Thesis (Ph. D.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 171-180).

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references.

Background: Results from various studies of Long-term Care (LTC) need in China have remained confusing with LTC rates ranging from 2.4% to 22%. Therefore, it has been difficult to ascertain LTC’s sustainability in China. Methods: 672 households with people aged 60+ in Haidian, Beijing, were successfully interviewed between June – August, 2011. interRAI – Home Care assessment tool and scales were used to identify LTC impairment, LTC services use and want, and LTC services drivers. Findings: If LTC need refers to LTC impairment, based on population of Haidian in 2010, it was estimated 3.7% or 14,000 persons aged 60+ in Haidian have LTC impairment. If LTC need refers to people’s use or want of LTC services, it was estimated 38.7% or 147,000 persons aged 60+ in Haidian used and wanted LTC services. In specific, 11.9% (45,000) used Community Care (CC), 6.7% (25,000) and 20.1% (77,000) wanted Residential Care and CC respectively. LTC impairment rate as identified by this study was lower than most of other LTC studies in China, probably due to varied impairment identification and measurement mechanisms. LTC impairment tended to be affected by social activity level (OR: Odds Ratio = 0.29), subjective environmental hazards (OR = 0.20) and poor self-rated health (OR = 2.00). In addition, as compared to their counterparts, respondents with LTC impairment tended to be older; with “fewer” education, social activity and good health practice; and “high” in caregiver stress, objective environmental hazards, behavioral problems and depressive symptoms. There was no statistically significant relationship between LTC impairment and LTC services use/want. For those who used/wanted LTC services, 95% had no LTC impairment. For those with LTC impairment, 54.2% used or wanted LTC services. As compared to their counterparts, respondents who used or wanted LTC services tended to be in more favorable conditions: younger, higher education, more income, living with others, socially active, good self-rated health and more good health practice. These people also tended to have fewer objective environmental hazards, caregiver stress, chronic conditions, behavioral problems, and depressive symptoms. Use of CC was driven by higher age (OR: Odds Ratio = 1.088), being female (OR = 0.268), higher education (OR = 0.260), higher income (OR =3.218), and more objective environmental hazards (OR = 2.522). CC want was driven by higher age (OR = 1.050), being female (OR = 0.625), higher education (OR = 0.348) and more depression (OR = 1.235). Good health practice was the only factor that affecting RC want (OR = 2.842). The overall Pseudo R^2 was 0.219. Implications: Better projection of LTC impairment and LTC services use/want via standardized assessment tool is needed in China. There is also a need to address the issue of mismatch in LTC impairment and services. This is to ensure allocation of LTC services is based on LTC impairment and not because of higher income or education. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Purpose: The purpose of this project was to implement a screening program that would identify older adults with depressive symptoms. Data Sources: The Mini Mental Status Exam (MMSE) is a baseline cognitive screen used to identify which depression screening tool should be used for the patient. The Geriatric Depression Scale-15 is used to screen patients with a MMSE score of 19 or higher. The Cornell Scale for Depression in Dementia is used for patients with a MMSE of 18 or below. Conclusions: This project had a small, convenience sample size (n=17). All (n=17) patients were given the cognitive screening. Due to inability to obtain consent, only 70% (n=12) were screened for depression. All 17 patients shared a total of five providers, who were contacted on two different occasions to notify them of the screening results and asked to complete the six-item survey. Two providers responded to the notification and completed the survey. Providers who completed the Likert survey strongly agreed that the depression treatment and tracking (DTT) form: (1) was helpful in documenting depression in the long-term care patients, (2) was easy to use, (3) decreased time spent per patient visit, and (4) was the one they would like to see used in the facility. Implications for Practice: Implementing a depression screening program through the use of a depression treatment and tracking form will assist staff with ease of documenting and communicating screening results to the patient’s primary care provider. The DTT form supports improved health outcomes for the long-term care patients by giving primary care providers a quick and easy-to-use form they can evaluate to determine if further evaluation and treatment is needed.

