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Social disability is a process or event that significantly disrupts, paralyzes, or prevents the formation and/or sustaining of interpersonal social relations required for meeting human needs. When prolonged, the 'disabling' of essential human interrelationships can have a destructive impact. This is especially true in communities where people are highly interdependent and where individuals living with disabilities rely upon social relationships to prevent isolation and decline in overall wellbeing. Meanwhile, disaster response systems have developed to first rescue or protect individuals' 'bare life' and immediate, bodily needs. We argue that these systems, intended to mitigate disaster, can exacerbate social disability as a kind of collateral damage. We explore this problem as it unfolded amidst the COVID-19 pandemic in two research sites: one located in rural, northern Scotland and another located in rural, Midwestern United States. The Scottish research focuses on experiences, causes and risks of social disability for adults living with disabilities within a small rural community, while the U.S. research focuses on emergence of and resistance to social disability among residents of a continuing care retirement community for 55+ aged adults. We conclude with implications and recommendations for disaster intervention and future research. [ABSTRACT FROM AUTHOR]

A crucial part of theory-driven realist thinking is retroduction, the process of looking backwards for explanation of how and why things may be. Conducted early in the realist evaluation process, it provides a foundation for evidenced 'theory gleaning'. Despite retroduction being an inherent part of the realist process, it is often 'hidden' in realist reports. This paper explains the thinking behind, alongside an example of, a framework created by the authors to make transparent the retroductive process as used in a realist evaluation of two community End of Life Care services. The approach makes visible the application of the 'sociological imagination' and lends robustness to hypotheses by establishing how the authors utilised: wide-ranging potential generative causation; stakeholder and Patient and Public Involvement feedback; literature scoping; and substantive theories at the middle range, specifically Transitions Theory. These stages led to the development of Initial Programme Theories, with a clear history of genesis. [ABSTRACT FROM AUTHOR]

Snakebite envenoming remains a public health threat in many tropical countries including Malawi. Traditional healers (THs) have been consulted by victims of snakebites as primary caregivers for millennia. There are no studies in Malawi to understand this phenomenon, therefore, our study aimed to explore the experiences and practices of THs regarding snakebite treatment and prevention in rural Malawi. Between August and September 2022, we conducted semi-structured interviews with 16 THs who were purposefully selected from various locations across Neno District, Malawi. We analysed the interview data using Dedoose software, where we generated codes and grouped them into themes. Out of the 16 THs interviewed, 68.8% (n = 11) were male, and 43.8% were aged between 40 and 60 years. Our study identified five themes: THs' knowledge of snakes and treatment, the continuum of care they provide, payment procedures, snakebite prevention, and their relationship with health facilities. They claimed a good understanding of the snakes in their area, including the seasons with more snakebites, and were confident in their ability to provide treatment, however, this was not scientifically proven. They offered a comprehensive care package, including diagnosis, first aid, main treatment, and follow-up care to monitor the victim's condition and adjust treatment as needed. THs provide free treatment for snakebites or use a "pay later" model of service delivery. All THs claimed a "vaccine" for snakebites that could prevent bites or neutralize the venom. However, no formal relationship existed between THs and Health Care Workers (HCWs). We recommend collaboration between HCWs and THs, establishing clear referral pathways for snakebite victims and educating THs on identifying danger signs requiring prompt referral to healthcare facilities. Author summary: Snakebite victims in the community continue to seek care from traditional healers for a variety of reasons including cultural influences, socio-economic factors, and the lack of snake antivenom in healthcare facilities among others. Thus, traditional healers play a vital role in the treatment of snakebites. However, one limitation of relying on traditional care is the potential delay or failure of patients to present themselves at hospitals for timely administration of antivenom for those who may require it. We interviewed sixteen traditional healers in Neno, Malawi, to explore their experiences and practices regarding snakebite treatment and prevention. The traditional healers displayed confidence in their treatment methods and offered a comprehensive approach to addressing snakebite cases from diagnosis to medication and follow-up, however, their claims were not scientifically proven. Some traditional healers provided their services free of charge, with some healers requesting payment only when their clients had recovered. Furthermore, traditional healers claimed to possess a snakebite vaccine, and there appeared to be no collaboration or relationship between them and healthcare workers for the management of snakebite cases. We recommend creating spaces for joint learning and collaboration between healthcare workers and traditional healers as they share a common goal of ensuring the recovery of snakebite victims. [ABSTRACT FROM AUTHOR]

