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Sutton N, Ma N, Yang JS, Lin J. Quality effects of home acquisitions in residential aged care. Australas J Ageing 2024; 43:158-166. [PMID: 38317602 DOI: 10.1111/ajag.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The recent consolidation of the Australian residential aged care market has raised concerns about the potential adverse effects of acquisition activity on quality of care (QoC). We examined changes in QoC outcomes within acquired homes and the influence of the acquiring providers' characteristics on these post-acquisition outcomes. METHODS A retrospective observational study was conducted using de-identified data sets obtained under the legal authority of the Royal Commission into Aged Care Quality and Safety. Regression analysis was used to investigate post-acquisition changes in QoC outcomes for 225 Australian home acquisitions between 2015 and 2019. The outcomes were analysed for the first two full financial years before and after the acquisition. RESULTS After controlling for other factors, we find acquired homes were associated with significantly worse QoC outcomes in the 2 years after acquisition, with higher rates of hospitalisations and reported complaints to the regulator. However, these results were driven by homes acquired by providers that were smaller in scale, for-profit or had comparatively poorer average quality across the other homes they operated. CONCLUSIONS Our finding that homes' QoC on average declines in the first 2 years following acquisition, are consistent with studies in other countries and points to the potential risks that consolidation poses to the care delivered to older people in Australia during that period.
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Affiliation(s)
- Nicole Sutton
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Nelson Ma
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jin Sug Yang
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jiali Lin
- University of Technology Sydney, Sydney, New South Wales, Australia
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2
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Bölenius K, Lämås K, Edvardsson D. Older adults' experiences of self-determination when needing homecare services-an interview study. BMC Geriatr 2023; 23:824. [PMID: 38066429 PMCID: PMC10709827 DOI: 10.1186/s12877-023-04533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Self-determination has been shown to be an important factor in mental health and wellbeing, but from the homecare recipients' point of view, autonomy and self-determination is not fully integrated into homecare services. The aim of this study was to explore older adults' experiences of self-determination when needing homecare services. METHODS In 2018, a qualitative descriptive study was conducted and a convenience sample of 15 older adults from 3 homecare service facilities were invited to participate in individual interviews. Data were analysed using qualitative content analyse. RESULTS The theme Transitioning from self-determination as independence towards self-determination as shared decision-making emerged through the older adults' narratives. This 'transition' is one in which older adult's understanding of self-determination and self-esteem was transitioning towards the acceptance of shared decision-making. The person's inner strength and willingness to make decisions was promoting to enact and preserve independence. Accepting one's dependence on others and being in a positive atmosphere were described as promoting self-determination and shared decision-making, and vice versa. The above overarching theme permeated all subthemes, which included: mobilising inner strength to enact independence; accepting increasing dependence on others; and being influenced by the atmosphere. CONCLUSIONS The study contributes increased understanding of older adults' experiences of self-determination. The results can act as a guide when planning future person-centred care interventions in the context of homecare services and help improve homecare services' ability to meet the needs of older adults. To summarise, older adults' reflections on their own self-determination highlighted relationships with other people as important for shared decision-making, which could help preserve older adults' autonomy and self-esteem.
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Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, Umeå, 90187, Sweden.
| | - Kristina Lämås
- Department of Nursing, Umeå University, Umeå, 90187, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, 90187, Sweden
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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3
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Wu SA, Morrison-Koechl JM, McAiney C, Middleton L, Lengyel C, Slaughter S, Carrier N, Yoon MN, Keller HH. Multi-Level Factors Associated with Relationship-Centred and Task-Focused Mealtime Practices in Long-Term Care: A Secondary Data Analysis of the Making the Most of Mealtimes Study. Can J Aging 2023; 42:696-709. [PMID: 37278323 DOI: 10.1017/s0714980823000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.
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Affiliation(s)
- Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura Middleton
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
| | - Christina Lengyel
- Department of Food and Human Nutrition Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Slaughter
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB, Canada
| | - Minn-Nyoung Yoon
- Department of Dentistry & Dental Hygiene, University of Alberta, Calgary, AB, Canada
| | - Heather H Keller
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Strauss K. Beyond crisis? Using rent theory to understand the restructuring of publicly funded seniors' care in British Columbia, Canada. ENVIRONMENT & PLANNING A 2023; 55:1506-1527. [PMID: 37810991 PMCID: PMC10555532 DOI: 10.1177/0308518x20983152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Crises of seniors' care in countries like the UK and Canada, further highlighted by the COVID-19 pandemic, have been connected to processes of privatization and financialization. In this paper I argue that rent theory is important for disaggregating mechanisms, including of accumulation by dispossession, the devaluation of labour, and assetization, that underpin the process of financialization in the sector. Work on rents often divides between critical approaches, especially to land rent, and mainstream institutionalist and public choice approaches to rent-seeking. Critical rent theory is evolving beyond this divide to understand a broader range of types of rent. Yet, despite attention to the increasing importance of economic rents and forms of rentierism, labour and social reproduction are often excluded from the analysis of how rent relations arise. This paper demonstrates the problems with these exclusions. The argument is illustrated through an analysis of the restructuring of eldercare in British Columbia, Canada, in the last two decades, and employs a feminist political economy approach to examine the social production of rent relations.
