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.     

We've Looked at Care from Both Sides Now: The Effects of Alternative Evaluation Strategies on Study Conclusions

This study uses two studies about the role of managed-care programs in serving Medicaid long-term care clients in Florida to illustrate how different research designs can reach divergent conclusions. Two reports from different groups using essentially the same database to assess the impact of managed care on a group of older Medicaid clients served by a Nursing Home Diversion Program reached different conclusions. The report from Florida's Office of Program Policy Analysis and Government Accountability concluded that the Diversion program saved money, whereas the report from the Florida Policy Exchange Center on Aging at the University of South Florida reached basically the opposite conclusion. Both agreed that the capitation rate was too high. How the policy questions are framed and analyzed can affect the conclusions reached. A variety of factors can influence the apparent effects of programmatic interventions. Evaluations must take relevant confounding variables into account.     

Integrating political activism and a professional career

Psychodynaniic theories, once an essential part of social work education but recently neglected, have been reinvigorated in recent years through contributions from social constructionism, infant research, and intersub‐jectivity. These theories, with their emphasis on multiple perspectives, context, and collaborative relationships allow for important considerations of diversity as well as clients’ strengths and resilience, and can serve as formats for the broadest forms of change. In its contemporary form, psychodynamic theory offers a complex and rich understanding of human behavior and a direction for practice that is utterly consistent with social work values and interests.     

Gay Community Involvement: Its Interrelationships and Associations With Internet Use and HIV Risk Behaviors in Swedish Men Who Have Sex With Men

We measured aspects of “community involvement” chosen for men who have sex with men (MSM) in Sweden (gay places, media accessed, Internet, gay festivals, and social engagement, measured as proportion of gay friends) in two Swedish Internet-based samples from 2006 (n?=?3,202) and 2008 (n?=?4,715). Data showed low to moderate reliability with a moderate (0.57) alpha coefficient. While there is moderate internal consistency, as might be anticipated from measures of actual community involvement, they can be treated as scales. The Internet scale indicated the lowest reliability, perhaps due to respondents having Internet sites of primary choice, rather than a high level of usage across several sites. A hypothesized lack of correlation between traditional domains of the gay community and the Internet did not appear: correlations between the Internet measure and the other measures were positive and significant, but among the lowest correlations obtained between the community measures, ranging from 0.06 to 0.24. Those who use the Internet extensively are less likely to be involved in other aspects of the community. Sexual risk was associated with high social engagement at sexual meeting sites and with Internet use. Gay community involvement, including the Internet community, may be complex and associated with both increase in HIV sexual risk behaviors (by measuring use of sexual risk sites) and preventive measures (HIV testing).     

Perspectives on elder abuse in Greece

The sample for this exploratory qualitative study of Greek perceptions of elder abuse consisted of 43 Greek participants from urban centers and 28 Greeks from a small island village. Participants were asked to provide examples of extreme, moderate, and mild abuse from an adult child toward his/her aging parent. Half of the examples of extreme abuse were various forms of physical aggression. Predominant examples of moderate abuse were psychological abuse and neglect, and at the mild level neglect was the most highly cited category. The most frequently mentioned specific types of elder mistreatment were verbal abuse, psychological neglect, physical neglect, and hitting. There were no gender differences in the kinds of examples that participants gave or the severity they attributed to their examples. Females were more often presented as victims of abuse than males. A negative correlation was found between age and the number of physical abuse examples given overall, and as types of severe abuse.     

Cognitive,social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model

ABSTRACT

In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.     

Rapid Response to a Conjunctivitis Outbreak: The Use of Technology to Leverage Information

Abstract

When an outbreak of conjunctivitis was identified at a rural New England college early in 2002, the college health center medical staff used various information management and communication systems to alert the community to the situation. They called upon the state Department of Human Services and the Centers for Disease Control and Prevention to help them understand and manage the outbreak. Technological systems already in place at the college allowed for rapid collection of data by means of a survey delivered over the Internet and a carriage study facilitated by a Web-based appointment and communication system. Within days, the data were collected and analyzed and an immediate response to contain the outbreak was launched.