The Role of Residential and Nursing Homes in the Last Year of People's Lives

Dr Ann Cartwright, Institute for Social Studies in Medical Care, 14 South Hill Park, London NW3 2SB. Summary Almost a quarter of a random sample of adults dying in 1987had spent at least part of the last year of their lives in aresidential or nursing home; one in eight spent all of thatyear in one. The old, the unmarried, those with difficulty lookingafter themselves, the confused, the incontinent, the blind,the deaf, and the bad tempered were more likely to be in suchhomes than others. With their greater dependency, people living in residentialhomes received rather more consultations and home visits—althoughnot night calls—from their general practitioners. Butthey did not get more help from community nurses and they wereless likely to be admitted to, or to die in, a hospital or hospice. According to the assesments of relatives, friends, and neighbourswho answered the questions, the quality of life of people whohad been in a residential home for a year or more before theirdeath was similar to that of others who died but had never beenin such a home. It was those who were admitted in the year beforethey died who were perceived as having a relatively poor qualityof life in that year. Increasingly, the quality of life duringthe year before death is going to depend on the attributes ofresidential homes and their staff.     

LEADERSHIP BY EXAMPLE IN THE WEAK‐LINK GAME

We investigate the effects of leadership in a four‐player weak‐link game. A weak‐link game is a coordination game with multiple Pareto‐ranked Nash equilibria. Because the more efficient equilibria involve a degree of strategic uncertainty groups typically find it difficult to coordinate on more efficient equilibria. We wanted to see whether leadership by example, in the form of one player acting publicly before the rest of the group, could help groups do better. Our results suggest that leadership can increase efficiency but is far from being a guarantee of success. Specifically, in a significant number of groups we observed successful leadership and increased efficiency, but in most groups efficiency was low despite the efforts of leaders. We did not find any difference between voluntary leaders and leaders that are randomly assigned. (JEL C72, H41)