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Borsa A, Bejarano G, Ellen M, Bruch JD. Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review. BMJ 2023; 382:e075244. [PMID: 37468157 DOI: 10.1136/bmj-2023-075244] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To review the evidence on trends and impacts of private equity (PE) ownership of healthcare operators. DESIGN Systematic review. DATA SOURCES PubMed, Web of Science, Embase, Scopus, and SSRN. ELIGIBILITY CRITERIA FOR STUDY SELECTION Empirical research studies of any design that evaluated PE owned healthcare operators. MAIN OUTCOME MEASURES The main outcome measures were impact of PE ownership on health outcomes, costs to patients or payers, costs to operators, and quality. The secondary outcome measures were trends and prevalence of PE ownership of healthcare operators. DATA SYNTHESIS Studies were classified as finding either beneficial, harmful, mixed, or neutral impacts of PE ownership on main outcome measures. Results across studies were narratively synthesized and reported. Risk of bias was evaluated using ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions). RESULTS The electronic search identified 1778 studies, with 55 meeting the inclusion criteria. Studies spanned eight countries, with most (n=47) analyzing PE ownership of healthcare operators in the US. Nursing homes were the most commonly studied healthcare setting (n=17), followed by hospitals and dermatology settings (n=9 each); ophthalmology (n=7); multiple specialties or general physician groups (n=5); urology (n=4); gastroenterology and orthopedics (n=3 each); surgical centers, fertility, and obstetrics and gynecology (n=2 each); and anesthesia, hospice care, oral or maxillofacial surgery, otolaryngology, and plastics (n=1 each). Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality. These outcomes held in sensitivity analyses in which only studies with moderate risk of bias were included. Health outcomes showed both beneficial and harmful results, as did costs to operators, but the volume of studies for these outcomes was too low for conclusive interpretation. In some instances, PE ownership was associated with reduced nurse staffing levels or a shift towards lower nursing skill mix. No consistently beneficial impacts of PE ownership were identified. CONCLUSIONS Trends in PE ownership rapidly increased across almost all healthcare settings studied. Such ownership is often associated with harmful impacts on costs to patients or payers and mixed to harmful impacts on quality. Owing to risk of bias and frequent geographic focus on the US, conclusions might not be generalizable internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022329857.
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Affiliation(s)
- Alexander Borsa
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Geronimo Bejarano
- Department of Epidemiology, University of Texas School of Public Health (UTHealth), Austin, TX, USA
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Health Policy Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joseph Dov Bruch
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
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Curioni C, Silva AC, Damião J, Castro A, Huang M, Barroso T, Araujo D, Guerra R. The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3373. [PMID: 36834068 PMCID: PMC9960182 DOI: 10.3390/ijerph20043373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and (v) economic evaluations arising from randomized controlled trials (RCTs). Two independent reviewers selected the studies, extracted data and assessed study quality. Of the 14 studies identified, homecare, when compared to hospital care, was cost-saving in seven studies, cost-effective in two and more effective in one. The evidence suggests that homecare interventions are likely to be cost-saving and as effective as hospital. However, the included studies differ regarding the methods used, the types of costs and the patient populations of interest. In addition, methodological limitations were identified in some studies. Definitive conclusions are limited and highlight the need for better standardization of economic evaluations in this area. Further economic evaluations arising from well-designed RCTs would allow healthcare decision-makers to feel more confident in considering homecare interventions.
