show that alcohol use and sexual activity increase during emerging adulthood, few studies examine within–ethnic group differences, particularly among African American college students. This investigation utilized a latent class analytic methodology to identify risk behavior profiles of alcohol use (frequency and amount of alcohol consumed), sexual activity (number of intimate partners), and co-occurring risk behaviors (drinking before sexual intercourse) among 228 African American college students. This investigation also examined whether identified risk behavior profiles were associated with stress (interpersonal, intrapersonal, academic, and environmental), experiences of racial discrimination, and social support (from family, friends, and the college community). Results identified five distinct profiles within this sample: (a) High Sexual Risk—above-average sexual activity; (b) Abstainers—below-average alcohol use and sexual activity; (c) Low Risk—average alcohol use and sexual activity; (d) Alcohol Risk—above-average alcohol use and below-average sexual activity; and (e) Co-Occurring Risk—above-average alcohol use and sexual activity. Identified profiles differed across interpersonal and environmental stress, and self-reported frequency of experiences with racial discrimination. Implications for prevention programs and interventions aimed at reducing alcohol and sexual activity for African American college students are discussed.     

Medicaid Beneficiaries' Access to Residential Care Settings

Residential care settings (RCSs) are community-based housing and supportive services providers. Medicaid beneficiaries' access to RCSs is of concern to policymakers and other stakeholders because most people prefer community-based to institutional services and RCSs are generally less expensive than nursing homes. To better understand Medicaid beneficiaries' access to state-licensed RCSs, we examined Medicaid policies in 50 states and the District of Columbia, interviewed seven subject-matter experts, and conducted four state case studies informed by reviews of state policies and interviews with 27 stakeholders. Factors identified as influencing Medicaid beneficiaries' access to RCSs include Medicaid reimbursement rates for RCS services, the supply of Medicaid-certified RCSs and RCS beds, and policies that affect RCS room and board costs for Medicaid beneficiaries. Shifting Medicaid spending toward community-based instead of institutional care may require attention to these interrelated issues of RCS payment, supply, and room and board costs.     

My Village Is Dying? Integrating Methods from the Inside Out

The purpose of this paper is to confront the notion of “decline” at the village level by illustrating a more immersive approach to sociological and demographic research within rural and remote communities. The research uses case studies of three villages in Australia, Canada, and Sweden, all of which have been labeled as “declining villages,” typified by population loss, an aging population, high rates of youth outmigration, and loss of businesses and services. This paper argues that focusing solely on quantitative indicators of demographic change provides a narrow view of rural village trajectories and ignores subtle processes of local adaptation that are hidden from quantitative data sets. Our research integrates quantitative data from the “outside” with qualitative data from the “inside,” including visual ethnography, to develop a more balanced perspective on how villages have been changing and what change could mean locally. These objectives are accomplished by revisiting a Dirt Research methodology applicable to a broad range of research into rural and remote villages.     

Reactions to a partner-assisted emotional disclosure intervention: direct observation and self-report of patient and partner communication

Partner-assisted emotional disclosure is a couple-based intervention designed to help patients disclose cancer-related concerns to their spouses-partners. We previously found that, compared with an education/support control condition, partner-assisted emotional disclosure led to significant improvements in relationship quality and intimacy for couples in which the patient initially reported holding back from discussing cancer-related concerns (Porter et al., 2009, Cancer, 115, 4326-4338). The purpose of this study was to examine the process data from couples who participated in the disclosure sessions including (a) observational ratings of couples' communication during the sessions; (b) couples' ratings of their communication during the sessions; and (c) associations between participants' observed communication and their baseline psychological/relationship functioning. As rated by trained observers, couples' communication was in the moderate range of adaptive skills. Self-report data indicated that participants had positive perceptions of their communication. Observational and self-report ratings were weakly associated. Patients reporting lower levels of relationship quality, higher levels of holding back, and higher partner avoidance at baseline were rated by observers as more expressive during the sessions. Overall, these findings suggest that the intervention was acceptable to couples and was particularly helpful for patients who had difficulty talking with their partners on their own without skills training.     

‘Imposed unknowns’: a qualitative study into the impact of Independent Living Fund closure on users

The Independent Living Fund (ILF) was a non-departmental public body funded by the Department for Work and Pensions. An efficient and popular system of support, the ILF enabled 46,000 people between 1988 and 2015; however, in 2015 the Fund closed and local authorities (LAs) assumed sole responsibility for supporting former ILF users. This article presents the experiences of 12 former ILF users as they transition from ILF to LA support. We focus on participants’ experiences of ILF and LA support, their transition from ILF to LA support, and the emotional impact of transition. Participants were universally positive about their dealings with the ILF, whilst nearly all were worried about LA provision. For most participants, the process of transfer was not smooth; participants received insufficient information and poor communication from LAs. Participants expressed anxiety and uncertainty over the future and these feelings were exacerbated by the actions of LAs during transfer.     

Household and economic factors associated with geographic and school mobility among low-income children

Child poverty has been shown to have lifelong consequences, and several policy interventions have sought to alleviate its effects. However, federal school policy insufficiently addresses ‘out of school’ factors, including high rates of residential and school mobility among poor students. The detrimental effects of school mobility on achievement and classroom behavior have been well documented, but the literature on the household dynamics associated with residential and school mobility among the poor is limited. This study uses detailed administrative data from Oregon's Supplemental Nutrition Assistance Program to provide more information on residential and school mobility among low-income children of early elementary school age. Changes in household composition, income, employment, residential address, and school catchment were analyzed over several years to measure the relationship between mobility and household dynamics. We find that Oregon children from low-income families have high rates of residential and school mobility and that family dynamics rather than economic opportunity appear to increase the probability of moving. We offer several policy recommendations in light of the findings.     

Graying of U.S. Bankruptcy: Fallout from Life in a Risk Society

As neoliberal ideology and policies gained a foothold in the early 1980s, the social safety net for older Americans contracted. Responsibility for the risks associated with aging, namely retirement income and healthcare costs, was increasingly transferred from the state to the individual. Using data from the Consumer Bankruptcy Project, we report that since 1991, there has been more than a twofold increase in the rate at which older Americans (age 65 and over) file for consumer bankruptcy and an almost fivefold increase in the percentage of older persons in the U.S. bankruptcy system. This magnitude of growth is so large that the broader trend of an aging U.S. population can explain only a small portion of the effect. Respondents report that inadequate income and unmanageable healthcare costs are the chief reasons for their bankruptcies. Our findings suggest that neoliberal policies that offload healthcare costs and retirement savings onto older Americans may facilitate their bankruptcy filings.     

What was the Dust Bowl? Assessing contemporary popular knowledge

This article reports on an assessment of contemporary popular knowledge and perceptions of the American Dust Bowl of the 1930s. In a region prone to recurrent drought and evolving resource issues such as the depletion of the Ogallala Aquifer, it follows that knowledge of the Dust Bowl can contribute to understanding and dealing with contemporary and future challenges to the human–environment dynamic of the region. An age-stratified sample of residents from 93 Great Plains counties provided their understandings of the three Dust Bowl concepts (era, event, and region) via questionnaire. When compared with the academic record on the subject, significant variation between respondent age groups was identified. Successively, older generations of the historic Dust Bowl region maintain higher degrees of knowledge than their younger counterparts, regarding this exceptional chapter of American environmental history. This record of knowledge erosion not only speaks to the necessity of enhancing Dust Bowl educational resources, but can be utilized to underscore the salience of studying and documenting adaptive strategies to drought on the American Great Plains.