Without access to ongoing care, rapid relapses of the illness are inevitable and poor families cannot afford to provide medical care to patients at the cost of working and trying to eke out a living. I tossed and turned all night in my bed wondering if I had made a horrible mistake and jeopardized the safety of both my patient and Sonia. Most mental illnesses are chronic and need ongoing care and while good quality mental health care can help a person recover to the point where they can lead normal lives, relapses do tend to happen for any number of reasons. [Extracted from the article]

The COVID-19 pandemic has exacerbated challenges to infrastructures of care. This study explores failures in governance, material and communication infrastructures for public housing residents during a detention order in response to a COVID-19 outbreak in Melbourne, Australia. We illustrate these failures through analysis of selected publicly available sources. Failures presented glitches in the capacity for community infrastructures of care to continue to function and emerge during the detention. Findings highlight that future pandemic planning and public housing policy needs to attentively listen to affected communities and engage with trusted community infrastructures of care, providing care that sustains our future cities. [ABSTRACT FROM AUTHOR]

Older adults needing assistance with activities of daily living can receive support in various settings. Senior housing communities, such as independent living, assisted living, and continuing care retirement communities, are an increasingly popular option for adults not requiring nursing home–level care. However, limited research exists due to a dearth of data on these types of communities. We use a proprietary data set to describe the market of private pay senior housing and community-level characteristics in 140 metropolitan statistical areas, from 2015 to 2019. Although the number of senior housing communities increased substantially, the supply of senior housing options supporting the continuum of care has not necessarily kept up with population growth. Describing the supply of senior housing communities across the spectrum of levels of care provides a more complete description of the formal noninstitutional long-term care supply among the 140 most populated metropolitan statistical areas. [ABSTRACT FROM AUTHOR]

Objectives: The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design: Prospective cohort study. Setting and participants: 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods: interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results: Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications: The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty. [ABSTRACT FROM AUTHOR]

The development of residential care has not kept pace with the growth of the older population in many places. We merged the California Department of Social Services residential care for the elderly dataset with census place data to document the growth of facilities and beds per older adults in all of California and in its three largest cities. From 1996 to 2015, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analyses. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the United States and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long‐term care facilities. Key Messages: Residential care and other forms of long‐term care are increasing along with the older adult population, but not uniformly across space and time.In certain locations, residential care capacity as measured in beds per older adults has decreased or experienced intermittent growth and decline.The greatest densities of oldest old adults in the jurisdictions studied appear to have overlapped with at least small traces of the residential care industry in cartographic analyses. [ABSTRACT FROM AUTHOR]

Background: Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community‐dwelling older adults and those in long‐term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)‐facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. Methods: Open‐label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. Setting: RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). Intervention: GNS‐facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n = 400: MDT intervention = 199; usual care = 201) were included in intention‐to‐treat analyses. Results: Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow‐up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR] = 1.01, 95% CI = 0.77–1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person‐year) and usual care (0.86 per person‐year) groups (incidence rate ratio = 0.81, 95% CI = 0.59–1.10). Similar results were seen for the proportion of residents with LTC transition (HR = 1.18, 95% CI = 0.65–2.11) and mortality (HR = 0.70, 95% CI = 0.36–1.35). Conclusion: Further studies are needed to assess the effects of other patient‐centered interventions and outcomes with adequate primary care integration. [ABSTRACT FROM AUTHOR]

The article discusses the things that elder law lawyers should know about continuing care retirement communities (CCRC) or life plan communities. Also cited are the potential benefits of CCRCs in the life of older adults like access to long-term medical care and a sense of control over their lives and the key roles played by CCRCs in the long-term care of older people.