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Affiliation(s)
- Cintia Curioni
- Institute of Nutrition, State University of Rio de Janeiro, R. São Francisco Xavier, 524-12º Andar-Bloco E-Sala 12008-Maracanã, Rio de Janeiro 20550-170, Brazil
| | - Ana Carolina Silva
- Institute of Nutrition, State University of Rio de Janeiro, R. São Francisco Xavier, 524-12º Andar-Bloco E-Sala 12008-Maracanã, Rio de Janeiro 20550-170, Brazil
| | - Jorginete Damião
- Institute of Nutrition, State University of Rio de Janeiro, R. São Francisco Xavier, 524-12º Andar-Bloco E-Sala 12008-Maracanã, Rio de Janeiro 20550-170, Brazil
| | - Andrea Castro
- Department of Family Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77-Vila Isabel, Rio de Janeiro 20551-030, Brazil
| | - Miguel Huang
- Institute of Nutrition, State University of Rio de Janeiro, R. São Francisco Xavier, 524-12º Andar-Bloco E-Sala 12008-Maracanã, Rio de Janeiro 20550-170, Brazil
| | - Taianah Barroso
- Hospital Estadual Ary Parreiras, R. Dr. Luiz Palmier, 762-Barreto, Niterói 24110-310, Brazil
| | - Daniel Araujo
- Institute of Nutrition, State University of Rio de Janeiro, R. São Francisco Xavier, 524-12º Andar-Bloco E-Sala 12008-Maracanã, Rio de Janeiro 20550-170, Brazil
| | - Renata Guerra
- Health Technology Assessment Unit, Brazilian National Institute of Cancer, R. Marques de Pombal, 125-7º andar-Centro, Rio de Janeiro 20230-240, Brazil
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Lindmark T, Engström M, Trygged S. Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol 2023; 42:347-359. [PMID: 36214292 PMCID: PMC9841825 DOI: 10.1177/07334648221131468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.
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Affiliation(s)
- Tomas Lindmark
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden,Tomas Lindmark, Faculty of Health and Occupational Studies, Department of Social work, University of Gävle, Kungsbäcksvägen 47, Gävle 801 76, Sweden.
| | - Maria Engström
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Sven Trygged
- Faculty of Health and Occupational Studies, Department of Social Work, University of Gävle, Gävle, Sweden
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8
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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9
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Armstrong P, Armstrong H, Bourgeault IL. Teaming up for long-term care: Recognizing all long-term care staff contribute to quality care. Healthc Manage Forum 2023; 36:26-29. [PMID: 36112848 DOI: 10.1177/08404704221115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
When looking to promising international approaches to improve quality care in long-term care, it is necessary to avoid cherry-picking specific dimensions ignoring the integrated nature of what makes these approaches promising in the first place. In looking at promising Scandinavian or Green House models, attention is often paid to the size of facility. This often overlooks the importance of higher level of staffing, mix, and compensation of direct care staff and the integration of dietary, laundry, and housekeeping staff to care teams. Other overlooked considerations include recognition of family and friends and policies supporting care continuity.
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10
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Garrett MD. Critical Age Theory: Institutional Abuse of Older People in Health Care. EUROPEAN JOURNAL OF MEDICAL AND HEALTH SCIENCES 2022; 4:24-37. [DOI: 10.24018/ejmed.2022.4.6.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Theories of elder abuse focus on the characteristics of the victim, the perpetrator, and the context of abuse. Although all three factors play a role, we are biased to notice individual misbehavior as the primary and sole cause of abuse. We see individuals as responsible for abuse. By examining abuses across a spectrum of healthcare services, abuse is more likely to be due to the institutional culture that includes the use of medications, Assisted Living, Skilled Nursing Facilities/nursing homes, hospices, hospitals, and Medicare Advantage programs. This study highlights multiple and consistent institutional abuses that result in harm and death of older adults on a consistent basis. The results show that when profit is increased, standards of care are diminished, and abuse ensues. Assigning responsibility to the management of healthcare becomes a priority in reducing this level of abuse. However, there are biases that stop us from assigning blame to institutions. Individual healthcare workers adhere to work protocol and rationalize the negative outcomes as inevitable or due to the vulnerability and frailness of older people. This culture is socialized for new employees that develop a culture of diminishing the needs of the individual patient in favor of the priorities dictated by the management protocol. In addition, the public is focused on assigning blame to individuals. Once an individual is assigned blame then they do not look beyond that to understand the context of abuse. A context that is generated by healthcare facilities maximizing profit and denigrating patient care. Regulatory agencies such as the U.S. DHHS, CDC, State Public Health Agencies, State/City Elder Abuse units, and Ombudsmen Programs all collude, for multiple reasons, in diminishing institutional responsibility.
