Social Participation in Long-term Residential Care: Case Studies from Canada, Norway, and Germany.

Meaningful social engagement in everyday activities can enhance resident quality of life in nursing homes. In this article, we draw on data collected in a multidisciplinary, international study exploring promising practices in long-term care homes across Canada, Norway, and Germany, to investigate conditions that either allow for or create barriers to residents' social participation. Within a feminist political economy framework using a team-based rapid ethnography approach, observations and in-depth interviews were conducted with management, staff, volunteers, students, families, and residents. We argue that the conditions of work are the conditions of care. Such conditions as care home location, building layout, staffing levels, and work organization, as well as governing regulations, influence if and how residents can and do engage in meaningful everyday social life in/outside the nursing home. The presence of promising conditions that facilitate resident social participation, particularly those promoting flexibility and choice for residents, directly impacts their overall health and well-being.

Spatiotemporal Characteristics of the COVID-19 Epidemic in the United States.

BACKGROUND: A range of near-real-time online/mobile mapping dashboards and applications have been used to track the coronavirus disease 2019 (COVID-19) pandemic worldwide; however, small area-based spatiotemporal patterns of COVID-19 in the United States remain unknown. METHODS: We obtained county-based counts of COVID-19 cases confirmed in the United States from 22 January to 13 May 2020 (N = 1 386 050). We characterized the dynamics of the COVID-19 epidemic through detecting weekly hotspots of newly confirmed cases using Spatial and Space-Time Scan Statistics and quantifying the trends of incidence of COVID-19 by county characteristics using the Joinpoint analysis. RESULTS: Along with the national plateau reached in early April, COVID-19 incidence significantly decreased in the Northeast (estimated weekly percentage change [EWPC]: -16.6%) but continued increasing in the Midwest, South, and West (EWPCs: 13.2%, 5.6%, and 5.7%, respectively). Higher risks of clustering and incidence of COVID-19 were consistently observed in metropolitan versus rural counties, counties closest to core airports, the most populous counties, and counties with the highest proportion of racial/ethnic minorities. However, geographic differences in incidence have shrunk since early April, driven by a significant decrease in the incidence in these counties (EWPC range: -2.0%, -4.2%) and a consistent increase in other areas (EWPC range: 1.5-20.3%). CONCLUSIONS: To substantially decrease the nationwide incidence of COVID-19, strict social-distancing measures should be continuously implemented, especially in geographic areas with increasing risks, including rural areas. Spatiotemporal characteristics and trends of COVID-19 should be considered in decision making on the timeline of re-opening for states and localities.

Statistical Assessment of Neighborhood Socioeconomic Deprivation Environment in Spatial Epidemiologic Studies.

Neighborhood socioeconomic deprivation has been associated with health behaviors and outcomes. However, neighborhood socioeconomic status has been measured inconsistently across studies. It remains unclear whether appropriate socioeconomic indicators vary over geographic areas and geographic levels. The aim of this study is to compare the composite socioeconomic index to six socioeconomic indicators reflecting different aspects of socioeconomic environment by both geographic areas and levels. Using 2000 U.S. Census data, we performed a multivariate common factor analysis to identify significant socioeconomic resources and constructed 12 composite indexes at the county, the census tract, and the block group levels across the nation and for three states, respectively. We assessed the agreement between composite indexes and single socioeconomic variables. The component of the composite index varied across geographic areas. At a specific geographic region, the component of the composite index was similar at the levels of census tracts and block groups but different from that at the county level. The percentage of population below federal poverty line was a significant contributor to the composite index, regardless of geographic areas and levels. Compared with non-component socioeconomic indicators, component variables were more agreeable to the composite index. Based on these findings, we conclude that a composite index is better as a measure of neighborhood socioeconomic deprivation than a single indicator, and it should be constructed on an area- and unit-specific basis to accurately identify and quantify small-area socioeconomic inequalities over a specific study region.

Influence of neighborhood-level factors on social support in early-stage breast cancer patients and controls.

RATIONALE: Low social support has been linked to negative health outcomes in breast cancer patients. OBJECTIVE: We examined associations between perceived social support, neighborhood socioeconomic deprivation, and neighborhood-level social support in early-stage breast cancer patients and controls. METHODS: This two-year longitudinal study in the United States included information collected from telephone interviews and clinical records of 541 early-stage patients and 542 controls recruited from 2003 to 2007. Social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SS). Residential addresses were geocoded and used to develop measures including neighborhood social support (based on MOS-SS scores from nearby controls) and neighborhood socioeconomic deprivation (a composite index of census tract characteristics). Latent trajectory models were used to determine effects of neighborhood conditions on the stable (intercept) and changing (slope) aspects of social support. RESULTS: In a model with only neighborhood variables, greater socioeconomic deprivation was associated with patients' lower stable social support (standardized estimate = -0.12, p = 0.027); neighborhood-level social support was associated with social support change (standardized estimate = 0.17, p = 0.046). After adding individual-level covariates, there were no direct neighborhood effects on social support. In patients, neighborhood socioeconomic deprivation was associated with support indirectly through marriage, insurance status, negative affect, and general health. In controls, neighborhood socioeconomic deprivation was associated with support indirectly through marriage (p < 0.05). CONCLUSION: Indirect effects of neighborhood socioeconomic deprivation on social support differed in patients and controls. Psychosocial and neighborhood interventions may help patients with low social support, particularly patients without partnered relationships in deprived areas.