Contexts: Inadequate pain management in community pediatric palliative care is common. Evidence to inform improved pain management in this population is limited.Objectives: To explore the barriers and facilitators to pediatric community-based pain management for infants, children and young people at end-of-life as perceived by healthcare professionals.Methods: A qualitative interview study was conducted. Semi-structured interviews were undertaken with 29 healthcare professionals; 12 nurses, five GPs, five consultants and registrar doctors, two pharmacists and five support therapists working in primary, secondary or tertiary care in the United Kingdom and involved in community end-of life care of 0 to 18-year-olds.Results: The data corpus was analyzed using an inductive thematic analysis and seven themes emerged: parents' abilities, beliefs and wellbeing; working relationships between families and healthcare professionals, and between healthcare teams; healthcare professionals' knowledge, education and experience; health services delivery; nature of pain treatment; and pediatric-specific factors. Across themes, the concepts of partnership working between families and healthcare professionals, and within healthcare teams, and sharing expertise were prevalent.Conclusion: Partnership working and trust between healthcare professionals and parents, and within healthcare teams, is needed for effective at-home pediatric palliative pain management. Community healthcare professionals require more education from experienced multidisciplinary teams to effectively manage pediatric pain at end-of-life and prevent emergency hospice or hospital admissions, particularly during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The article discusses benefits of lifestyle medicine shared medical appointments (LMSMAs) for patients, providers and health systems. Lifestyle medicine clinic visits focus on the use of evidence-based lifestyle therapeutic intervention, including a wholefood, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection, as a primary modality.

Background: Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia. Main body: Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty. Conclusions: Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries. [ABSTRACT FROM AUTHOR]

Trauma is experienced throughout the life span, and traumatic experiences may be remote events or current and ongoing. The health care community continues to learn the many ways in which trauma affects an individual’s health, relationships, utilization of the health care system, health care experience, and ability to adopt healthrelated recommendations. It is important for obstetrician–gynecologists and other health care practitioners to recognize the prevalence and effect of trauma on patients and the health care team and incorporate trauma-informed approaches to delivery of care. Although trauma spans all races, ages, and socioeconomic statuses, some populations are exposed to trauma at higher rates and with greater frequency of repeated victimization. A number of health effects that may be associated with trauma are seen frequently in obstetrics and gynecology, including chronic pelvic pain, sexually transmitted infections, unintended pregnancy, conflicted feelings about pregnancy and sexuality, and difficulty with infant attachment postpartum. Obstetrician–gynecologists should become familiar with the trauma-informed model of care and strive to universally implement a trauma-informed approach across all levels of their practice with close attention to avoiding stigmatization and prioritizing resilience. [ABSTRACT FROM AUTHOR]

Aim: This study examined the contribution of the social network to one's sense of belonging to the community (SCB) in two different long‐term care settings: Continuing care retirement communities (CCRCs) and adult day care centers (ADCCs). Methods: Overall, 245 respondents participated in both waves of the study that were spaced about 1 year apart. Results: Results show that constraint in the social network (e.g., being socially invested in a single group of interconnected ties) is particularly detrimental for CCRC residents, but not for ADCC participants. Betweenness, defined as the number of shortest paths that pass through the focal person, was not significantly related to SCB. In addition, the size of the egocentric network, obtained through a name generator of a list of all potentially meaningful individuals identified by respondents, was directly correlated with SCB at follow‐up. Conclusions: The findings are discussed in light of differences between the two long‐term care settings and the different social network indicators examined in this study. [ABSTRACT FROM AUTHOR]