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Allan S, Irvine L, Achterberg WP. Should we take Mum to market? Quality and funding in the care home sector. Age Ageing 2022; 51:6770070. [PMID: 36571771 DOI: 10.1093/ageing/afac223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, UK
| | - Lisa Irvine
- University of Hertfordshire (Centre for Research in Public Health and Community Care, CRIPACC), UK
| | - Wilco P Achterberg
- Professor of institutional care and elderly care medicine, department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
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12
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Pratt G, Johnston C. Dementia Care for Europeans in Thailand: A Geography of Futures. THE AMERICAN BEHAVIORAL SCIENTIST 2022; 66:1880-1895. [PMID: 36366768 PMCID: PMC9638707 DOI: 10.1177/00027642221075263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We explore the creation of private care facilities around Chiang Mai in northern Thailand to provide dementia care for people from the Global North. We draw on three periods of ethnographic observation at care facilities, and interviews with Swiss and British owners and family members, as well as Thai managers and care workers. We locate this offshoring of dementia care from the Global North to South within existing underfunding of dementia care in the Global North and a "regime of anticipation" built around expected substantial growth in the numbers of people living with dementia. These facilities are opening new futures for those who migrate for care as they leverage their relative wealth and privilege to purchase care in Thailand. In line with other readings of international health migration, we note the negative impact of this state-supported privatized industry on the availability of nurses and care aids in public hospitals in Thailand. We then venture into less examined and expected futurities, namely, the opportunities these facilities provide to two groups of stigmatized Thai workers: transgender and Indigenous Karen caregivers.
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Affiliation(s)
- Geraldine Pratt
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - Caleb Johnston
- School of Geography, Politics and Sociology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Nursing Homes: Affiliation to Large Chains, Quality and Public–Private Collaboration. Healthcare (Basel) 2022; 10:healthcare10081431. [PMID: 36011087 PMCID: PMC9408552 DOI: 10.3390/healthcare10081431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
The objective of this paper was to estimate the influence of being affiliated with an NH chain on perceived consumer quality, and whether this relationship is affected by maintaining a collaboration agreement with public administrations. We used a combination of theoretical foundations: (1) From the consumer perspective, we focussed on online reviews of the quality of nursing homes (NHs); (2) from the industrial organisation literature, we proposed arguments regarding the advantages and disadvantages of belonging to a chain; (3) the theory of transaction costs was used to explain public–private collaboration. The study was carried out on a sample of 642 chain-affiliated Spanish NHs, with data from quality scores downloaded from the website topMayores.es. We distinguished between the six largest chains and the rest. We applied linear regression models. The results show that NHs affiliated with one of the largest NH chains obtained worse quality scores in the assessment made by users, although quality scores improved for the largest chains of NHs involved in an agreement with the public administration.
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14
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Quintelier KJP. Stakeholder-Oriented Firms Have Feelings and Moral Standing Too. Front Psychol 2022; 13:814624. [PMID: 35265012 PMCID: PMC8898933 DOI: 10.3389/fpsyg.2022.814624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
A central claim in stakeholder theory is that, if we see stakeholders as human beings, we will attribute higher moral standing or show more moral consideration to stakeholders. But would the same hold for firms? In this paper, I apply the concepts of humanization and moral standing to firms, and I predict that (1) individuals attribute higher moral standing to stakeholder-oriented than to profit-oriented firms, because (2) individuals attribute more experience (such as feelings) to stakeholder-oriented than to profit-oriented firms. Five experiments support these predictions across different operationalizations of stakeholder and profit orientations. The analyses show that moral standing attributions are not fully explained by attributions of agency (such as thinking) to firms, or by attributions of experience or agency to human stakeholders (instead of firms). By unearthing the importance of experience attributions for moral standing attributions to firms, this work provides novel insights in ongoing legal, philosophical and public debates related to firms' moral standing. The findings also bring the debate about firms' moral standing to the heart of stakeholder theory, and lead to new normative and descriptive research questions about the interests of firms and their stakeholders.
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Affiliation(s)
- Katinka J. P. Quintelier
- Department of Management and Organization, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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15
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Lämås K, Bölenius K, Sandman PO, Lindkvist M, Edvardsson D. Effects of a person-centred and health-promoting intervention in home care services- a non-randomized controlled trial. BMC Geriatr 2021; 21:720. [PMID: 34922494 PMCID: PMC8684168 DOI: 10.1186/s12877-021-02661-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff. METHODS This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses. RESULTS Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: - 4, p 0.026, CI: - 10. 766, - 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: - 7 control: + - 0, p 0.048, CI: - 17.435, - 0.098). No significant effects were found among staff. CONCLUSIONS The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS. TRIAL REGISTRATION NCT02846246. Date of registration: 27 July 2016.
