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.     

Coping Resources and Stress Reactions Among Three Cultural Groups One Year After a Natural Disaster

The aim of this study was to examine patterns of personal and community coping resources in explaining stress reactions among three cultural groups: Jews, Muslims and Druze, 1 year after the massive forest fire on Mount Carmel, Israel. We first compared the three cultures in their levels of personal and community resources as well as their stress reactions: anxiety, anger and psychological distress. Data on demographics, personal and community sense of coherence (SOC), as well as stress reactions of state anxiety, state anger and psychological distress, were gathered a year after the fire in northern Israel, among adolescents aged 12–18 belonging to three cultural groups. Results indicate that the personal coping resource of SOC was the strongest predictor of ‘stress reactions’ in all cultures. Community SOC, however, played a significant role especially for the collectivistic culture of the Druze. We will discuss the results in the framework of Antonovsky’s salutogenic model and his conviction that the personal resource of SOC functions as a protective or resiliency mechanism in all cultures whose members are in a chronic state of stress. Implementation of the findings for establishing interventions for social workers to promote sense of coherence and increase resiliency of adolescents will be presented as well.     

Re-Reading Homonationalism: An Israeli Spatial Perspective

In this article we stress the need for specifically located understandings of the concept of homonationalism, by introducing an analysis of spatial and political power relations dissecting disparate constructions of LGBT arenas. The article explores three spaces: Tel-Aviv—an urban space of LGBT belonging; Jerusalem—the Israeli capital where being an LGBT individual is problematic both in public and in private spaces; and Kiryat-Shmona—a conservative and peripheral underprivileged town in the north of Israel. By showing how local understandings of queer space shape power relations and translate into subjective spaces within wide-ranging power dynamics, we claim that homonationalism cannot be seen as one unitary, consolidated category or logic. Instead, we argue, homonationalism should be considered a multidirectional and multiscale political stance, manifesting cultural practices and political relationship with the state and society in distinct settings. By expanding considerations of the nuanced interplay of state power and LGBT spaces we aim to elucidate some paradoxes of homonationalism.     

HCBS Spending and Nursing Home Admissions for 1915(c) Waiver Enrollees

Medicaid waiver programs for home- and community-based services (HCBS) have grown rapidly and serve a population at high risk for nursing home (NH) admission. This study utilized the Medicaid Analytic Extract Personal Summary File and the NH Minimum Data Set and tested whether higher levels of per-beneficiary HCBS spending were associated with (1) lower risk of long-term (90+ days) NH admission and (2) higher functional/cognitive impairment at admission for new enrollees in 1915(c) aged or aged and disabled waiver programs. Waiver enrollees in states and counties with higher HCBS spending were found to have lower risk of long-term NH admission and greater functional impairment at NH admission compared to waiver enrollees in states and counties with lower spending. This indicates that higher per-enrollee HCBS spending may enable waiver enrollees to remain in the community until their functional impairment becomes more severe.     

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.     

Ede: Race,the Law,and I

In the context of the United States, interpellation is perhaps most visible, even tangible, in the arena of race and racism. Orna Guralnik tells us of Ede, a Nigerian immigrant suffering from depersonalization and struggling to be interpellated out of her postcolonial Blackness. This struggle manifests in the treatment relationship as Guralnik, experiencing her Whiteness, tracks their mutual run-in with racial interpellation at the nexus of class, ethnicity, money, and public power. In showing, also, how interpellation partners with dissociation, this vignette illuminates a dilemma found in many other domains of existence, including—perhaps especially—those central to this journal's focus, gender and sexuality.     

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.     

Development of a lateral mobility task to identify individuals at risk for mobility disability and functional decline

Lateral mobility is integral to many activities of daily living involving transfer from one position to another. The objective of this study was to develop and evaluate the validity and test-retest reliability of a lateral-mobility (LATMOB) task for older adults. Measurements of lateral mobility, balance, and strength and self-reported and performance-based physical functioning were obtained in 63 women and 77 men > or = 50 years of age. The LATMOB task was significantly correlated with age, knee-extensor strength, grip strength, functional reach, and one-leg-stance time. Test-retest reliability of the task was excellent. The LATMOB task was highly correlated with the car task. Balance was significantly correlated with time to get into and out of a car and performance on the LATMOB task. The LATMOB task was significantly correlated with the Short Physical Performance Battery score. The LATMOB task is valid and reliable, but additional work is needed to assess its sensitivity to change and predictive validity.     

From bedside to bench: research agenda for frailty

The American Geriatrics Society sponsored a working conference in January 2004, funded by the National Institute on Aging, to establish the state of the art in frailty research and to set a research agenda for the future. The invited participants included senior basic biologists, epidemiologists, geneticists, and clinical investigators who study aging-related issues. This article summarizes the central theoretical observations on frailty and research needs and opportunities presented and discussed at this conference, and lays out an agenda for future research on frailty.