Land of the Free,Home of the Brave: Voting Accommodations for Older Adults

Voting is a fundamental right for all United States citizens, one that usually continues for elderly people as long as they are alive. As adults age, certain issues regarding voting warrant deeper consideration than in previous years, especially those presenting as a result of impaired sight, hearing difficulty, dementia, or other special needs. What will happen to millions of men and women who have taken the right to vote for granted, but who gradually become immobile or physically impaired? What are states doing to help secure the enfranchisement of an increasing number of older adult voters? The purpose of this article is to address these issues by focusing on the following questions: What has been the historical nature of polling place accommodations for elderly people? What are states doing in terms of accommodating older voters at the polls while ensuring the integrity of the voting process? What effect has recent Help America Vote Act legislation had with regard to polling place accommodations? Our results indicate that accommodations for older voters are being made but are not yet at a level required to serve a rapidly aging population.     

Monitoring Quality of Care in Residential Care for the Elderly: The Information Challenge

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs.     

Old-Age Income Security and Private Transfers in South Korea

We examined the relative contributions of government income support programs and familial transfers to old-age income security in Korea. This issue is critical, as policy reforms are in progress, and the potential crowding-out effect of government programs on familial transfer is at the center of heated debate. Using the 2006 Korean Longitudinal Study of Aging, we found that one-third of the elderly were poor and the contribution of public transfer to income security for the elderly was limited, whereas family, especially children, played a large role both by co-residing and through private transfers. Crowding out is less of a problem for the poor but a sensitive issue for middle-income families.     

The Woodwork Effect: Estimating It and Controlling the Damage

Many patients in home- and community-based services (HCBS) are not people who, without HCBS, would be in nursing homes. Those attracted to HCBS tend to be people who are younger, better supported, less dependent, and more mentally intact than their nursing home counterparts. Studies show that only about a quarter of the clients selected as likely to enter nursing homes within the coming year are likely to do so, even though they receive no HCBS. Of the 43 studies reported, more than two-thirds had rates of control group nursing home admission of less than 20%. Most patients would also be likely to have experienced only a short nursing home stay even if they were admitted. The result: Receiving HCBS reduced nursing home use rates on average by only a small percentage, not enough to offset the costs of HCBS. Moreover, both older and more recent studies show only small to insignificant effects on most adverse patient outcomes.     

Nursing Home Deficiencies: An Exploratory Study of Interstate Variations in Regulatory Activity

This study examines nursing home regulatory activity by the states, assesses interstate variations in the volume and severity of nursing home deficiencies, and explores state-level factors that may account for these differences. Nursing home deficiency citation data over a 5-year period (2000–2004) were obtained from the Centers for Medicare and Medicaid Services. We examined interstate variations in regulatory activity and identified predictors of deficiency volume and severity at the state level (demographics, elected officials, industry characteristics, etc.) using the linear mixed model. Deficiency volume remained stable across the 50 states from 2000 to 2004, while deficiency severity decreased significantly. California had the highest volume of deficiencies per nursing home; Wisconsin had the lowest. New Hampshire had the highest percentage of severe deficiencies; California had the lowest. Higher deficiency volume was found in states with lower median household income, a lower proportion of residents aged 85 and older, and a Democratic legislature. Higher deficiency severity was associated with higher median household income and a higher proportion of Medicaid nursing home residents in a state. In contrast, greater state agency funding, higher state standards for nursing home administrators, and a Democratic and more professional legislature predicted lower deficiency severity. Nursing home residents in the United States receive unequal protection from abuse and neglect, and this is partly due to their state of residence. Interstate variations in deficiency volume and severity are due to a complex set of factors beyond nursing home quality.     

Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

Rosalie Wolf Memorial Lecture: A logic model to measure the impacts of World Elder Abuse Awareness Day

ABSTRACT

This commentary discusses the need to evaluate the impact of World Elder Abuse Awareness Day activities, the elder abuse field’s most sustained public awareness initiative. A logic model is proposed with measures for short-term, medium-term, and long-term outcomes for community-based programs.     

“Capacity Is Key”: Investigating New Legal Provisions in England and Wales for Adult Safeguarding

This study aimed to investigate the views and experiences of local Safeguarding Adults Coordinators of the newly implemented Mental Capacity Act 2005. This legislation in England and Wales has both protection and empowerment as its dual goals. Fifteen Safeguarding Adults Coordinators (SACs) employed by local authorities in the London area were interviewed in 2008, and again 2 years later. A total of 12 SACs participated in the 2010 follow-up interviews. The findings are reported here, covering experiences and views on the implementation and uses of the Act. There was overwhelming support for the Act as enhancing people's rights to a life free from abuse, of providing a framework for the assessment of decision-making capacity, and of assisting practitioners in reducing risks and responding to abusive situations. Participants urged better publicity about the Act, more detailed guidance on the new offenses, and greater attention to the interactions with other government policy goals.     

Evaluation of a Seven State Criminal History Screening Pilot Program for Long-Term Care Workers

This article summarizes results from an evaluation of a federally sponsored criminal history screening (CHS) pilot program to improve screening for workers in long-term care settings. The evaluation addressed eight key issues specified through enabling legislation, including efficiency, costs, and outcomes of screening procedures. Of the 204,339 completed screenings, 3.7% were disqualified due to criminal history, and 18.8% were withdrawn prior to completion for reasons that may include relevant criminal history. Lessons learned from the pilot program experiences may inform a new national background check demonstration program.     

Elder Mistreatment in U.S. Residential Care Facilities: The Scope of the Problem

Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.