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Affiliation(s)
- Kristina Lämås
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.
| | - Karin Bölenius
- Department of Nursing, Umeå University, 90187, Umeå, Sweden
| | | | - Marie Lindkvist
- Department of Statistics, Umeå School of Business, Economics and Statistics (USBE), Umeå University, Umeå, Sweden.,Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, 90187, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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16
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Sturm T, Mercille J, Albrecht T, Cole J, Dodds K, Longhurst A. Interventions in critical health geopolitics: Borders, rights, and conspiracies in the COVID-19 pandemic. POLITICAL GEOGRAPHY 2021; 91:102445. [PMID: 34785870 PMCID: PMC8580506 DOI: 10.1016/j.polgeo.2021.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
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17
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Marier P. How Will COVID-19 Alter the Politics of Long-Term Care? A Comparative Policy Analysis of Popular Reform Options. Can J Aging 2021; 40:1-10. [PMID: 34711297 DOI: 10.1017/s0714980821000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This policy analysis reviews three popular proposals with significant political endorsement to enhance long-term care (LTC), here defined broadly to include residential care facilities, home care, and community care, in the wake of the coronavirus disease (COVID-19) crisis: national standards, provincial autonomy, and de-privatization. The proposals are summarized succinctly followed by a neo-institutionalist analysis of the obstacles to enact them based upon a series of interviews conducted prior to COVID-19 with senior civil servants in Canadian provinces for a newly published book (Marier, 2021) and political considerations. While the federal government has pursued the avenue of instituting national standards, the provinces have clearly expressed a desire to secure higher federal health transfers and pursue LTC reforms on their own. Considering the diversity of LTC arrangements across the provinces, which impact the politics of LTC within each jurisdiction, and the presence of many Conservative governments in provincial capitals, Ottawa faces an uphill battle to transform profoundly the LTC landscape.
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Affiliation(s)
- Patrik Marier
- Department of Political Science, Concordia University, Montreal, QC, Canada
- Équipe VIES (Vieillissements, exclusions sociales, et solidarités), Montreal, QC, Canada
- Centre de recherche et d'expertise en gérontologie sociale (CREGÉS), Montreal, QC, Canada
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18
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Bach-Mortensen AM, Verboom B, Movsisyan A, Degli Esposti M. A systematic review of the associations between care home ownership and COVID-19 outbreaks, infections and mortality. NATURE AGING 2021; 1:948-961. [PMID: 37118328 DOI: 10.1038/s43587-021-00106-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/02/2021] [Indexed: 04/30/2023]
Abstract
Social care markets often rely on the for-profit sector to meet service demand. For-profit care homes have been reported to suffer higher rates of coronavirus disease 2019 (COVID-19) infections and deaths, but it is unclear whether these worse outcomes can be attributed to ownership status. To address this, we designed and prospectively registered a living systematic review protocol ( CRD42020218673 ). Here we report on the systematic review and quality appraisal of 32 studies across five countries that investigated ownership variation in COVID-19 outcomes among care homes. We show that, although for-profit ownership was not consistently associated with a higher risk of a COVID-19 outbreak, there was evidence that for-profit care homes had higher rates of COVID-19 infections and deaths. We also found evidence that for-profit ownership was associated with personal protective equipment (PPE) shortages. Variation in COVID-19 outcomes is not driven by ownership status alone, and factors related to staffing, provider size and resident characteristics were also linked to poorer outcomes. However, this synthesis finds that for-profit status and care home characteristics associated with for-profit status are linked to exacerbated COVID-19 outcomes.
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Affiliation(s)
| | - Ben Verboom
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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19
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Yong J, Yang O, Zhang Y, Scott A. Ownership, quality and prices of nursing homes in Australia: Why greater private sector participation did not improve performance. Health Policy 2021; 125:1475-1481. [PMID: 34565611 DOI: 10.1016/j.healthpol.2021.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examines whether greater private-sector participation in aged care can lead to better outcomes by comparing quality of care and prices of residential aged care facilities across three ownership types: government-owned, private not-for-profit and for- profit facilities. Australia, like many other countries, has been implementing market-oriented reforms aiming to promote greater consumer choice and increase the role of markets and private-sector participation in aged care. METHODS Using retrospective facility-level data, the study relates several measures of quality of care and a measure of price to ownership types while controlling for facility characteristics. The data covered six financial years (2013/14-2018/19) and contained 2,900 residential aged-care facilities, capturing almost all facilities in Australia. About 55% were private not-for-profit, 30% private for-profit and 15% government-owned. RESULTS Government-owned facilities provide higher quality of care in most quality measures and charge the lowest average price than private for-profit and not-for-profit facilities. DISCUSSION Reforms promoting private-sector participation in aged care are unlikely to result in effective competition to drive quality up or prices down unless sources of market failure are addressed. In Australia, the lack of public reporting of quality and the complex pricing structure are key issues that prevent market forces and consumer choice from working as intended.
