Florida's Efforts to Improve Quality of Nursing Home Care Through Nurse Staffing Standards,Regulation, and Medicaid Reimbursement

Between 1999 and 2007, Florida implemented two initiatives combining legislative, regulatory, and reimbursement strategies to increase nurse staffing levels in nursing homes to improve quality of care. Despite a $40 million incentive package allocated for direct-care staffing, per-resident-day staffing increased only after legislative requirements mandated minimum nursing hours per resident day. Total Medicaid expenditures grew by $1.1 billion over the 8 years; per diem rates increased 65% to reimburse providers' costs. Registered nurses' hours decreased, while licensed nurses' and paraprofessionals' hours increased. This article describes the impact of staffing policy changes, includes stakeholders' views about approaches to achieve quality outcomes, and documents state policy implementation efforts. Seven lessons from the implementation of state nurse staffing standards to improve quality of care outcomes are also presented.     

Nursing Home Ownership

Abstract

Following the Second World War, the idea of the life course with distinct periods of education, work, and retirement became popular as a result of the alliance of interests of unions and management, with politicians seizing the opportunity to accommodate them. These “social partners” implemented benefit rules and created practices for using old age and disability to ease the exit of older workers. Although justifiable at the time, now those rules and practices hinder individual and employer incentives to invest in human capital and work environments that enable older workers to remain in the workforce. The article argues that the workforce environment of the coming half-century, which is relevant for persons born around 2000, is much different from that a hundred years earlier, which determined the opportunities for people born around 1900. People are healthier and live much longer and work environments are friendlier. The article argues that it is no longer justifiable to subsidize exit from the workforce around the age of 60 for healthy workers, especially in view of the coming labor shortage in Europe. It also argues that the introduction of the principles of the Swedish NDC pension reform in Europe would provide possibilities for flexible exit from the workforce and remove impediments to labor mobility in Europe, which are embedded in many of Europe's present pension arrangements.     

Ethical challenges in researching in group homes for people with severe learning difficulties: shifting the balance of power

Our aim in this paper is to open up debate about informed consent. We do this by presenting stories from group homes where staff have frustrated our research efforts and marginalised the interests of people with severe learning difficulties. We problematise normative ethics and argue that in some circumstances the basic principle of informed consent should be waived for employees of human service organisations. We maintain that, in such circumstances, researchers and an organisation’s senior managers can still act in a manner that is consistent with the broad aims of ethical regulation. We consider the role of Research Ethics Committees and suggest that in order to fully consider the conflicting interests of multiple stakeholders, the application of different ethical theories is required. A requirement for making balanced ethical judgements is to see outside the extant dominant view of ethical research standards and behaviour.     

Social Work Student Interest in Nursing Home Employment: A North American Study

Nursing homes (NHs) are a primary setting for gerontological social work; yet, little is known about social workers' career interest relative to this setting. This article reports the findings of an online survey of social work students (177 US and 91 Canadian) that sought to identify personal characteristics and beliefs that influence NH employment intentions. Students who were enrolled in bachelors programs, lacked previous practice experience, and had already had a NH field placement or wanted this experience were more likely to express employment intent. The implications of these findings for social work education and research are discussed.     

Theorizing Sexuality, Sexual Abuse and Residential Children's Homes: Adding Gender to the Equation

This article is primarily concerned with emphasizing the importanceof gender in relation to understanding and responding to sexualityand sexual abuse/exploitation issues within residential children’shomes. Initially, past research and inquiry reports are analysedand evaluated, not only in relation to their overall conclusionsand recommendations, but also with regard to their consideration,misrepresentation or omission of gender issues. A theoreticalframework is then drawn up which takes into account historicaldebates and contestations around notions of gender. This illustrateshow gender is frequently conflated or merged with understandingsabout sex and sexuality. This theoretical conceptualizationis then extended to consider the effects of the social constructionof childhood and childhood sexuality, and how sex, gender andsexuality may commonly be represented and understood withinorganizational, public-sphere contexts. Important findings froma recent indepth qualitative research project focused on sexualityissues in children’s homes are then presented thematicallyand through narrative excerpts. These findings are also locatedwithin and made comprehensible in relation to the theoreticalframework previously constructed. The conclusion examines theimplications of the findings presented and their theorization,and briefly evaluates the usefulness of recent policy initiativesintended to improve the care and development of ‘lookedafter’ children.     

民营养老机构中的老年虐待:表现、原因和对策

随着老龄化进程的加剧以及核心家庭的迅速增加,机构养老成为部分老年人主动或被动的选择.然而大多数入住民营养老机构的老年人在一定程度上遭受了暴力虐待,这些暴力可以粗略划分为软暴力和硬暴力.机构护工个人素质不高、机构缺乏监管、老年人子女的疏忽都是导致老年人虐待发生的原因.缓解对策主要包括:一是要完善相关法律法规和制度建设,二是民营养老机构要加强监管和控制,三是护工要提高个人素质和技能,四是老年人的子女要加强对老年人的关注,五是老年人要加强自我保护,寻求积极干预,六是要加强第三方的监督和评估.     

Latinas in Treatment

Abstract

This study analyzed secondary data collected from a recovery home specifically for Hispanic female substance abusers, and from four other recovery homes. Demographics, drug use history, and length of stay were compared to determine if participants of the culturally specific home remained in the program longer, and the reasons why. Results indicated that the women in the Hispanic recovery home stayed over a month longer and were more likely to be poor, unemployed, and methamphetamine or heroin addicts. Regression analysis was used to determine how these and other characteristics predicted length of stay, a variable that has been found to correlate with successful outcomes. Length of stay was associated with the culturally specific program, prior arrests, and years of problem drug usage. Implications for program design and treatment are discussed.     

Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

ABSTRACT

The prevalence of mental health disorders among nursing home residents has been noted. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression and 37% had schizophrenia.     

Bringing Together Housing and Aging Services

Aging organizations generally do not consider housing issues as an important priority. Research suggests that lack of knowledge may be a significant barrier that prevents their involvement in housing-related activities. This article reports on a study that examined the extent and level of AAAs' involvement in housing-related activities with particular attention to instances of cooperation and collaboration between AAAs and housing agencies. It employed a national survey of Area Agencies on Aging (AAAs). Further, since the lack of knowledge about housing is a barrier to involvement, the study examined the role of a housing specialist in motivating higher levels of activity. Though there is no single overall indicator of activities to do with housing, the results indicate a range of activities pursued by AAAs. The presence of a housing specialist within the AAA generally served as a catalyst, motivating higher levels of this kind of activity. The importance of housing as a component of a comprehensive long-term care continuum is also discussed.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.