Comparing GIS-based measures in access to mammography and their validity in predicting neighborhood risk of late-stage breast cancer.

BACKGROUND: Assessing neighborhood environment in access to mammography remains a challenge when investigating its contextual effect on breast cancer-related outcomes. Studies using different Geographic Information Systems (GIS)-based measures reported inconsistent findings. METHODS: We compared GIS-based measures (travel time, service density, and a two-Step Floating Catchment Area method [2SFCA]) of access to FDA-accredited mammography facilities in terms of their Spearman correlation, agreement (Kappa) and spatial patterns. As an indicator of predictive validity, we examined their association with the odds of late-stage breast cancer using cancer registry data. RESULTS: The accessibility measures indicated considerable variation in correlation, Kappa and spatial pattern. Measures using shortest travel time (or average) and service density showed low correlations, no agreement, and different spatial patterns. Both types of measures showed low correlations and little agreement with the 2SFCA measures. Of all measures, only the two measures using 6-timezone-weighted 2SFCA method were associated with increased odds of late-stage breast cancer (quick-distance-decay: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.01-1.32; slow-distance-decay: OR = 1.19, 95% CI = 1.03-1.37) after controlling for demographics and neighborhood socioeconomic deprivation. CONCLUSIONS: Various GIS-based measures of access to mammography facilities exist and are not identical in principle and their association with late-stage breast cancer risk. Only the two measures using the 2SFCA method with 6-timezone weighting were associated with increased odds of late-stage breast cancer. These measures incorporate both travel barriers and service competition. Studies may observe different results depending on the measure of accessibility used.

Positional accuracy and geographic bias of four methods of geocoding in epidemiologic research.

PURPOSE: We examined the geographic bias of four methods of geocoding addresses using ArcGIS, commercial firm, SAS/GIS, and aerial photography. We compared "point-in-polygon" (ArcGIS, commercial firm, and aerial photography) and the "look-up table" method (SAS/GIS) to allocate addresses to census geography, particularly as it relates to census-based poverty rates. METHODS: We randomly selected 299 addresses of children treated for asthma at an urban emergency department (1999-2001). The coordinates of the building address side door were obtained by constant offset based on ArcGIS and a commercial firm and true ground location based on aerial photography. RESULTS: Coordinates were available for 261 addresses across all methods. For 24% to 30% of geocoded road/door coordinates the positional error was 51 meters or greater, which was similar across geocoding methods. The mean bearing was -26.8 degrees for the vector of coordinates based on aerial photography and ArcGIS and 8.5 degrees for the vector based on aerial photography and the commercial firm (p < 0.0001). ArcGIS and the commercial firm performed very well relative to SAS/GIS in terms of allocation to census geography. For 20%, the door location based on aerial photography was assigned to a different block group compared to SAS/GIS. The block group poverty rate varied at least two standard deviations for 6% to 7% of addresses. CONCLUSION: We found important differences in distance and bearing between geocoding relative to aerial photography. Allocation of locations based on aerial photography to census-based geographic areas could lead to substantial errors.

"They suffered with us and should be compensated": entitling caregivers of Canada's veterans.

This article examines the struggle to win lifetime eligibility for selected home care benefits provided through the Veterans Independence Program (VIP) for veterans' widows in recognition of their years of unpaid caregiving - a policy change eventually implemented between 2003 and 2004. It explores how arguments on their behalf shifted from discourses of dependency, cost-saving, and compassion to ones of entitlement and commemoration between 1981 and 2004 as the large cohort of Second World War veterans and their wives moved towards the end of their lives. This policy victory for veterans' widows marked a historic shift in mandate for Veterans Affairs Canada and an important recognition by the state of unpaid caregiving as a form of national service. If Canadians are to learn from this example, however, it must be through seeing all caregiving labour - not just that of veterans' wives - as equally heroic and worthy of compensation.

"No place like home": Gender, family, and the politics of home care in post-world war II Ontario.

Since the early 1990s home care increasingly has emerged as a favoured policy response to the growing costs which an aging population poses for our health care system. This paper explores the early history of home care for the elderly in Ontario during the first three decades after World War II. It demonstrates that policy debates over the merits of home versus institutional care for the elderly, and community-based over hospital-based approaches to home care are not recent phenomenon but have been on going since the 1940s within the public health and social services sector. The paper examines why home care failed for so long to develop beyond the margins of Ontario's highly institutionalized health care system. It also explores how earlier visions of community-based home care, designed to help the elderly age in place, increasingly were obscured by an exclusive preoccupation with home care's "cost effectiveness" as an alternative to hospital or residential care, a rationale which discounted home care's costs to unpaid and principally female care givers. The paper concludes that the Ontario health ministry's systematic devaluing of caregiving and home maker skills, the fear of undermining the family's willingness to provide care, as well as the failure to develop effective mechanisms for integrated regional health care planning, also impeded the progress of home care's development before the 1980s.