Culture Change in Skilled Nursing: An Exploratory Comparison of a Traditional Home to a New Model

Abstract

The culture change movement has pushed for reform for more than two decades to align policy, the long-term care industry, and resident preferences with regard to care. Evidence from research indicates that culture change has the potential to improve quality in nursing homes. There is no one-size-fits-all way to implement culture change; however, there are key elements and associated concepts and models. A common thread is that they run counter to the medical model, typically found in nursing homes, where care is provided in a hospital-like setting according to the schedules and routines of physicians and staff with little resident input. This qualitative study looks for evidence of culture change in a traditional model of care compared to a newer culture change model, by describing the differences in practices associated with the medical model, person-centered care, and person-directed care between the two settings. Our results indicate that there is evidence of person-directed care in one model of culture change—the Green House home—but not in the traditional nursing home. Future studies should examine other culture change models to compare the differences in the utilization of person-directed care. This information will help to clarify the definitions and concepts of culture change, along with developing best practices for future culture change models.     

Family Members' Reports of Abuse in Michigan Nursing Homes

The objective of this article is to describe abuse and neglect of adults age 65 and older in Michigan nursing homes, as reported by members of their families. Using list-assisted random-digit dialing, data on abuse and neglect for a 12-month period were collected from individuals who had a relative age 65 or older in a Michigan nursing home. Of the nursing home residents represented in this analysis, the majority were female, Caucasian, and widowed. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of these data with data from the National Ombudsman Reporting System suggests that family members constitute a sensitive source of data on abuse in nursing homes.     

The Effect of Care Setting on Elder Abuse: Results from a Michigan Survey

This study compares abuse rates for elders age 60 and older in three care settings: nursing home, paid home care, and assisted living. The results are based on a 2005 random-digit dial survey of relatives of, or those responsible for, a person in long-term care. Nursing homes have the highest rates of all types of abuse, although paid home care has a relatively high rate of verbal abuse and assisted living has an unexpected high rate of neglect. Even when adjusting for health conditions, care setting is a significant factor in both caretaking and neglect abuses. Moving from paid home care to nursing homes is shown to more than triple the odds of neglect. Furthermore, when computing abuse rates by care setting for persons with specified health conditions, nursing homes no longer have the highest abuse rates.     

The Relation between Accounting Conservatism and Corporate Social Performance: An Empirical Investigation

Accounting conservatism and corporate social responsibility have received much attention in the recent literature. The current study draws upon Watts, who recognizes that one role of conservatism is to reduce the likelihood of excess wealth transfers to its stakeholder groups and Post et al., who assert that a key aspect of positive corporate social performance is the (equitable) distribution of corporate wealth. Accordingly, this study empirically investigates and finds a positive relation between conservatism and strong social performance.     

Nowhere to go: Housing pathways of college students with foster care and homelessness experience

This study builds on previous research to understand longer term housing experiences in late adolescence and early adulthood for vulnerable college students. Using a biographical, qualitative method, we study high school and college housing and family circumstances for 27 students with homelessness or foster care experience enrolled in 4-year colleges in Georgia. We identified three different housing pathway types in high school—family homelessness, unaccompanied youth and foster care. Housing instability and frequent moves were common in high school among all housing pathway types. In college, students who were able to find low or no-cost housing and those who identified a foster care pathway in high school achieved greater housing stability. Others students experienced a continuation of housing instability that began in high school. Additional funding to cover the cost of on-campus housing would likely contribute to increased stability. Additional strategies, such as rental assistance programmes tailored for college students, may be needed to address housing instability for vulnerable college students. More research on the unmet housing needs and the consequences of housing instability during college for homeless and foster youth is needed to further a housing policy agenda that focuses on practical solutions.     

The Psychological and Health Consequences of Caring for a Spouse With Dementia: A Critical Comparison of Husbands and Wives

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.     

Perceptions of Substance Abuse on College Campuses: Proximity to the Problem,Stigma, and Health Promotion

For college students recovering from substance addiction, the path to sobriety is fraught with challenges. Many campuses offer recovery support resources, but students indicate stigma associated with recovery prevents them from using these services. This problem could be ameliorated through communication campaigns addressing misperceptions of substance abuse and recovery. The purpose of this study was to understand how students’ perceptions of addiction and recovery vary based on their experience and background. A quantitative survey was employed to examine stigma beliefs among 2 subpopulations of college students at a large Southwestern university. Findings indicate students with exposure to issues surrounding substance abuse and recovery held fewer stigmatized beliefs, emphasizing the importance of identifying and researching a target audience before developing a health promotion campaign.     

Misconceptions about strength exercise among older adults

The purposes of this study were to determine current opinions of strength exercise among older adults and whether knowledge of recommended protocols differs between strength-exercise participants and nonparticipants. One hundred twenty-nine older adults (77.5 +/- 8.6 years) responded to questions about their opinions, experiences, and knowledge of strength-exercise recommendations. Some misconceptions were identified in the sample, with 48.4% of participants responding "no" to "strength training increases muscle mass," 45% responding "no" to "increasing weight is more important than number of repetitions for building strength," and 37% responding that walking is more effective than lifting weights at building muscle strength. The number of correct responses was related to the number of years in school (semipartial r(2)= .046). More education is needed about the benefits and recommendations to ensure proper use of current strength-exercise protocols among older adults.     

My Body,Your Body: Speaking the Unspoken between the Thin Therapist and the Eating-Disordered Patient

As thin therapists, who work with eating-disordered patients, we have found that our bodies have an appreciable impact on the treatment. In this article, we discuss issues of transference–countertransference, disclosure, the use of the therapist’s self including the body, and the vicissitudes of the treatment. Patients use the therapist’s thin body in various ways: as evidence to support a number of distorted beliefs and assumptions; as a target of envy; as a container for projections and fantasies. We illustrate through case examples, the importance of including the therapist’s body in the therapeutic dialogue, so that it can be used as a tool, rather than a barrier to recovery.