This study examines two theoretical explanations for the existence of close ties among continuing care retirement community residents: the attractiveness theory, which suggests that residents who possess certain attributes are more likely to be perceived as appealing to others; and the homophily theory, which argues that individuals are more likely to have close ties with people who share similar attributes. As a variant of the homophily theory, we also examined whether sharing a physical location makes the existence of certain connections more likely. Data from four continuing care retirement communities were used. To test the attractiveness theory, correlations between the number of individuals who named a person as a significant contact (ego's in-degree) and ego attributes were examined. To test the homophily theory, the median value of existing ties was compared against all possible social ties as though they were randomly formed. Finally, to further test the role of the institutional culture against various motivations that drive social ties—attractiveness and homophily—we used link prediction models with random forests. In support of the homophily theory, beyond the institutional culture, the only consistent predictor of the existence of close ties among residents was sharing a wing in the retirement community (geographic proximity). Therefore, we discuss the role of the physical location in the lives of older adults. [ABSTRACT FROM AUTHOR]

Paper prototypes have been successful for gathering concrete, grounded user feedback. Most of these prototypes are used to elicit feedback during bounded design sessions. However, for systems that support new social practices these bounded sessions do not fully materialize the interactions the prototype supports. This paper presents a case study of a six-month paper prototype deployment that materialized collaborative interactions in care retirement community. Throughout this deployment the prototype was situated within the lives of participants, where they shaped the interactions and usage of the prototype over time. As these interactions materialized, the evoked community practice was unlike what participants envisioned during our first, more traditional paper prototyping and design sessions. This article shows how our interactive, paper prototype provided critical guidance in how realistic our imagined practice would be. • Deploying a paper prototype for months, not hours, at a time can reveal more detail. • Creative use of paper prototypes can support collaborative and social practices. • Temporal and physical space to evolve prototypes grants more accessible participation. [ABSTRACT FROM AUTHOR]

Across Canada the demand for continuing care services is increasing. However, little is known about the implications this has for rural communities. This scoping review identifies several key themes in the literature related to continuing care in Alberta. These include contextual factors, quality assurance and improvement, and workforce issues. We identify the ways in which rural dynamics are included in, or omitted from, this literature and recommend areas for future research on rural continuing care provision. Further research on residential care services in rural communities should work towards bridging the rural health, academic, and organizational literature on continuing care. This synthesis will help to position rurality as a determinant of health and to situate continuing care services in specific rural settings. Key Messages: The literature on continuing care in Alberta primarily focuses on quality assurance and improvement and the changing structure of the continuing care workforce.Little is known about the continuing care needs of rural Albertans.Future research ought to explore rural assets and challenges related to continuing care provision. [ABSTRACT FROM AUTHOR]

As rural communities face aging, population decline, and the withdrawal of public services, the provision of care in rural and northern areas becomes increasingly complex, draws from multiple and often over-lapping stakeholders and organizations, and often functions differently than in more urban or ex-urban areas. Drawing from a series of continuing care capacity workshops held in Northern Alberta, this paper presents a roadmap of both continuing care in the region, as well as a refined model for how capacity can be built, maintained and developed for continuing care practitioners and organizations. Based on five broad research questions, we demonstrate not only the differentiation between rural, Aboriginal and northern communities in terms of continuing care, but also the need to acknowledge that the factors driving the functional success of the provision of continuing care can also become weaknesses. [ABSTRACT FROM AUTHOR]

Many countries, including Thailand, are entering an aging society. Older people have various problems and needs that affect their health in terms of social, economic, environmental, and medical aspects. Critical ethnography was employed herein to understand the community' s continuing care for older people. This study was conducted with the key informants being 59 older people and caregivers and 41 related people. Participant observation, in-depth interviews, and focus group discussions were used to collect the data. Content analysis was employed to analyze the data. The results showed that there were 6 dimensions of continuing care in the community for older people: 1) Potential development, 2) Improvement of a suitable environment for the older people, 3) Development of the service system, 4) Establishment of funds or welfare, 5) Development of information for problem solving, and 6) Development of rules and regulations to support the implementation. Moreover, it was found that the activities of the community' s continuing care for older people affected 7 groups of older people: 1) older people in general, 2) the home-bound older people, 3) the bed-bound older people, 4) older people with disabilities, 5) older people who were abandoned or living alone, 6) older people with chronic illnesses, and 7) people who were preparing to become older people. The activities covered 5 aspects: 1) social, 2) economic, 3) environmental, 4) health care, and 5) political which can all be the guidelines for community nurses and multidisciplinary teams in providing continuing care for older people to improve their quality of life. [ABSTRACT FROM AUTHOR]