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Affiliation(s)
- Jongsay Yong
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia.
| | - Ou Yang
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia
| | - Yuting Zhang
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia
| | - Anthony Scott
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, FBE Building, L5, 111 Barry Street, Parkville, Victoria 3010, Australia
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20
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Wang K, Ke Y, Sankaran S, Xia B. Problems in the home and community-based long-term care for the elderly in China: A content analysis of news coverage. Int J Health Plann Manage 2021; 36:1727-1741. [PMID: 34080743 DOI: 10.1002/hpm.3255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The purpose of this paper is to identify the issues that limited the supply of home and community-based Long-Term-Care (LTC) for the elderly, offer essential insights into the sustainable development of China's LTC. DESIGN/METHODOLOGY/APPROACH A content analysis of news coverage on 12 major portals in China has been conducted to identify the issues. FINDINGS The results demonstrate that there are 12 significant problems in the supply of home and community-based LTC for the elderly. For the service providers, the lack of qualified LTC professionals, limited service types/low service quality and unrealised integrated care, lack of steady profit patterns are the three major problems. The deficiencies of the LTC system and the lack of incentive policies and legislation for private investors' participation are the two major problems faced by the government. The public is confronted with a shortage of home and community support resources and unable to adapt to a change due to their mindsets. PRACTICAL IMPLICATIONS The issues identified in this paper can not only provide some opportunities to various stakeholders in this area but also offer insights into the sustainable development of China's LTC. ORIGINALITY/VALUE The findings presented in this paper provide the means to understand the home and community-based LTC market in China for private investors and government, which will help to promote the cooperation between the two.
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Affiliation(s)
- Kun Wang
- School of Civil and Environmental Engineering, Ningbo University, Zhejiang, China.,School of Built Environment, University of Technology Sydney, Ultimo NSW, Australia
| | - Yongjian Ke
- School of Built Environment, University of Technology Sydney, Ultimo NSW, Australia
| | - Shankar Sankaran
- School of Built Environment, University of Technology Sydney, Ultimo NSW, Australia
| | - Bo Xia
- School of Architecture and Built Environment, Queensland University of Technology, Brisbane, Australia.,Hefei University of Technology, College of Civil Engineering, Anhui, China
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21
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Lundin A, Bülow PH, Stier J. Assistant Nurses' Positioned Accounts for Prioritizations in Residential Care for Older People. THE GERONTOLOGIST 2021; 61:573-581. [PMID: 33063827 DOI: 10.1093/geront/gnaa154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks. RESEARCH DESIGN AND METHODS Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg's three-level positioning analysis. RESULTS The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and "the other things." They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of "icing on the cake." Morale is complex in residential care. A narration of "the torn carer" was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values. DISCUSSION AND IMPLICATIONS When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. "The torn carer" is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.
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Affiliation(s)
- Anette Lundin
- Department of Social Work, Linnaeus University, Kalmar, Sweden
| | - Pia H Bülow
- School of Health and Welfare, Jönköping University, Sweden.,Department of Social Work, University of the Free State, Bloemfontein, South Africa
| | - Jonas Stier
- Department of Social Work, Mälardalen University, Västerås, Sweden
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22
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Williams JA, Vriniotis MG, Gundersen DA, Boden LI, Collins JE, Katz JN, Wagner GR, Sorensen G. How to ask: Surveying nursing directors of nursing homes. Health Sci Rep 2021; 4:e304. [PMID: 34136659 PMCID: PMC8177897 DOI: 10.1002/hsr2.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error. METHODS We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. RESULTS The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. CONCLUSION A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.
