From precarious employment to precarious retirement: neoliberal health and long-term care in the United States

2020 ◽  
pp. 191-214
Author(s):  
Larry Polivka ◽  
Baozhen Luo
Keyword(s):  
Long Term Care ◽  
The United States ◽  
Term Care ◽  
Policy Regimes ◽  
Political Economies ◽  
Care Systems ◽  
Bail Out ◽  
The U.S ◽  
Public Revenues

Neoliberal political economies have emerged across the west over the last 40 years. This development has been driven by several forces including public policy regimes that prioritize privatization of public assets and services, deregulation of the economy, reduced taxes on high incomes and wealth and use of public revenues to bail out corporate entities that are “too big to fail”. This chapter draws on Streeck’s theory of the Consolidation State dominated by corporate priorities. It describes how neoliberal policy priorities, especially privatization, are being implemented in the health and long term care systems in the U.S, and how these are in turn creating the same levels of economic insecurity and precarity in the context of work and retirement over the last 20 plus years.

Social Workers’ Impact on Policy Through Regulations: A Case Study of the U.S. Long-Term Care Ombudsman Program

2021 ◽  
pp. 146801732110103
Author(s):  
Susanny J Beltran ◽  
Vivian J Miller ◽  
Tyrone Hamler
Keyword(s):  
Social Work ◽  
Social Workers ◽  
Long Term Care ◽  
Writing Process ◽  
The United States ◽  
Term Care ◽  
The Social ◽  
The U.S

Summary Involvement in the political process in the United States is critical for social work professionals, as social policies dictate funding and programming in social work practice. Yet, there is little to no focus given to the regulation writing process in the social work literature in the United States. This article contributes to the scant body of knowledge that addresses the regulatory process from a social work perspective. A brief overview of the regulation writing process is provided, followed by a case study using the regulations for the U.S. Older Americans Act Long-Term Care Ombudsman Program to illustrate the process. Findings A total of 85 comments, submitted to the Federal Register docket, were analyzed using content analysis. Findings reveal that comment submissions varied greatly in terms of length, source, and input. Notably, findings indicate low participation from the social work profession. Application The open comment period of the regulation writing process offers a free, but effortful, window of opportunity for social workers to engage in post-legislative advocacy. There is a need to support the involvement of the social work profession in the regulation writing process, through practice and training enhancements.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

scholarly journals Understanding contributors to quality of care in long-term care and changes under COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 960-960
Author(s):  
Sara Luck ◽  
Katie Aubrecht
Keyword(s):  
Quality Of Care ◽  
Long Term Care ◽  
The United States ◽  
Control Measures ◽  
Qualitative Description ◽  
Care Staff ◽  
Term Care ◽  
The Impact

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.

Prevalence and Correlates of Gray Market Use for Aging and Dementia Long-Term Care in the U.S

2021 ◽  
pp. 073346482110236
Author(s):  
Regina A. Shih ◽  
Esther M. Friedman ◽  
Emily K. Chen ◽  
Grace C. Whiting
Keyword(s):  
Rural Areas ◽  
Long Term Care ◽  
Term Care ◽  
Unpaid Care ◽  
Gray Market ◽  
Sociodemographic Correlates ◽  
Nationally Representative ◽  
National Prevalence ◽  
The U.S

Objectives To estimate the national prevalence and sociodemographic correlates of gray market utilization, consisting of paid providers who are unrelated to the recipient, not working for a regulated agency, and potentially unscreened and untrained, for aging and dementia-related long-term care. Methods We surveyed a nationally representative sample of 1,037 American Life Panel respondents aged 18 years and older. Results Nearly a third of Americans who arranged paid care sought gray market care for persons with dementia, and most (65%) combined it with unpaid care. Respondents who arranged gray market care had 66% lower odds of currently working, and those living in rural areas had an almost 5-times higher odds of arranging dementia gray market care. Discussion Gray market care represents a substantial proportion of paid, long-term care for older adults and may fill gaps in access to care.

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

scholarly journals The Effectiveness of Contact Precautions on Methicillin-Resistant Staphylococcus aureus in Long-term Care Across the United States

2019 ◽  
Vol 71 (7) ◽  
pp. 1676-1683 ◽  
Author(s):  
Daniel J Morgan ◽  
Min Zhan ◽  
Michihiko Goto ◽  
Carrie Franciscus ◽  
Bruce Alexander ◽  
...  
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Long Term Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
The United States ◽  
Standard Precautions ◽  
Term Care ◽  
Contact Precautions ◽  
Care Facilities

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of health care–associated infections in long-term care facilities (LTCFs). The Centers for Disease Control and Prevention recommends contact precautions for the prevention of MRSA within acute care facilities, which are being used within the United States Department of Veterans Affairs (VA) for LTCFs in a modified fashion. The impact of contact precautions in long-term care is unknown. Methods To evaluate whether contact precautions decreased MRSA acquisition in LTCFs, compared to standard precautions, we performed a retrospective effectiveness study (pre-post, with concurrent controls) using data from the VA health-care system from 1 January 2011 until 31 December 2015, 2 years before and after a 2013 policy recommending a more aggressive form of contact precautions. Results Across 75 414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using standard precautions versus contact precautions in a multivariable, discrete time survival analysis, controlling for patient demographics, risk factors, and year of admission (odds ratio, 0.97; 95% confidence interval, .85–1.12; P = .71). Conclusions MRSA acquisition and infections were not impacted by the use of active surveillance and contact precautions in LTCFs in the VA.

The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

2019 ◽  
Vol 34 (4) ◽  
pp. 258-267
Author(s):  
Lisa Yamagishi ◽  
Olivia Erickson ◽  
Kelly Mazzei ◽  
Christine O'Neil ◽  
Khalid M. Kamal
Keyword(s):  
Severe Pain ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
Self Report ◽  
Prescribing Practices ◽  
Term Care ◽  
Data Set ◽  
Opioid Prescribing

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.<br/> DESIGN: Interrupted time-series analysis on retrospective observational cohort study.<br/> SETTING: 176-bed skilled-nursing facility (SNF).<br/> PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.<br/> MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.<br/> RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).<br/> CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

Kelly, James R., Jr.

2021 ◽  
Author(s):  
Sadye L. M. Logan
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Veterans Administration ◽  
Term Care ◽  
Extended Care

James R. Kelly, Jr. (1934–2002) undertook pioneering work in the development and administration of the Veterans Administration (VA) Extended Care programs that has basically shaped the modalities of long-term care now available to veterans across the United States.

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