The Seniors Health Strategic Clinical Network's (SH SCN) work is aligned with 3 strategic priorities as outlined in the Transformational Roadmap: Aging Brain Care, Late-life Transitions Initiative (FRAILTI) and Anticipating an Aging Alberta. Examples of work led by the SH SCN include the Appropriate Use of Antipsychotics project, Elder Friendly Care in Acute Care and the Primary Health Care Integrated Geriatric Services Initiative. In preparation for the unprecedented demographic shift in Canada's population, the SCN continues to align its strategic priorities with Alberta Health Services' pursuit of a patient-centred, quality health system that is both accessible and sustainable for all Albertans. [Extracted from the article]

The Problem: Continuing care retirement communities (CCRCs) promise a setting that provides a high quality of life (QOL) throughout residents' lifetimes, but we know little about how residents themselves conceptualize QOL within a CCRC context. The Resolution: We conducted an in-depth case study of one CCRC by examining its residents' and administrators' conceptions of QOL and strategies for achieving QOL through qualitative analyses of interviews and surveys. Tips for Success: Residents and administrators identified three central components of QOL: sense of community; resident-driven active engagement; and individual autonomy, independence, and respect. They also identified six clusters of strategies that are key to promoting QOL, require minimal resources, and appear easily translatable to varied forms of group senior living facilities. [ABSTRACT FROM AUTHOR]

The Problem: Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long- Term Care Providers. The Resolution: About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. Tips for Success: An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively. [ABSTRACT FROM AUTHOR]

While continuing care for substance use treatment has been associated with reduced involvement in the criminal justice system, much of this research lacks random assignment to continuing care and so is limited by self-selection bias. This study sought to determine the impact of adding telephone-based continuing care to intensive outpatient programs on criminal justice outcomes for people with cocaine dependence. In three continuing care studies, spanning 1998-2008, participants were randomly assigned to an intensive outpatient program or an intensive outpatient program plus a telephone-based continuing care intervention. Cocaine-dependent participants from these three studies were included in the analyses, with outcomes derived from a dataset of jurisdiction-wide criminal sentences from a state sentencing agency. Multiple logistic regression was employed to examine the odds of a criminal conviction occurring in the 4 years after enrollment in a continuing care study. The results showed that, controlling for a criminal sentence in the previous year, gender, age, and continuing care study, people with cocaine dependence randomized to an intensive outpatient program plus a telephone-based continuing care intervention had 54% lower odds (p = 0.05, odds ratio = 0.46, 95% CI: 0.20-1.02) of a criminal sentence in the 4 years after enrollment in the continuing care study, compared with those randomized to an intensive outpatient program alone. We can conclude that adding telephone monitoring and counseling to intensive outpatient programs is associated with fewer criminal convictions over a 4-year follow-up period compared with intensive outpatient programs alone. [ABSTRACT FROM AUTHOR]

