Senior Centers and Nutritional Outcomes: A Texas Example.

Healthy diet and weight control are important for elders and senior centers (SCs). The authors consider effects of SCs on attendee nutrition and health and efforts to improve diets and weight. Data derive from surveys in 2006 (N = 798) and 2007 (N = 742) at 21 multipurpose SCs in Tarrant County, Texas, supplemented with data from 2012 (N = 1,402). Measures included attendee agreement that SC meals improved nutrition, improved health, attempts to improve diets, and success in controlling weight. Cumulative and binary logistic regression methods were employed. SC attendance and social engagement explained agreement that SC meals improved nutrition and health but were not shown to predict changes in diet or weight control. Findings suggest success of SC programs, as well as physician recommendations, in influencing attendee nutritional behavior and perceptions of nutrition and health effects. Practice recommendations include SC collaborations with local health providers to promote attendee nutritional health.

The level of willingness to evacuate among older adults.

The issues of rising numbers of disasters, overwhelming increases in number of older adults, and historically flawed evacuations present real challenges. During the next two decades, the number of American baby boomers, who turn 65, will increase by 40%. As evidenced by recent disasters, the imperfections and vulnerabilities of flawed evacuations for older adults are still present. This study examined the level of willingness to evacuate among older adults in the event of a disaster. Despite the extensive literature on disasters and evacuation, a significant question regarding evacuation and older adults has not been addressed. The study addressed the following concern: What is the level of willingness among older adults to evacuate when asked to do so by emergency management officials? The sample population consisted of 765 voluntary participants aged 60 years and older from 30 senior/community centers within seven counties within a midwestern state. A group administered survey (The Disaster Evacuation Survey) included a total of 15 questions. The findings revealed that older adults are more likely to comply with a mandatory evacuation order. Important practical implications for emergency officials responding to vulnerable older adults in disaster situations are also provided.

Medicaid nursing facility rates, capacity, and utilization: a structural analysis.

This analysis extends earlier work using national data to examine Medicaid nursing facility (NF) utilization (participants per aged population) and its interrelationships with Medicaid per diem NF reimbursement rates and NF bed capacity, using state-level data over 19 years to estimate two-stage structural equations. Findings demonstrate complex relationships among these factors. Reimbursement rates showed no demonstrable impact on utilization but positive effects on beds. Beds, in turn, positively predict utilization and negatively predict rates. Findings suggest that policy makers might focus on constraining Medicaid NF costs through controlling bed stock rather than by keeping rates lower, which can have untoward effects on quality and equity.

Getting tougher for the fourth quarter: boomers and physical activity.

Baby Boomers might not consider themselves as growing old but are starting to reach the last quarter of average life spans. This article asks how Boomers prepare for their fourth quarters through physical activity. Three years (1999-2001) of National Health Interview Survey data yielded 96,501 adult respondents. Dependent variables were moderate, vigorous, and strengthening activity. Old boomers (1946-1955) and young boomers (1956-1965) were compared to respondents born before 1926, after 1975, and 10-year cohorts between. SUDAAN multiple logistic regression adjusted for complex sampling structure and multiply imputed income. Age-adjusted, older cohorts showed greater likelihood of activity than younger cohorts, offsetting moderate-activity declines with age until sharp decreases at advanced age: a plateau across Boomer and younger-aged cohorts. Interventions should promote activity at intensities and frequencies to which Boomers are most receptive.

Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

OBJECTIVE: To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates. DATA SOURCES: Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources. STUDY DESIGN: Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix. PRINCIPAL FINDINGS: RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors. CONCLUSIONS: To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.

California nursing facility quality and union environments.