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Affiliation(s)
| | - Mary G. Vriniotis
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Daniel A. Gundersen
- Survey and Qualitative Methods CoreDana‐Farber Cancer InstituteBostonMassachusetts
| | - Leslie I. Boden
- Environmental HealthBoston University School of Public HealthBostonMassachusetts
| | - Jamie E. Collins
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Jeffrey N. Katz
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Gregory R. Wagner
- Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Glorian Sorensen
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
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23
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Yang O, Yong J, Scott A. Nursing Home Competition, Prices and Quality: A Scoping Review and Policy Lessons. THE GERONTOLOGIST 2021; 62:e384-e401. [PMID: 33851988 DOI: 10.1093/geront/gnab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years, countries have increasingly relied on markets to improve efficiency, contain costs, and maintain quality in aged care. Under the right conditions, competition can spur providers to compete by offering better prices and higher quality of services. However, in aged care, market failures can be extensive. Information about prices and quality may not be readily available and search costs can be high. This study undertakes a scoping review on competition in the nursing home sector, with an emphasis on empirical evidence in relation to how competition affects prices and quality of care. RESEARCH DESIGN AND METHODS Online databases were used to identify studies published in English language between 1988 and 2020. A total of 50 studies covering nine countries are reviewed. RESULTS The review finds conflicting evidence on the relationship between competition and quality. Some studies find greater competition leading to higher quality, others find the opposite. Institutional features such as the presence of binding supply restrictions on nursing homes and public reporting of quality information are important considerations. Most studies find greater competition tends to result in lower prices, although the effect is small. DISCUSSION AND IMPLICATIONS The literature offers several key policy lessons, including the relationship between supply restrictions and quality which has implications on whether increasing subsidies can result in higher quality and the importance of price transparency and public reporting of quality.
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Affiliation(s)
- Ou Yang
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Jongsay Yong
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute: Applied Economic & Social Research, The University of Melbourne, Parkville, Victoria, Australia
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24
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Rand S, Smith N, Jones K, Dargan A, Hogan H. Measuring safety in older adult care homes: a scoping review of the international literature. BMJ Open 2021; 11:e043206. [PMID: 33707269 PMCID: PMC7957135 DOI: 10.1136/bmjopen-2020-043206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Safety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted. OBJECTIVES The aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes. SOURCES OF EVIDENCE Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. ELIGIBILITY CRITERIA Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. CHARTING METHODS Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps. RESULTS AND CONCLUSIONS Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Alan Dargan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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25
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Gonzalez L. Will For-Profits Keep Up the Pace in the United States? The Future of the Program of All-Inclusive Care for the Elderly and Implications for Other Programs Serving Medically Vulnerable Populations. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:195-202. [PMID: 33019864 DOI: 10.1177/0020731420963946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Program of All-Inclusive Care for the Elderly (PACE) has provided, for more than 4 decades, high-quality, cost-effective medical and social care to older people in the United States under nonprofit ownership. Recent rulings by the Centers for Medicare & Medicaid Services (CMS), however, will fundamentally change the initial intent and operation of the program. CMS's final rule (4168-F) removes the provision that PACE operators be nonprofit. This article provides the legislative background for the final ruling and critiques the study that was used to justify the removal of the nonprofit provision. Although the Balanced Budget Act of 1997 listed a number of requirements for evaluating for-profit PACE programs, the secretary of the Department of Health and Human Services did not follow them before establishing for-profit PACE sites as permanent providers. It also argues that the ruling was made without much evidence that for-profit compared to nonprofit operators can provide a similar level of quality of care, access, and cost-effectiveness and urges policymakers to increase regulatory accountability, given what we know about other shifts in profit status and health care.
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Affiliation(s)
- Lori Gonzalez
- Claude Pepper Center, 375481Florida State University, Tallahassee, FL, USA
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26
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Bos A, Kruse FM, Jeurissen PPT. For-Profit Nursing Homes in the Netherlands: What Factors Explain Their Rise? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:431-443. [PMID: 32276563 PMCID: PMC7441333 DOI: 10.1177/0020731420915658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This exploratory, mixed-methods study analyzes characteristics of the emerging
for-profit nursing home industry in the Netherlands and identifies the
interrelated set of factors (context, trends, and sector conditions) that
contribute to its growth. Until recently, the Dutch nursing home sector relied
almost exclusively on nonprofit providers. Even though profit distribution in
nursing home care is still banned, the for-profit nursing home sector is
expanding. The study uses economic theory on nonprofit organizations and
mixed-form markets to understand this expansion. We find that changes in the
regulatory framework have unlocked the potential of the for-profit nursing home
sector, enabling for-profit nursing homes to circumvent the for-profit ban. The
expansion of the for-profit sector was mainly driven by the low responsiveness
of the nonprofit sector to increased and changed demands. For-profit providers
took advantage of this void. Moreover, they exploited “cream-skimming” potential
in the market and used the wider care system to reduce their labor costs by
relying on external specialist care. Another main driver was the access to
financial capital from private investors (e.g., private equity firms).
