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Many older vulnerable adults live in care facilities or are in frequent contact with healthcare professionals, which in this article means professionals specializing in elder care such as nurses, social workers, and specialized elder care ombudspersons. Healthcare professionals are in a position of authority and can strongly influence the well-being of older vulnerable adults in their care. This article examines how such healthcare professionals perceive elder maltreatment and its contributing factors. A total of 25 elder healthcare professionals working in the United States were interviewed about what types of maltreatment they have observed working in healthcare facilities and the reasons to which they attribute this maltreatment. The findings in this study highlight two major themes in what healthcare professionals perceive impact the occurrence of elder maltreatment. The first theme reflects factors related to the individual care worker such as organizational and private stressors and healthcare professionals' mental state, attitudes, and training. The other theme reveals that characteristics of the older vulnerable adults such as reduced capabilities and combativeness can, according to the healthcare professionals, contribute to maltreatment occurring. Implications of these findings and future research avenues are also discussed. [ABSTRACT FROM AUTHOR]

This article deals with the concept of assisted living in relation to long-term care choices for the aged in the U.S. Assisted living is a relatively new concept developed in the mid 1980s. A generally accepted definition of assisted living is that it is a residential care alternative to a nursing home that allows people to age in place while receiving services to help them retain their dignity and preserve and enhance their autonomy. Allegedly, there are about 39,500 assisted-living facilities in the U.S. Such facilities are called by a variety of names, such as residential care, personal acre homes, and board-and-care homes, and can range from small mom-and-pop operations to large facilities that look more like luxury hotels. A typical resident is female between the ages of 75 and 85. Most residents need help with activities of daily living. Activities of daily living are defined as transferring, bathing, dressing, toileting, eating, and continence; 64 percent of these residents have Alzheimer's disease or some form of dementia. Deciding to move to assisted living is perhaps more complex and involves evaluating several factors, namely physical and cognitive health, the social environment, availability of family and other caregivers, and financial resources.

Background: Advances in treatments for cystic fibrosis (CF) continue to extend survival. An updated estimate of survival is needed for better prognostication and to anticipate evolving adult care needs. Objective: To characterize trends in CF survival between 2000 and 2010 and to project survival for children born and diagnosed with the disease in 2010. Design: Registry-based study. Setting: 110 Cystic Fibrosis Foundation–accredited care centers in the United States. Patients: All patients represented in the Cystic Fibrosis Foundation Patient Registry (CFFPR) between 2000 and 2010. Measurements: Survival was modeled with respect to age, age at diagnosis, gender, race or ethnicity, F508del mutation status, and symptoms at diagnosis. Results: Between 2000 and 2010, the number of patients in the CFFPR increased from 21 000 to 26 000, median age increased from 14.3 to 16.7 years, and adjusted mortality decreased by 1.8% per year (95% CI, 0.5% to 2.7%). Males had a 19% (CI, 13% to 24%) lower adjusted risk for death than females. Median survival of children born and diagnosed with CF in 2010 is projected to be 37 years (CI, 35 to 39 years) for females and 40 years (CI, 39 to 42 years) for males if mortality remains at 2010 levels and more than 50 years if mortality continues to decrease at the rate observed between 2000 and 2010. Limitations: The CFFPR does not include all patients with CF in the United States, and loss to follow-up and missing data were observed. Additional analyses to address these limitations suggest that the survival projections are conservative. Conclusion: Children born and diagnosed with CF in the United States in 2010 are expected to live longer than those born earlier. This has important implications for prognostic discussions and suggests that the health care system should anticipate greater numbers of adults with CF. [ABSTRACT FROM AUTHOR]

The article discusses several concerns regarding the source and quality of the food products being served in various institutions in the U.S. as of September 2012, including food services in hospitals, prisons, and nursing homes across America. An analysis of research conducted by the New York State Department of Health on food service violations in adult care facilities is provided. The U.S. District Court case Disability Advocates Incorporated v. Paterson is also examined.

