Nursing Home Deficiency Citations for Safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

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.     

Inconsistencies in reporting the occurrence and timing of first intercourse among adolescents

Two types of reporting inconsistency for sexual initiation were analyzed—event occurrence and its timing—using data from two waves of the National Longitudinal Study of Adolescent Health (Add Health). Overall, 11.1% of those who reported they were sexually active at the time of first interview denied this at the subsequent one. Males of each race/ethnic group had higher percentages of inconsistency than their female counterparts. Being older, not living with parents, or having a highly educated mother was negatively associated with rescinding. Among those reporting sexual experience at both interviews, only 22.2% reported the same date of first sex. On average, teens revised their age at first sex to older ages, and boys, especially African American boys, had large variability in reporting dates, as did teens with lower verbal ability. Seven strategies for resolving inconsistent reports are presented and implications for substantive findings are discussed.     

Indigenous identity construction: enacted upon us,or within us

ABSTRACT

This commentary essay questions, theorizes, explores and grapples with the phenomenon of the creation of racial, social and cultural identity: in childhood as Native American identity is negotiated from others; and in adulthood as Native identity is constructed from within. ‘Indigenous Identity Construction: Enacted upon Us, or Within Us?’ is a commentary piece focused around Native American identity and how it is formed both through childhood and into adulthood. I analyze and interpret my experiences and understanding of my identity formation as an indigenous person- which usually is left out of the socio-political notions of modernity. Conceptualizations from ‘othering’ racial identities are discussed along with indigenous ontologies constructed within land and water. Through metaphorically revisiting past racializing incidents this piece continues working through the idea of othering and induction into whiteness in childhood, but also focuses on how indigenous identities might be constructed and sustained in adulthood. Efforts to model the indigenous assertion of self-determination and decolonizing the mind was used to re-present thoughts on the construction of Native American identity     

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.     

Integrating Participation into Research and Consultancy: A Conservation Example from Arabia

Conservation projects in the Middle East have recently focused on reintroducing extinct mammals into their former grazing lands. The indigenous human populations in these areas—mainly nomadic pastoralists—have been, until very recently, excluded from any part of the information gathering, planning, implementation and management of such schemes. This intellectual and physical exclusion has resulted in hostility, distrust and occasionally sabotage. To succeed, many conservation efforts have had to rethink and redesign their activity. The key concept underlying this restructuring is 'participation'. The term, however, means many things to the various actors involved in conservation research and consultancy and care must be taken to identify its uses and meanings. Looking at recent Syrian government efforts to reintroduce the Arabian oryx into the desert as an example, I examine the major pseudo-scientific assumptions which have underpinned most projects and consultancies in the semi-arid lands of Syria. These positions, I show, have led to an untenable 'no-win' situation for the nomadic pastoralists. Finally I examine the way in which an effort to introduce the concept of participation through a series of consultancies has resulted in some encouraging collaboration between the indigenous human population, the conservation experts, the local government technocrats and higher authorities.     

Capital Dependence,Financial Risk,and Change from the Multidivisional to the Multilayered Subsidiary Form

Students of the modem corporation continue to assume that corporations have the same form as they did before the turbulent 1980s when the economy became increasingly globalized and competitive. Our analysis shows that corporations are changing from the multidivisional form to a multilayered subsidiary form. Previous research showed that most corporations were multidivisional in the late 1970s. However, by 1993, 42% of the largest 100 industrial corporations had one or no divisions. The mean number of divisions per corporation declined from 8.8 in 1981 to 4 in 1993, while the mean number of domestic subsidiary corporations increased from 23 in 1981 to 51 in 1993. Parent corporations are creating a hierarchy of subsidiary corporations. Most of these changes occurred after the mid-1980s change in state business policy. The theoretical framework historicizes the corporation by identifying how capital accumulation constraints and changes in the institutional arrangements (e.g., the state) within which corporations are embedded created motives and behaviors that resulted in a change in the corporate form. Findings from logistic regression suggest that corporations that have low profits, have low working capital, have a decline in dividend payments, and manufacture high-risk, liability prone product lines have an increased probability of change to the multilayered subsidiary form. Our results provide support for the capital dependence perspective.