Farmers will supply the raw ingredients for the emerging cellulosic ethanol industry. The long-term relationship between a farmer and a processing firm is expected to be contractual. A processing firm has an incentive to sign long-term contracts to ensure a cost-efficient level of raw ingredient supply. However, farmers generally prefer to operate with either no contract or a short-term contract in order to maintain options for adjustments in future acreage allocations due to changes in relative prices. Of interest in this research is to understand the incentives of farmers and calculating the efficient level of the “inflexibility premium”, which a processing firm must provide to a farmer when a long term contract is signed. A stochastic dynamic programming model is solved and with the help of Microsoft Excel numerically evaluated to illustrate the marginal inflexibility premium is increasing with contract length and the level of price variability, and is decreasing with the size of acreage adjustment costs.

Long-term residential care (LTRC) is a complex sociopolitical milieu where people from diverse backgrounds come to live and work together. In recent years health care restructuring has resulted in the closure of facilities; health care policy has narrowed the population that accesses LTRC so that only those who are the most medically and socially complex are admitted; and there has been a transformation of the work force, a workforce that is mainly comprised of Women of Colour and is among the lowest paid in health care. The purpose of this study was to critically examine the organization of care in LTRC within this context. The theoretical perspective guiding the study was informed by postcolonialism, postcolonial feminism, intersectionalities, and Foucaudian epistemology. The method of inquiry for the study was critical ethnography, which allowed for critical analysis of `taken for granted' assumptions in the organization of care. Over a period of ten months, I was immersed in two LTRC facilities in the Lower Mainland of British Columbia. Field work consisted of approximately 218 hours of participant observation. I conducted 51 interviews with administrators, family members, residents, and staff. I reviewed relevant provincial policies and facility-based policies and procedures. I also collected quantitative data related to resident transitions in the health care system (for example, admissions, discharges, and hospital admissions), and staffing levels. Findings from this study were discussed in three key themes. First, a systematic decommissioning of citizenship occurred for residents and staff in this setting. Second, the impact of health care restructuring over the past decade had important consequences for relationships between residents, family, and staff. Third, relational care took place in `stolen' moments that occurred despite heavy workloads. All of these themes were underscored by intra-gender oppression, relations of power, and influenced by discourses of ageism and corporatism, which ultimately played out in day to day interactions between those who live and work there. Recommendations from this study included: addressing the entrenched hierarchies in nursing, further examination of the public-private funding model in LTRC, and the introduction of an independent ombudsperson to ensure consistent, high quality care across the LTRC sector.

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The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results.

Introduction: Vitamin D deficiency is prevalent among older adults in long-term care (LTC) contributing to increased risk of falls and fractures, and decreased quality of life. The primary factors include limited dietary sources containing vitamin D, poor dietary intake, and low sunlight exposure. Vitamin D supplementation is recommended in LTC; however this practice varies across Canada. Objectives: The objectives of this study were to 1) examine the perceptions of LTC health professionals, staff, and visitors (family and friends) regarding vitamin D supplementation in LTC facilities; and (2) determine what barriers exist in providing vitamin D supplementation to all residents in LTC facilities. Methods: The study was conducted in two phases. Phase 1: Five focus group sessions (9-12 health professionals per group) were conducted in 5 LTC facilities within a Manitoba Regional Health Authority. Each focus group session was audio recorded to assist in generating themes. Phase 2: A self-administered nutrition survey was completed by LTC staff, health professionals, and visitors (family and friends) in all five recruited LTC facilities. Descriptive statistical analyses were conducted. Results: Phase 1: A total of 51 individuals participated (mean age = 46.7 years ± 10.3; female = 90.2%). The majority of participants consisted of Registered Nurses, Health Care Aides, Clinical Dietitians, Pharmacists, Social Workers, Recreation Therapists, and Administrators. Phase 2: A total of 102 individuals participated with an average age of 48.4 ± 13.8 years and were predominately (87.3%) female. Eighty-five percent of participants were LTC health professionals and staff, and 14.7% were visitors (family or friend) of a LTC resident. The results from both phases found that perceptions were positive about providing vitamin D supplementation to residents. Eighty-two percent (phase 1) and 92.2% (phase 2) of participants thought that receiving a supplement would make a difference to the overall health of LTC residents. The major barriers to vitamin D supplementation were: cost (healthcare cost, cost of the supplement, and cost of laboratory tests for serum vitamin D levels), the complexity of residents due to swallowing problems and reluctance with taking medications, polypharmacy, physician resistance, and differences between participants’ knowledge and education on vitamin D. Conclusions: Providing vitamin D supplementation to LTC residents was deemed important and would improve their overall health, but more education is needed to prevent vitamin D deficiency in LTC.