The article explores the legalities within the doctrines regarding the financial viability of Continuing Care Retirement Communities (CCRCs) and Life Care Communities (LCCs) in Pennsylvania. It highlights the investigation by the U.S. Senate Special Committee on Aging which found that the major downturns in the financial health of CCRCs resulted from financial pressures. In the light of the continuation of services to CCRCs, the need for regulations has been rejected due to budget constraints.

The article offers information on the U.S. Department of Health and Human Services' "Use of Resources in Adult Social Care" guide. It says that the guide offers best practice direction on how local authorities can maximize the use of limited resources to guarantee that they follow a balance between the pattern of spending and priorities. It says that the guide explores spending resources on adult social care; therefore, it supports the ongoing trend of diluted use of residential care.

This analysis provides an overview of the major policy themes and promising practices emerging in recent years as policymakers and researchers struggle to design a long-term care system that meets the needs of an aging population. Themes that have dominated the long-term care policy debates include: recruiting and retaining a qualified long-term care workforce; devising financing mechanisms for those requiring long-term care; and moving away from an institutional-based long-term care system towards more home- and community-based services. Three promising practices that have emerged in the past few decades include: the culture change movement; service integration that combines medical and social care; and various forms of community residential care that bring together housing and services in a more home-like environment. It concludes with long-term care recommendations for policymakers. [ABSTRACT FROM AUTHOR]

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs. [ABSTRACT FROM AUTHOR]

Purpose: We compared the prevalence of disability among older American Indians and Alaska Natives (Al/ANs) with that among their African American and White peers, then examined sociodemographic characteristics associated with disability among Al/ANs. Design and Methods: We analyzed the 5% 2000 Census Public Use Microdata Sample. We assessed disability by functional limitation, mobility disability, and self-care disability for four age groups (55-64, 65-74, 75-84, and 85 years or older). Results: For all age strata, Al/ANs reported the highest rates of functional limitation and African Americans the highest level of mobility disability. In the 55-to-64 age group, Al/ANs experienced the highest prevalence of self-care disability, and among those aged 65 years or older, African Americans reported the highest prevalence. Compared to Whites, the adjusted odds ratios for Functional limitation, mobility disability, and self-care disability were significantly elevated in Al/ANs (1.62, 1.33, and 1 .56, respectively) and African Americans (1 .27, 1 .54, and 1 .56, respectively). For Al/ANs, being of increased age, being female, having lower educational attainment and household income, not being married or in the labor force, and residing in a metropolitan area were associated with disabilities. Implications: This study contributes to re- searchers' limited knowledge regarding disability among older Al/ANs. The lack of available empirical data poses obstacles to understanding the antecedents and consequences of disability for Al/ANs. More information on the nature and extent of disabilities among Al/AN elders would enhance the ability of advocates to document their needs and raise public awareness. Likewise, policy makers could enact prevention strategies and make comprehensive rehabilitative and long-term care services available to this population. [ABSTRACT FROM AUTHOR]

The authors discuss the risk of COVID-19 in older adult living facilities other than nursing homes. They mention the varieties of living facilities and the abilities of staff, the risk factors for COVID-19 transmission, and the need for government entities to look beyond nursing homes in setting policies and funding.

The article presents a study on the influence of verbal communication on the decision to conduct required analgesia to people with dementia in care homes in the U.S. Majority of the staff interviewed from 3 care homes acknowledged the need to ask patients about their care needs. It was also found from most of the patients that verbal communication is important to the pain management process.

The article features the variety of approaches to the design, operation, regulation, and payment of assisted living as a new model of long-term care for older people in the U.S. The Oregon model was originally conceived as an alternative to both nursing home care and traditional board and care wherein early proponents advocated for settings that could be more responsive to consumer preferences and longer-term service needs. The author highlights the origins and development of assisted-living movement. The characteristics and features of assisted living is presented.