This study assesses service quality and suggests customized strategies for improvement of the service quality in a continuing care retirement community (CCRC). Questionnaires based on the SERVQUAL framework and adapted for CCRCs were distributed to 293 CCRC residents first to measure their perceived importance and subsequently asses the performance of the CCRC on 25 service quality attributes. Descriptive analysis, confirmatory factor analysis, paired-samples t-test, and regression were used to analyze the data from 118 respondents who participated in both surveys. The results indicated that four service-quality attributes (one item in the reliability dimension and three items in the responsiveness dimension) were the priorities for service quality improvement. Theoretical and practical implications are discussed and recommendations are made for future research in the CCRC context. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to clarify the effect of swallowing disorders on functional decline in community-dwelling older adults receiving home care. This was a 1-year follow-up survey of 176 individuals ≥60 years living at home and receiving homecare services, without total dependence in basic daily living activities, in two mid-sized municipalities in Fukuoka, Japan. Functional decline was measured using the Barthel index ( BI), and the primary outcome was total dependence in basic daily living activities ( BI ≤ 20 points). Swallowing function was assessed using cervical auscultation, and the primary predictor was swallowing disorders. Logistic regression models were used to assess univariate and multivariate associations between baseline swallowing function and functional decline during follow-up. During follow-up 16 (9.1%), the participants became totally dependent in basic daily living activities. The participants with swallowing disorders had 6.41 times higher odds of total dependence in basic daily living activities compared to participants with normal swallowing function. After adjusting for potential confounders, swallowing disorders were significantly associated with higher odds of total dependence in basic daily living activities (odds ratio = 5.21, 95% confidence interval = 1.33-20.44). Regarding swallowing disorders, the corresponding population attributable fraction (%) of the incidence of total dependence in basic daily living activities was 50.4%. The current findings demonstrated that swallowing disorders were associated with greater risk of functional decline in basic daily living activities among older adults living at home and receiving home nursing care. Maintenance and improvement of swallowing function may prevent late-life functional decline. [ABSTRACT FROM AUTHOR]

This paper deals with life care annuities, i.e. bundled products comprising a life annuity and long-term care insurance. It aims to assess the cost of converting retirement benefit into a life care annuity with graded benefits using a pre-existing public pay-as-you-go pension scheme. With this objective in mind, we present an actuarial method based on array calculus for valuing this type of life care annuity. The health dynamics of the annuitant rely on a reversible illness-death multistate framework. The paper contains a numerical example in which mortality and disability assumptions are based on data from the USA and Australia, although this should be viewed simply as an illustration. In addition, in order to check the coherence of these data, we compute life expectancy for both healthy and dependent persons, and then for dependent persons in each of the states of dependence. The effect of ruling out the recovery assumption on the annuity's cost is also assessed. The analysis provides valuable insights into how much it would cost to introduce these annuities and enables us to make some policy recommendations to help ensure that this combined pension scheme has a good actuarial design. [ABSTRACT FROM AUTHOR]

Although the burden of caring is well described, the value of home as a potential place of wellbeing and support for informal caring networks when providing end-of-life care is not well recognised. Interviews and focus groups with 127 primary carers and members of informal care networks revealed their collaborative stories about caring for a dying person at home. Four themes emerged from the data: home as a place of comfort and belonging; places of social connection and collaborative caring; places of connection to nature and the non-human; places of achievement and triumph. When support is available, nurturing carer wellbeing may be best achieved at home. [ABSTRACT FROM AUTHOR]

The article discusses the court case Continuing Life Communities Thousand Oaks LLC v. Commissioner of Internal Revenue, wherein the U.S. Tax Court allowed deferral of income and method of accounting for continuing care community. It raises arguments of the Commissioner regarding the discretion of accounting method for deferred fees. The Tax Court cited a Treasury Regulation governing compensation for services and applicable Generally Accepted Accounting Principles (GAAP).

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment. [ABSTRACT FROM AUTHOR]

The Contracts, Prompts, and Reinforcement (CPR) intervention has demonstrated an ability to increase the duration of continuing care participation following substance use disorder (SUD) treatment, resulting in improved treatment outcome. The current project was a qualitative pre-implementation study aimed at identifying barriers and facilitators to implementation of CPR using an evidence-based quality improvement (EBQI) approach. Formative evaluations were conducted with staff from residential SUD treatment programs across three VA sites, and key informant interviews were completed with opinion and program leaders. Data were analyzed using a grounded theory approach, which identified barriers and facilitators to implementation. Fidelity measures were developed for each of the core CPR components, and the research-focused treatment manual was rewritten to facilitate future implementation efforts with the design and content of the documents shaped by the findings of the qualitative analyses. Overall, data suggested that clinicians and administrators are receptive to the core components of CPR. [ABSTRACT FROM AUTHOR]