California’s elderly population over age 85 is estimated to grow 361% by the year 2050. Many of these elders are frail and highly dependent on caregivers making them more likely to need nursing home care. A 1998 United States Government Accountability Office report identified poor quality of care in California nursing homes. This report spurred multiple Assembly Bills in California designed to increase nursing home nurse staffing, change the state’s Medi-Cal reimbursement methodology, or both. The legislation culminated in Assembly Bill (AB) 1629, signed into law in September 2004, which included the Long-Term Care Reimbursement Act. This legislation changed the state’s Medi-Cal reimbursement from a prospective, flat rate to a prospective, cost-based methodology and was designed in part to increase nursing home nurse staffing. It is estimated that this methodology change moved California from the bottom 10% of Medicaid nursing home reimbursement rates nationwide to the top 25%. This study analyzed the effect of AB 1629 on a panel of 567 free-standing nursing homes that were in continuous operation between the years 2002 – 2007. Resource Dependence Theory was used to construct the conceptual framework. Ordinary least squares (OLS) and first differencing with instrumental variable estimation procedures were used to test five hypotheses concerning Medi-Cal resource dependence, bed size, competition (including assisted living facilities and home health agencies), resource munificence, and slack resources. Both a 15 and 25 mile fixed radius were used as alternative market definitions instead of counties. The OLS results supported that case-mix adjusted licensed vocational nurse (LVN) and total nurse staffing hours per resident day increased overall. Nursing homes with the highest Medi-Cal dependence increased only increased NA staffing more than nursing homes with the lowest Medi-Cal dependence post AB 1629. The fixed effects with instrumental variable estimation procedure provided marginal support that nursing homes with more home health agency competition, in a 15 mile market, had higher LVN staffing. This estimation procedure also supported that nursing homes with more slack resources (post AB 1629) increased nurse aide and total nurse staffing while nursing homes located in markets with a greater percentage of residents over the age of 85 had more nurse aide staffing.

In the Czech Republic the Romani minority is a numerous as well as often discussed minority in these days. As one of the largest minorities in the Czech Republic is involved, not only nurses in health care facilities but also nurses working for home-care agencies meet members of the Romani minority at work. For a Romani family it is almost a duty to take care for their ill and dying relatives at home in a family circle. This care still bears elements of Romani tradition, which however often contravene with treatment regime. Despite this fact nurses from home-care agencies have good experience with taking care for Romani patients, and sometimes certain Romanies accept the use of home-care agency services. These theses on Specific Features of Nursing Care for Romani Minority in the Framework of Home-care Agencies deals in its theoretical part with a history, communication, religion, traditions and manner of living of Romani minority, further it focuses on history and scope of activities of home-care agencies, on ethics of dying and death in health-care facilities and on basic information in the field of palliative care. The second part of the theses is focused on quantitative and qualitative research. The quantitative research has been carried out in a form of a questionnaire addressed to nurses working in home-care agencies. Seventy one nurses from selected home-care agencies from the whole Czech Republic took part in this research. Qualitative research was carried out through structured interviews with 15 members of Romani minorities. Tasks of the work: to ascertain extent of use of services of home-care agencies by Romani minority, and to determine specific features of nursing care for dying member of the Romani ethnicity were fulfilled. Three hypotheses were determined to such tasks ? H1: Nurses from home-care agencies have already provided services to members of Romani ethnicity. H2: The Romani minority uses services of home-care agencies. H3: Nurses from home-care agencies are aware of specific features of nursing care for Romani minority. Hypotheses H1 and H2 were accepted. H3 was not accepted, as from the statistical evaluation of quantitative research it follows that nurses are not aware of specific features of nursing care. The following research questions were determined for the qualitative research: Are the members of Romani ethnicity aware of a possibility to receive help from home-care agencies in care for a dying family member? Are the members of Romani minority interested in help offered by nurses from home-care agencies in nursing of a dying family member? Results of the research of these theses were used for creation of a manual of specific features of nursing care for a dying Romani patient. The manual was sent to selected home-care agencies. Information contained in the manual may serve to nurses in an out-patient and patient departments of health-care facilities as well, as knowledge in the field of care for a member of the Romani minority dying at home may help such nurses to understand acting, communication, manner of living as well as life values of such patients at hospitalization. The whole theses may also serve in practice as an indicator of insufficient foreknowledge of the Romani minority on services of home-care agencies and necessity to spread information on such services to the Romani ethnicity.