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Motivational style, length of residence, voluntariness, and gender as influences on adjustment to long term care: a pilot study
- Authors:
- CURTISS Karin, HAYSLIP Bert, DOLAN Diana C.
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 15(4), 2007, pp.13-34.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
A range of measurement instrument was administered to 75 nursing home residents (mean age 79.08 years; 25 men, 50 women) who varied by length of residence, gender and motivational style. The aim was to examine the impact of these variables on indicators of adjustment such as health, life satisfaction, desired and expected control, self-esteem, activities of daily living and positive/negative affect. MANCOVAs (controlling for social desirability) showed that a self-determined motivational style had a positive impact on adjustment, and interacted with gender in this respect. Length of residence and gender influenced activities of daily living, and motivational style also affected desired/expected control and self-esteem, where those with higher self-determined motivational styles had expectations for, and desirability of, control. Voluntariness of the decision to move into a nursing home generally had a positive impact on adjustment but was moderated by motivational style. The implications for nursing homes are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Factors predicting lawsuits against nursing homes in Florida 1997–2001
- Authors:
- JOHNSON Christopher E., et al
- Journal article citation:
- Gerontologist, 44(3), June 2004, pp.339-347.
- Publisher:
- Oxford University Press
The authors explore how nursing home characteristics affect the number of lawsuits filed against the facilities in Florida during the period from 1997 to 2001. They examined data from 478 nursing homes in 30 Florida counties from 1997 to 2001. We obtained the data from Westlaw's Adverse Filings: Lawsuits database, the Online Survey, Certification, and Reporting system database from the Centers for Medicare and Medicaid Services, and state complaint surveys, and we also used primary data. We used negative binomial regression to explain total lawsuit variance by year. They controlled for acuity and year effects, and our explanatory variables included (a) facility characteristics—including staffing, number of beds, multistate system membership, and for-profit ownership—and (b) quality measures—including total number and type of state licensing survey deficiencies, pressure-sore development, and medication errors per resident. Higher registered nurse and certified nursing assistant staffing levels were associated with fewer lawsuits. More deficiencies on the licensing survey and larger and for-profit nursing homes were positively related with higher numbers of lawsuits. This study suggests that nursing homes that meet long-stay staffing standards, meet minimum quality measures, are not for profit, and are smaller will experience fewer lawsuits.
Proposed changes to residential care charges from 4 April 2005: consultation
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2005
- Pagination:
- 4p.
- Place of publication:
- London
The Department of Health intends to lay regulations in Parliament by early March 2005 to increase from 4 April 2005: i) the level of personal expenses allowance (PEA) to £18.80 to reflect the rise of 3.8% in average earnings over the last twelve months; ii) the capital limits to £12,500 (lower limit) and £20,500 (upper limit) to reflect the anticipated GDP deflator of 2.52%. The additional costs to councils will be covered by an increase in income generated through charges for residential
A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care
- Authors:
- POLITIS Antonios M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1087-1094.
- Publisher:
- Wiley
Apathy is a common symptom in patients with dementia and has adverse consequences for patients and caregivers. Most treatments for apathy, particularly non-pharmacologic interventions, have not been evaluated in controlled trials. This study evaluated the efficacy of a kit-based activity intervention, compared to a time and attention control (one-on-one meetings with an activity therapist) in reducing apathy and improving quality of life in 37 patients with dementia. The design was a randomized, controlled, partially masked clinical trial. All outcome measures were administered at baseline and follow-up. The primary outcome measure was the apathy score of the Neuropsychiatric Inventory (NPI). Other outcome measures were the NPI total score, the Alzheimer Disease Related Quality of Life scale(ADQRL), and the Copper Ridge Activity Index (CRAI). There was a significant reduction in NPI apathy scores in both treatment groups. The only significant difference between the two treatment groups was a modest advantage for the control intervention on the CRAI cueing subscale (p = 0.027), but not on the other CRAI subscales. There was also a greater within group improvement in quality of life ratings in the control intervention (p = 0.03). Despite the substantial improvement in apathy scores during the course of the study, there was no clear advantage to the reminiscence-based intervention over the time and attention, one-on-one control intervention. More research is needed to develop specific behavioral interventions for apathy in patients with dementia.
Do out-of-pocket health expenditures rise with age among older Americans?
- Author:
- STEWART Susan T.
- Journal article citation:
- Gerontologist, 44(1), February 2004, pp.48-57.
- Publisher:
- Oxford University Press
Relationships are examined between age and out-of-pocket costs for different health goods and services among the older population. Age patterns in health service use and out-of-pocket costs are examined by use of the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (N = 1,031, age 66+). Multivariate regression is used to examine how age effects are mediated by health, insurance, and socioeconomic variables. Although long-term care expenditures increased with age, out-of-pocket costs for most other services did not. Total out-of-pocket costs increased with age only when nursing home costs were included. Increases with age in hospital and prescription costs were explained by declining health. Patterns of service use suggested reduced access to discretionary care among the oldest old. Although expenditures did not increase with age for most services, the high personal cost for nursing home care among the oldest old underlines the need for increased efforts to support them in the community. Greater spending by those in poor health highlights the importance of preventing age-related health conditions and their complications. Improved access to discretionary care among the oldest old may help to reduce the need for care in higher cost settings. The high prevalence of out-of-pocket prescription spending across the age range provides impetus for current efforts to reduce these costs.