The article focuses on the importance of identifying the need and allocating resources for supportive housing of frail, low-income older adults in the U.S. The characteristics that would expect to be predictors of occupancy in a deserving location include at-risk older people who can't live independently and communities that offer too little affordable housing and inadequate long-term-care resources. The changing population settlements as well as regional differences affect how older people live. Furthermore, it is important for government planners to carefully interpret data distinguish particular places according to growth rates and size of older populations. The sociodemographic composition and the housing arrangements in a location may still offer an incomplete portrayal of older people with unmet needs.

The article focuses on the growth of residential services in Australia and the United States during 1997-2002. The most significant factors increasing demand for services and supports for people with intellectual disability are growth in national population and changes in the demographic structure of the population, particularly aging. To identify the extent of real growth in residential services, the researches compared annual changes in service provision with growth of national population in Australia and the United States since 1997. By 2002, the number of consumers of Australian residential services had increased by 5.69% relative to 1997, and the Australian population had grown by 6.15% in the same period.

Reports on the demand for the development of community-based alternatives to institutional care for older adults with serious mental illness in the U.S. Components of an effective strategy to meet the needs and preference of the rapidly growing population of older Americans with serious mental illness; Initiatives of state Medicaid aimed at shifting long-term care from an overreliance on nursing homes to home and community-based alternatives; List of several convergent sources affecting the demand.

Background Residential care/assisted living (RC/AL) is a rapidly growing, long-term care setting, where medication use has not been carefully examined. We sought to determine the prevalence and predictors of nonprescribing of selected medications whose value in decreasing morbidity has been established in clinical trials. Methods As part of a survey of a stratified random sample of 193 RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina, data were gathered on 2014 residents 65 years and older. Patient characteristics and diagnoses were recorded based on medical record reviews and in-person patient assessments; all medications administered at least 4 of the previous 7 days were recorded. Data on facility characteristics were obtained by interviewing facility administrators. Bivariate and multivariate logistic regression was performed to identify associations between medication nonprescribing and facility characteristics, physician visitation, and patient age, sex, race, comorbidity, functional dependency, and cognition. Results Of 328 subjects with congestive heart failure, 204 (62.2%) were not receiving an angiotensin-converting enzyme inhibitor; of 172 subjects with prior myocardial infarction, 60.5% were not receiving aspirin and 76.2% were not receiving β-blockers; of 435 patients with history of stroke, 37.5% were not receiving an anticoagulant or antiplatelet agent; and of 315 patients with osteoporosis, 61.0% were not receiving calcium supplementation and 51.1% were not receiving any treatment for the condition. Resident age, race, sex, comorbidity, cognitive status, and dependency in activities of daily living were rarely associated with nonprescribing; in contrast, facility factors—particularly facility type and the frequency of physician visits—were somewhat more frequently associated with nonprescribing. Conclusions Undertreatment appears to be prevalent in RC/AL facilities. Since preserving independence is often a primary goal of care in these settings, more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity. [ABSTRACT FROM AUTHOR]

Using Long-Term Care Ombudsman Program complaint data (N = 3,360) from all of Connecticut's 261 nursing facilities, this study investigated facility characteristics that may be correlated with resident complaints. Complaints per 100 beds and four subcategories of complaints established by the Administration on Aging (AoA) were the dependent variables. The presence of volunteers trained by the Ombudsman Program significantly predicted total complaints. At the bivariate level, profit status, size, location, citations, and the presence of a volunteer resident advocate were associated with the rate of complaints. However, multivariate analysis exposed a more complex pattern of relationships. The strongest model explained slightly more than 9% of the variance using the nine predictors. This indicates that other factors such as psychosocial characteristics of complainants may influence complaint reporting, rather than structural/organizational components of the facility. [ABSTRACT FROM AUTHOR]

Examines adult protective services (APS) as an independent risk factor of nursing home placement. Description of protective services for elders in Connecticut; Postulated causes of self-neglect; Responsibilities of APS agencies.