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Affiliation(s)
- Aline Bos
- Utrecht University School of Governance, Utrecht, the Netherlands
| | - Florien Margareth Kruse
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands *Both the authors share first authorship of this article
| | - Patrick Paulus Theodoor Jeurissen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands *Both the authors share first authorship of this article
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27
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Harrington C, Mollot R, Edelman TS, Wells J, Valanejad D. U.S. Nursing Home Violations of International and Domestic Human Rights Standards. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 50:62-72. [DOI: 10.1177/0020731419886196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a review of the international covenants and conventions and U.S. domestic laws and regulations that are designed to protect nursing home residents in the United States. Based on a review of research studies, government reports, and news reports, we found extensive evidence of widespread and systematic abuse and neglect of nursing home residents in the United States that needs urgent government action to protect the basic human rights of residents.
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Affiliation(s)
| | - Richard Mollot
- The Long Term Care Community Coalition, New York, NY, USA
| | | | - Janet Wells
- California Advocates for Nursing Home Reform, San Francisco, CA, USA
| | - Dara Valanejad
- School of Nursing, University of California, San Francisco, CA, USA
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28
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Harrington C, Edelman TS. Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 55:46958018788686. [PMID: 30027788 PMCID: PMC6055099 DOI: 10.1177/0046958018788686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Large for-profit nursing home chains in the United States have generally reported low nurse staffing levels. This historical case study examined a class action litigation case regarding staffing levels, resident rights, and quality outcomes in 12 Arkansas nursing homes owned by a large for-profit chain. The questions were as follows: (1) How did the residents’ care needs compare with actual nurse staffing levels? (2) How did the staffing levels compare with federal and state nurse staffing requirements and professional staffing standards? (3) Did the facilities comply with state and federal residents’ rights and quality of care requirements? The findings showed staffing levels marginally above state minimum standards, staffing shortages that violated state standards, staffing levels not adjusted for resident acuity, and shortages that resulted in omitted care. Staffing levels were lower than needed according to nursing directors, lower than average facilities in the state, and lower than professional standards. The findings showed many resident grievances regarding basic care and residents’ rights, clinical measures of poor quality, and state deficiencies. A large settlement was agreed on to compensate the residents. The case shows that chain’s management, as well as the regulatory system, failed to ensure adequate staffing levels that took into account regulatory requirements and professional standards and resulted in violations of residents’ rights, health, safety, and well-being.
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29
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Leahy-Warren P, Varghese V, Day MR, Curtin M. Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants. Int Nurs Rev 2018; 65:327-335. [PMID: 29424421 DOI: 10.1111/inr.12434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To examine the perceptions of nurse managers, registered nurses and healthcare assistants of physical restraint use on older people in a long-term care setting in the Republic of Ireland. BACKGROUND The use of physical restraint, although controversial, persists in long-term care settings, despite recommendations for restraint-free environments. Perception and attitude of staff can influence use of physical restraint. METHODS A descriptive cross-sectional design was used. A total of 250 nursing and healthcare assistant staff were recruited. A questionnaire incorporating demographics and the Perceptions of Restraint Use Questionnaire was used. Descriptive and inferential statistical analyses were conducted. RESULTS Mean age of respondents (n = 156) was 41 years, and the majority were female. Overall, a low level of importance was attached to the use of restraint. Nurse managers and registered nurses compared favourably with healthcare assistants who attached a higher importance to use of restraint. Across all three staff groups, greatest importance was attached to the use of physical restraint for reducing falls, followed by prevention of treatment interference. Restraint was least favoured as a means of impairment management. Education was not an explanatory factor in perceived importance of physical restraint use. CONCLUSION Nurse managers and registered nurses are unlikely to use physical restraint. However, there is concern regarding perception of healthcare assistants on use of restraint. IMPLICATIONS FOR NURSING AND HEALTH POLICY Results from this study compare favourably with those in countries that have no policy on physical restraint use. Educational programmes alone are insufficient to address use of physical restraint. Attention to skill mix with adequate support for healthcare assistants in long-term care settings is recommended.
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Affiliation(s)
- P Leahy-Warren
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - V Varghese
- Health Services Executive South, Cork, Ireland
| | - M R Day
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - M Curtin
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Bos A, Harrington C. What Happens to a Nursing Home Chain When Private Equity Takes Over? A Longitudinal Case Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017742761. [PMID: 29161948 PMCID: PMC5798733 DOI: 10.1177/0046958017742761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/15/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022]
Abstract
We analyzed what happens to a nursing home chain when private equity takes over, with regard to strategy, financial performance, and resident well-being. We conducted a longitudinal (2000-2012) case study of a large nursing home chain that triangulated qualitative and quantitative data from 5 different data sources. Results show that private equity owners continued and reinforced several strategies that were already put in place before the takeover, including a focus on keeping staffing levels low; the new owners added restructuring, rebranding, and investment strategies such as establishing new companies, where the nursing home chain served as an essential "launch customer."
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