Debra Street

Residential Context, Social Relationships, and Subjective Well-Being in Assisted Living

Adaptive reframing and cumulative inequality theory provide the conceptual framework for investigating associations between four measures of subjective well-being (general, temporal, comparative, and experiential), residential context, and social relationships. Data from 344 cognitively intact assisted living (AL) residents aged 60 years and older interviewed for the Florida Study of Assisted Living were analyzed using logistic regression. Having control over the AL transition, often associated with socioeconomic status, was positively associated with all four dimensions of subjective well-being, consistent with a cumulative inequality framework. Other residential context characteristics (living arrangements prior to AL, private pay, size, licensure status) were less consistently associated with well-being. High-quality staff relationships were associated with temporal well-being, while positive coresident relationships were associated with all four well-being indicators. Compared with preexisting external relationships with family and friends, and consistent with adaptive reframing, social relationships unique to AL were independently and more consistently associated with residents’ perceptions of subjective well-being.

Recent Trends in U.S. Social Welfare Policy Minor Retrenchment or Major Transformation

Many scholars have characterized the United States as a welfare state “laggard,” less generous than most other nations because of a peculiarly American set of historical circumstances and values. This article explores “American exceptionalism” in the context of welfare state reforms over the past two decades. The authors first describe recent social policy innovations in Western democracies, considering two competing views of welfare state change. The first asserts that welfare states have been fundamentally transformed into “enabling” states, characterized by efforts to promote work, privatize benefits and services, and target benefits to the most needy. The second holds that policy structures have remained essentially intact because of “path-dependent” processes that create institutional continuity. Although evidence for the United States is somewhat mixed, the general direction of policy decisions and current frameworks of policy debates is consistent with a transition toward an enabling state.

Nurse practitioners’ contributions to cultural competence in primary care settings

Purpose: To document unique ways Nurse Practitioners (NPs) contribute to the delivery of culturally competent healthcare to diverse and underserved patient populations in urban primary care practices. Data Sources: Data are from a multi‐year, multi‐site study and includes 50 intensive interviews with healthcare professionals and repeated observations at three urban primary health clinics in a Northeastern U.S. city. Conclusions and Implications for Practice: Different healthcare professionals reported common perspectives on cultural competence dealing with distinctive patient communities, including altruistic motivations, advocacy, and addressing root causes while treating diverse patients. What made NPs distinct among healthcare workers in this study was the comprehensiveness of their cultural competence approaches, both in patient interactions and within healthcare teams. NPs established culturally sensitive partnerships with patients, encouraged self‐advocacy, addressed contextual considerations, and adjusted practices to meet the patient needs. They also developed niches in multidisciplinary teams that emphasized holistic approaches to establish trust and to cross cultural boundaries, both with other health professionals and their diverse patients.

Planning for Old Age

For many individuals, planning for old age is somewhat analogous to generals’ propensity to fight the last war. What is to be planned for, and when, depends on how typical experiences of old age are perceived, whether an individual expects to fit within the typical mold, and which goals for later life seem to have been attainable in the recent past. The looming “silver tsunami” of Baby Boomer retirees, who transitioned to adulthood during expansive educational opportunities, maturing welfare states and booming economies, reflects a challenge for aging societies now confronting very different contemporary socioeconomic conditions. From the mid to late twentieth century (the Baby Boomers’ temporal frame of reference for what to expect in old age) most individuals’ eventual retirement in developed countries was taken for granted and pension systems appeared relatively stable. However, both prospects – universal retirement and secure pensions – are far less certain for cohorts contemplating old age at the outset of the twenty-first century.

Policy, Autonomy, and Physician Satisfaction

It is important to understand how policy influences physician satisfaction, which in turn affects access to and quality of care. Two Mississippi policy crises in the past decade indirectly jeopardized its primary health care supply. During a volatile malpractice climate in 2002, physician groups claimed physicians would retire or relocate or quit medicine entirely. The second crisis in 2005 temporarily shut down Medicaid reimbursement. Both crises had the capacity to undermine physician satisfaction, a predictor of physician retention. We used data from two cross-sectional Mississippi physician surveys to test how malpractice experiences and Medicaid reimbursement influenced physician satisfaction. The Medicaid shutdown had no measurable effect on physician satisfaction, while the immediate effects of a litigious malpractice climate dampened physician satisfaction. However, the data indicate that the effects of malpractice experiences may be quite short-lived.

Gender and age implications of extended working life policies in the US and Ireland

Policies designed to extend working life and reduce pension costs have been the dominant policy response to population ageing. Such policies include increasing state pension age, flexible working and privatisation of pensions. Despite men’s and women’s typically different work-life trajectories, policymakers have paid little attention to either the differential effects of such policies on the economic well-being of older women and men, or to the implications for diverse groups of women. This article on policy, employment and pension outcomes in the US and Ireland analyses these issues, using a feminist political economy of ageing framework to assess the likely gender implications of these policy trends. It finds that existing and proposed reforms are likely to take what are already poor pension and employment outcomes for many contemporary older women and make them even worse in future. It concludes with suggested policy modifications and future avenues for research.

Provider's Perspectives on Cultural Competence in Ethnically Diverse Primary Care Practices

This study explores how frontline healthcare providers describe and understand the delivery of culturally competent care to underserved groups in three neighborhood primary health care practices. Data from fifty intensive interviews and observations at three field sites in a multi-year study are analyzed using grounded theory techniques. Findings show that providers used a range of deliberate strategiesfrom establishing provider/patient concordance, to finessing language issues, practicing cultural humility, being in the trenches and enacting patient advocacy-to bridge cultural gaps with their patients. Medical directors modeled culturally competent care within each practice, contributing to organizational unity. Frontline providers’ practices demonstrate some of the complexities of enacting culturally competent care and provide evidence for techniques that could be used to improve healthcare encounters with culturally diverse patients.