Satisfaction with long-term care has received the attention of academics, policymakers, and the general public. However, little attention has been paid to ethnic differences in satisfaction, despite the increasing proliferation of long-term care options and minority representation in such facilities. The authors find that ethnic differences exist in satisfaction with adult care homes. Dependency, satisfaction with health, resident involvement in placement decisions, home type, and percentage of private rooms vary in their impact on satisfaction by ethnicity. Predictors of satisfaction within groups are primarily intra/interpersonal versus organizational characteristics. African Americans are more affected than Whites by organizational factors. Different predictors of satisfaction by ethnicity may indicate that elders bring different life experiences, cultural beliefs, and expectations with regard to long-term care that may influence their degree of satisfaction. Service delivery in long-term care institutions should be aware of the unique experiences of their residents and implement services to ensure optimal satisfaction and care. [ABSTRACT FROM AUTHOR]

The article describes the resident and facility characteristics of several adult licensed residential care settings in Washington State. Residential care settings are receiving increasing attention as a long-term care resource among both private and public payers. One type of residential care setting that has experienced tremendous growth is assisted living. This paper presents the findings from a survey of facility and resident characteristics of adult family home (AFH), adult residential care (ARC), and assisted living (AL) settings in Washington State. Data describing resident and facility characteristics were obtained from a questionnaire mailed to these three types of licensed residential care settings. The outcome of findings suggests that the overall disability of residents was high, with AFHs serving a more impaired clientele than ARCs or ALs. ALs were more likely to serve private pay residents and had the highest occupancy rates. Although, hourly staff wages were similar, AFHs reported greater difficulties in hiring and retaining staff and were more likely to report difficult residents contributed to staffing problems. AFHs also reported the greatest dissatisfaction with state reimbursement rates. Finally, the need to carefully match resident impairment to provider capacity, especially among AFHs is the need of the hour.

The author discusses assisted-living facilities in the U.S., residents, services provided, and whether requirements to publicly disclose associated operational data would benefit the industry or its users. He introduces the article "Monitoring Quality of Care in Residential Care of the Elderly: The Information Challenge," by Flores and Newcomer elsewhere in the issue . The author believes that data collection and reporting discussed therein would benefit some residents, but not others. Also, he does not believe that the corporations that manage assisted-living facilities or public regulators want to administer such data collection and management efforts.

The article focuses on the application of technology by senior service providers to make a significant difference in the lives of individuals in senior services and activity programs in the U.S. According to the author, activity programs in the country have utilized a variety of technology programs, such as electronic mail, to enrich the lives of individuals served. He notes the importance of technology to individuals residing in a care community because it helps them to stay in touch with family members around the world.

The article presents views and insights of the author in selecting the right housing and services for older people in U.S. Elders and families can seek professional help by identifying sources of assistance. Parents can move in with an adult child to lessen the cost of assisted living. On the other hand, the Internet provides answers to questions about local community services. Significantly, a professional or a family member who has done research can know what could be the right or best for an older adult.

The article addresses the growth in assisted living facilities in the U.S. The living conditions in the facilities are described. The causes of depression are enumerated. The need for integration of generations is also proposed.

Comments on the public policy over elder care in the U.S. Proliferation of closures of home health care agencies across the country; Implementation of the Medicare interim payment system that led to increased closures of such health care agencies; Considerations in addressing the problem of elder care as a public policy issue.

Lifecare, a long-term care proposal announced by U.S. Senator Edward Kennedy, would provide health benefits to all elderly without an income means test. His plan has two parts. One part would pay for all needed home care for the frail and ill elderly plus the first 6 months of nursing home care. The second part would provide 65% of costs of the nursing home stays beyond 6 months. The cost of the necessary long-term care required by disabled senior citizens is high in the U.S., so high as to be out of the reach of all but the most affluent.