VA Staff Perceptions of Barriers and Facilitators to Home-and Community-Based Placement Post–Hospital Discharge

This study identifies factors U.S. Department of Veterans Affairs (VA) staff perceived to promote or impede home- and community-based services (HCBS) placement post–hospital discharge among Veterans cared for within the VA. Data derive from 35 semi-structured interviews with staff from 12 VA medical centers from around the country. VA staff reported that Veteran’s care needs and social and financial resources influence HCBS placement. They also reported prerequisites for successful placement, including housing, unpaid informal care, and non-VA services funded privately and by public programs such as Medicaid and the Older Americans Act. Lack of staffing and failure to offer the specific types of services needed limit referral to and use of HCBS. Budgetary imperatives influence the relative availability of HCBS across VA medical centers. Findings highlight patient-, provider-, and system-level constraints that impede successful placement at home and in the community of Veterans in need of long-term services and supports after hospitalization.     

Agency of preservation or change: ultra-Orthodox educated women in the field of employment

ABSTRACT

Within the last two decades, significant changes have been taking place in ultra-Orthodox society in Israel regarding higher education and entry into the workforce. This study examines the socio-religious identity of educated ultra-Orthodox women in light of their entry into the workforce. Findings show that although these women are leading a process of academic and occupational changes in the ultra-Orthodox community, they actually function as agents of preservation, and attest to a rise in their level of religiosity, despite the changes in their lives. Most of them continue to maintain the core values of Ultra-Orthodox society, especially the ideal of a ‘society of scholars’. They do reveal some openness towards the world, but in a limited and controlled manner.     

Exploring sequences: a graphical tool based on multi-dimensional scaling

Summary.  Sequence analysis has become one of the most used and discussed tools to describe life course trajectories. We introduce a new tool for the graphical exploratory analysis of sequences. Our plots combine standard sequence plots with the results that are provided by multi-dimensional scaling. We apply our procedure to describe work and family careers of Israeli women by using data from the Israel Social Mobility Survey. We first focus on some preliminary choices relative to the definition of the sequences: the age span, the length of the sequences and the set of states registered in each time period. We then describe how our plots can be used to gain insights about the main features of sequences and about the relationships between sequences and external information.     

The impact of intermarriage on ethnic stratification: Jews in Israel

We investigate macro-level implications of ethnic/racial intermarriage in one generation on ethnic/racial inequality in the subsequent generation. In our theoretical model, ethnic intermarriage affects ethnic stratification through intergenerational transmissions of socioeconomic status and ethnicity. The effects of ethnic intermarriage depend on the association between ethnic intermarriage and socioeconomic status in the parents’ generation, as well as the association between ethnic (self-)identification and socioeconomic status in the offspring generation. The model suggests that under plausible scenarios, intermarriage may increase socioeconomic gaps across ethnic groups. Thus, the model's predictions temper those of assimilation and melting pot theories, which suggest that ethnic intermarriage unequivocally reduces ethnic inequality.     

My Hot Toddler

This is a commissioned attempt to think-about the intense and intimate reactions my hypertypical toddler, Jasper, evokes with his capable and beautiful body and mind. It is a short meditation on desire, sexuality, gender, and maternal love through the dialectical frame of feminism, queer sensibility, and the dreaded essentialism.     

Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004–2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.     

Fatherhood: Comparison Between Divorced Custodial Fathers,Married Fathers,and Divorced Non-Custodial Fathers in Israel

Paternal involvement and acceptance were compared among 218 custodial fathers, 222 married fathers, and 105 divorced noncustodial fathers. Findings show that the custodial fathers were more involved with their children, coordinated less with their children’s mother, and viewed their children as more difficult than the other fathers. Two regression analyses were conducted. One revealed that greater paternal involvement was predicted by greater self-differentiation, greater sense of having received care from one’s own father, and a less avoidant caregiving disposition. The other showed that greater paternal acceptance was predicted by greater self-differentiation, greater sense of having received care from one’s own father, and a less anxious caregiving disposition. Finally, the findings show that coparenting, social support, and sense of the child as difficult moderated the associations between the fathers’ personal variables and their involvement, but not their acceptance.     

The Mother Stands for the Realm That Must Be Exited

ABSTRACT

Attempts to narrate the experience of the mother consistently and compulsively collapse into her function, always idealized and overinvested. These massive social projections onto the mother quickly become evidence of her multitude of failures, meanwhile leaving her experience forever emptied of any possible substantive point of interest.     

The Tango of Loving Hate: Couple Dynamics in High-Conflict Divorce

This article explores the dynamics of couples embroiled in high-conflict divorce through the theoretical prism of British object relations theory. Such couples are often characterized by primitive object relations, and use splitting and projection as a way of “being in the world.” The fear of the ex-spouse’s retaliation is accompanied by fear of their own destructiveness and a desire to make reparation; however, attempts at reparation at this level of relational functioning rarely achieve reconciliation. In fact, such dynamics create a cycle of terror, retaliation, and failed reparation attempts that in turn leads to further terror, splitting and projection, with the resulting outcome often a high-conflict divorce.