Subsidized elderly housing: public-private partnerships on the brink

Starting in the early 1960s, the federal government joined with the private-sector housing developers in a partnership: in return for subsidized mortgages and tax benefits, developers would rent to low- and moderate-income tenants. Today, many elderly people live in these "publicly subsidized" units. The initial agreement, however, held out an escape clause: after 15 to 20 years, for-profit developers that wanted to end the partnership could prepay their mortgages, leaving tenants in those buildings "at risk" of rent increases and/or evictions. This article discusses that partnership, its options for dissolution, and the current solutions to the problem of the expiring agreements, including a moratorium, vouchers, and incentives. The compromise legislation responds to all interested parties--owners, current and would-be tenants, local governments, tax-payers--through a multi-stage sequence of dissolution, yet such a finely tuned, acutely sensitive legislative solution may not work easily or efficiently.     

The double-edged sword of social service contracting: public accountability versus nonprofit autonomy

The increased role of government contracts in the funding of nonprofits has heightened tensions as governments seek accountability and nonprofits seek to preserve autonomy. Considering both sides of the contract market this article suggests that the threat of government funding is exaggerated. Nonprofits are attractive contractor options because of their experience and trustworthiness. Governments should recognize that excessive intrusions limit the advantages of the nonprofit sector. At the same time, nonprofits should be conscious of the implications of public funding, just as they must be of other sources of funding.     

Pastoral care in Candyland. Maintaining power and life in a world of illness

Wrestling with ghosts and staging fatal accidents with Matchbox cars allow a critically ill six-year-old to come to terms with the fears prompted by his illness.     

Our bodies, our families. The family's role in organ donation

The 1968 Uniform Anatomical Gift Act--in keeping with a legal (and medical) concern for individual autonomy--bypassed the family in establishing the legal requirements for cadaveric organ donation, but current practice wisely recognizes a role for families in the decision making.     

Protecting hospital records from discovery

One of the more burdensome tasks confronting hospital administrators and defense counsel in hospital liability cases is attempting to protect sensitive or confidential information contained in hospital records. Plaintiffs' counsel continue to refine and broaden document requests as they become more sophisticated and experienced, learning about additional categories of documents that may be helpful to their cause. There are conditions that protect documents from discovery, but the rules of privilege are complicated and are frequently misunderstood.     

The private practitioner in hospital quality assurance

External forces continue to dictate the necessity of delivering high-quality health care along with methods of proving that the claimed quality is attained. Gone are the days when both the institution and its practitioners could answer quality questions simply by stating that they were delivering excellent health care to their patient population. The federal government, via the Health Care Financing Administration, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are mandating that institutions prove, without question, that they are delivering health care of the highest quality. The essential key to attaining these goals is cooperative private practitioners.     

Informed decision making: the new paradigm

Health care cannot survive in its present form. It is becoming unaffordable for a large share of the country's population. Its quality and effectiveness inexplicably vary between communities and across time. With all these problems, the process of health care can be understood. All that are needed are good, basic data; its access, management, and analysis; and then presentation of facts and observations. Together, these functions describe the translation of data into information--the field of medical informatics. Information about such management concerns as clinical efficiency (which largely is related to appropriateness and cost-effectiveness) and about the realities of day-to-day medical practice can be used to improve the value of health care. Informed decision making is based solely on confidence that, given the right information and understanding, we can all make the right decisions. The right decisions mean better patient acceptance and satisfaction, a sense of value enhancement by payers, and support of the Hippocratic tradition.     

Interviewing from the organization's perspective

Hiring medical professionals is an expensive process. It is important to conduct an effective interview to help you determine the qualifications of a candidate and to persuade the candidate to join your organization if that's what you decide you want.