Consumer satisfaction in long-term care: state initiatives in nursing homes and assisted living facilities
- Authors:
- LOWE Timothy J., et al
- Journal article citation:
- Gerontologist, 43(6), December 2003, pp.883-896.
- Publisher:
- Oxford University Press
The authors report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programmes for legislators and public administrators contemplating the initiation of their own state programmes. Data on state initiatives and programmes were collected during March and April 2000 through a mailed questionnaire and follow-up telephone interviews and were current as of September 2002. Of the 50 states surveyed, 50 responses were received (response rate = 100%); 12 states (24%) reported the use of consumer satisfaction measures, and 7 (Florida, Iowa, Ohio, Oregon, Texas, Vermont, and Wisconsin) reported using resident satisfaction data within their consumer information systems for nursing homes or assisted living facilities. Additionally, 2 states (Iowa and Wisconsin) use resident satisfaction data for facility licensing and recertification. The design of the instruments and collection methods vary in these states, as do the reported response rates, per-resident cost, and the purpose for satisfaction data collection. State satisfaction efforts are in an early stage of development. Well-produced, easily understandable reports on nursing home and assisted living quality could provide information and guidance for patients and families contemplating the utilization of long-term care services. Dissemination of quality information may also facilitate sustained quality and efficiency improvements in long-term care facilities and thus enhance the quality of care for and quality of life of long-term care residents.
A national survey of assisted living facilities
- Authors:
- HAWES Catherine, et al
- Journal article citation:
- Gerontologist, 43(6), December 2003, pp.875-882.
- Publisher:
- Oxford University Press
Throughout the 1990s, assisted living was the most rapidly growing form of senior housing. The purpose of this paper is to describe the existing supply of assisted living facilities (ALFs) and examine the extent to which they matched the philosophy of assisted living. The study involved a multistage sample design to produce nationally representative estimates for the ALF industry. Administrators of nearly 1,500 eligible ALFs were interviewed by telephone. As of 1998, there were an estimated 11,459 ALFs nationwide, with 611,300 beds and 521,500 residents. Nearly 60% offered a combination of low services and low or minimal privacy, whereas only 11% offered relatively high services and high privacy. Seventy-three percent of the resident rooms or apartments were private. Aging-in-place was limited by discharge policies in most ALFs for residents who needed help with transfers, had moderate to severe cognitive impairment, had any behavioral symptoms, or needed nursing care. The industry is largely private pay and unaffordable for low- or moderate-income persons aged 75 unless they use assets as well as income to pay. ALFs differed widely in ownership, size, policies, and the degree to which they manifested the philosophy of assisted living. This diversity represents a challenge for consumers in terms of selecting an appropriate facility and for policy makers in terms of deciding what role they want assisted living to play in long-term care.
Administrative justice and charging for long-term care
- Author:
- BRADLEY Greta
- Journal article citation:
- British Journal of Social Work, 33(5), August 2003, pp.625-639.
- Publisher:
- Oxford University Press
Drawing on the findings of a study in the area of charging for long-term care for older people, this article makes links between perceptions and practices of local authority professionals and the concept of administrative justice. The research revealed that discretion was exercised at all levels, although not all staff were aware of this. Cases may be treated differently and accidents of geography, local political culture or personnel are likely to affect the outcome of financial assessments of adults. The implications of this work remain timely since means tested assessment of personal care and residency costs look set to continue in England and Wales.
Linkages in the rural continuum: the Balanced Budget Act and beyond
- Authors:
- ANGELELLI Joseph, et al
- Journal article citation:
- Gerontologist, 43(2), April 2003, pp.151-157.
- Publisher:
- Oxford University Press
This American study examined how rural hospitals altered their postacute and long-term care strategies after the Balanced Budget Act of 1997 (BBA97). Methods:A nationally representative sample of 540 rural hospital discharge planners were interviewed in 1997. In the year 2000, 513 of 540 discharge planners were reinterviewed. The study is a descriptive analysis of how rural hospitals formed new and altered existing organizational strategies during a time of turbulent changes in federal government reimbursement policy. The authors classify rural hospital strategic behavior in 1997 according to the Miles and Snow typology of Prospectors, Analyzers, Defenders, and Reactors, and then examine how the various hospital types altered key strategies following BBA97. Between 1997 and 2000, more than 26% of sampled rural hospitals that did not participate in the swing-bed programme in 1997 (44/167) had chosen to do so in 2000, whereas only 3% of those using swing beds in 1997 had eliminated them (12/346). Other strategies such as divestiture of hospital-based nursing homes were related to concurrent swing-bed adoption. Rural hospitals also increased their reliance on formal linkages with external providers of long-term care. After the BBA97 reimbursement changes, rural hospitals increased their reliance on swing beds and formal linkages to external providers. We observed changes in overall strategy types, away from the Defender and toward the Prospector and Analyzer strategy types. Our findings illustrate the importance of swing beds as a critical buffer for rural hospitals challenged by the uncertainty of the post-BBA97 environment.
Small scale, domestic style, longstay accommodation for people with dementia
- Author:
- MARSHALL Mary
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1993
- Pagination:
- 22p.,bibliog.
- Place of publication:
- Stirling
All the available research evidence points in favour of small scale units for people with dementia. This report describes several types of small scale units and presents the research. It is argues that small scale units are essential for people with dementia if they are not to be overloaded with stimuli and incomprehensible activity.