OBJECTIVE: Many studies have examined quality effects of nursing facility (NF) staffing, but few have examined effects of unionization. Concerned with possible effects of unionization on quality, we analyzed unionization and local market climate of unionization, predicting both complaints (reflecting either quality problems or better monitoring and advocacy) and the substantiation of serious complaints (indicating major quality problems). METHOD: Data were analyzed on California freestanding NFs in 1999 (N = 1,155). OLS regression was employed to predict both quality complaints and serious violations, the latter both controlling and not controlling for numbers of complaints. RESULTS: Unionized NFs showed more complaints than did non-unionized NFs. Non-unionized NFs had more serious violations, particularly when the proportion of other county facilities unionized was higher. DISCUSSION: These findings suggest that unionization enhances problem reporting while, especially in stronger union environments, reducing the incidence of serious quality violations.

Effectiveness of a videotape for sexual counseling after myocardial infarction.

A two-group randomized clinical trial was used to test the hypothesis that patients with myocardial infarction (MI) who receive both written instructions and a videotape to view at home will have greater knowledge, better quality of life, less anxiety, greater sexual satisfaction, and will resume sexual activity more quickly than will those who receive written instructions alone. The participants, 115 patients diagnosed with an MI, were pretested in the hospital and followed at home at 1, 3, and 5 months. The intervention was an educational videotape on return to sexual activity. Significant improvements in knowledge were found for the experimental group at 1 month. The videotape intervention provides an alternative method for education to facilitate recovery post-MI.

Nursing home staffing, turnover, and case mix.

This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.

Medicaid case-mix nursing home reimbursement in three states.

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

Access and attitudes toward oral health care among Hispanics in Wichita, Kansas.

PURPOSE: The purpose of this pilot study was to obtain information on access to care and attitudes toward oral health among the Hispanic population in Wichita, Kansas. METHODS: A convenience sample of 75 Hispanic adults, who attended clinics serving Hispanics and two social events, volunteered to complete a 63-item Spanish/English survey. Likert and open-ended questionnaires addressed issues of access and attitudes towards oral health, barriers to care, dental insurance, and demographic information. Data were analyzed using logistic regression, multivariate logistic, and OLS regression analysis, cross tabulation, and coefficient alpha. RESULTS: A total of 78 adults voluntarily completed the survey. Of those, three were under the age of 18 and were excluded from the sample. Of the 75 remaining surveys, 9 respondents did not report their age, rendering 66 usable responses. The age range was 18 to 80. Females comprised 56% and males 44% of the sample. Older respondents had greater consistency in oral health care, were more likely to have a regular place they received their care, and more recent visits for care. Education beyond high school predicted more dental visits, fewer months since the last oral health exam, and greater frequency of oral health care. Office workers showed more recent and more oral health care visits. Those with greater education perceived their oral health as better, recognized greater oral health needs, and were less likely to delay seeking care. Insured participants averaged fewer months since their last dental visit. CONCLUSION: This pilot study furnishes base information to begin addressing the problems of access and attitudes toward oral health care by the Hispanic population in Wichita, Kansas. It provides insight into what is happening in this community and alerts oral health practitioners of needed changes. Changes include learning about cultural diversity to increase understanding of how to address and service ethnic minorities, as well as illustrating the importance of educating this population about oral health care and how to access it. These changes should in turn increase treatment acceptance and compliance. Further study including a larger sample is needed.

Prospects for single payer coverage after Harry and Louise.

PURPOSE OF THE STUDY: This paper considers evidence of indirect influences of the Harry and Louise media campaign on public support of single payer health coverage in a conservative state. DESIGN AND METHODS: Data from a statewide, representative public opinion survey on health reform conducted in Oklahoma over a two-year period, 1992-1994, were combined with data on the Harry and Louise media campaign broadcasts. A two-stage structural-equation model tested the hypothesis that support for single payer varied inversely with support for "mainstream" health reform. RESULTS: Findings support the hypothesis, providing evidence that a campaign affecting support for mainstream health reform inversely affects support for single payer, despite the tendency for support for health reform to correlate with support for single payer. IMPLICATIONS: Findings suggest that an unintended indirect effect of a campaign against mainstream health reform may have been increased support for single payer. Those proposing future reforms should be aware of available media technologies and how they will be used.