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Elderly patients can remain in acute care hospitals for protracted periods of time waiting for transfer to long-term care facilities. Because such patients no longer require acute care services, hospitals often fail to provide programs for them and staff may experience them as inappropriate. This study provides a descriptive understanding of these patients and examines factors associated with length of stay. Although differences were found between patients who were discharged in 6 months or less and those who remained in hospitals longer than 6 months, no significant differences were found among patients who remained for varying lengths of time beyond 6 months. Impact of long stay on patients and families is explored and implications for social work practice and discharge planning are examined. [ABSTRACT FROM AUTHOR]

Purpose of the Study: While theories of job turnover generally assume a strong correlation between job satisfaction, intention, and retention, such models may be limited in explaining turnover of low-wage health care workers. Low-wage workers likely have a lower ability to act on their employment intentions or plans due to a lack of resources that serve to cushion higher wage workers. In this study, we examine the relationship between job satisfaction, intention, and retention of nursing assistants in nursing homes and the role that "contingency factors" play in employment intentions and retention. We conceptualize "contingency factors" as resource-related constraints (e.g., being a single mother) that likely influence employment trajectories of individuals but can be independent of job satisfaction or intent., Design and Methods: We use survey data from 315 nursing assistants in 18 nursing homes in a U.S. southern state to model employment intentions and retention., Results: We find that job satisfaction and other perceived job characteristics (e.g., workload and perceived quality of care) are significant predictors of an individual's intent to stay in their job, the occupation of nursing assistant, and the field of long-term care. However, we find that job satisfaction and employment intentions are not significant predictors of retention. Instead, "contingency factors" such as being a primary breadwinner and individual characteristics (e.g., tenure and past health care experience) appear to be stronger factors in the retention of nursing assistants., Implications: Our findings have implications for understanding turnover among low-wage health care workers and the use of proxies such as employment intentions in measuring turnover.

Recent policy shifts in the United States have resulted in an increase in the number of older workers remaining in the labor force. Increases in the retirement age for receiving full Social Security benefits coupled with declining pension funds and the erosion of employer retiree health benefits, mean that current cohorts of older workers may fully expect to work longer than previous generations. Yet, working longer may not always be possible due to health problems, outdated skills, economic insecurity, and competing obligations. We examine the consequences of unmet expectations for full time work after age 62 for life satisfaction in a nationally representative sample of older Americans. With longitudinal data from the Health and Retirement Study (1998-2008), this paper uses repeated measures of expectations for later life work among a cohort of Americans (N=1684) gathered prospectively over an eight year period, and examines the effects of unfulfilled expectations on subsequent life satisfaction. Using generalized growth mixture modeling three latent classes of individuals were identified with distinct trajectories of later life work expectations (low expectations, high expectations, and neutral expectations for full time work after age 62). A majority of men had generally high expectations to work full time past age 62, whereas the majority of women reported a low probability of working full time after age 62. When comparing expectations to actual full time work past age 62, we found no effects of unmet expectations for women. But men with less job stability (reflected by shorter job tenure and lower incomes) generally had high expectations to work longer, and their life satisfaction scores were significantly lower when these expectations were not realized. The hazards of missed expectations for later life work have consequences for subjective well-being in older adults.

The process of transitioning into, and living in, a retirement community can be usefully examined with the concept of 'therapeutic landscapes.' While underutilized in anthropology and gerontology, the concept offers a combination of geographical and cultural views on the place and well-being relationship. The inclusion of an occupational science perspective, wherein occupations (or everyday activities of meaning) are seen as a crucial part of the person-place relationship, should enhance the therapeutic landscape perspective of older persons and their retirement communities. We present a case study analysis that attempts to combine these perspectives and examine the role of occupation in the lives of older people who moved to a Continuing Care Retirement Community (CCRC). 116 movers completed pre- and post-move questionnaires about their levels of engagement in 20 activities. Frequency distributions, paired t-tests, and logistic regression analyses performed on the data indicate that while overall levels of activity did not change from pre- to post-move, patterns of engagement did change in the course of the move to the CCRC. Some social and cultural activities (e.g., parties, concerts, movies, meetings) increased in frequency, and some maintenance chores (e.g., grocery shopping, housekeeping) and communication (email) decreased in frequency. Moreover, total activity engagement after the move was associated with residential satisfaction in the CCRC. Even with their limitations, the data and analytical findings suggest that occupations are an important part of the CCRC therapeutic landscape process.

The rapid growth of the population of older adults and their concomitant physical status and health needs have captured the attention, collaboration, and funding support of an array of leaders in the fields of aging and health care. To help fill the void of literature available to social workers interested in health promotion and aging, the authors provide a conceptual clarification of the meaning of health and explain how health is a resource for optimal living and not merely the absence of disease. The authors analyze frameworks of health promotion and suggest that the ecological approach provides the ideal framework for devising successful strategies in the area of aging. Finally, using the example of promoting physical activity as a healthy aging strategy, they detail eight ways that social workers can provide leadership in promoting positive health in later life.

This study examined the complexities of age relations at work. Garment workers believed that their fate was linked to ageism and that their work experience was discounted by management. Managers wanted to be rid of older workers because they commanded higher wages than younger workers. The issue was cost reduction, and age was implicated unintendedly. Still, managers seemed to use stereotypical images to discourage older workers and they did not organize work routines to facilitate the adaptation of them. Instead, they subcontracted the easy jobs, relying on the experience of the older employees for difficult work while not adapting the workplace. Theoretically, the authors argue that ageism and age discrimination can best be understood through a recognition of the importance of structured age relations and human agency.

Objective: To examine the contribution of patterns of sexual partnering to the spread of HIV/STD infection between communities., Methods: 651 randomly selected Aboriginals from 11 reserve communities in Ontario were interviewed. This analysis included those who had sex in the previous 12 months. Descriptive statistics and multivariate analyses identified associations with patterns of sexual partnering., Results: 22% reported having partners from both within and outside the community, 51% from within only, and 27% from outside only. Those with partners from both within and outside were more likely to be male, unmarried, from a remote community, have more sexual partners and perceive that their behaviour placed them at higher risk of HIV/STD infection. They were least likely to perceive their community to be at risk from their behaviour., Conclusions: Findings suggest that Aboriginal communities are not insulated and that HIV could spread rapidly if introduced.

Objective: This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population., Method: The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province., Results: Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across "sober" and "drunk or high" states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse., Conclusions: Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while "drunk or high." Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern.

Factors contributing to depressive symptoms in a group of 67 family caregivers of hospitalized "long-stay" patients were investigated. Levels of depressive symptoms were quite high and were related to level of patient dependency, caregiver's health, feeling too many demands were being made on the caregiver, feeling torn between the patient's needs and the caregiver's own needs, not getting enough rest, amount of time spent in caregiving activities, feeling someone else could take over caregiving if necessary, and perceptions of staff. The factors contributing to depressive symptoms differed among spouses, children and other caregivers, but for all the strongest contributor was experiencing difficulty with staff.

Data from a survey of anglophone Canadian snowbirds wintering in Florida and one of U.S. snowbirds in the Texas Lower Rio Grande Valley are used to compare the two groups in terms of sociodemographics, chronic health conditions, and use of health services. The Canadians were younger and reported fewer chronic problems than did the U.S. snowbirds; Canadians aged 65 and over had a lower reported prevalence for four of five chronic conditions than did persons of the same age in the Canadian population. In contrast, the U.S. snowbirds had higher reports on four of the conditions than did U.S. Whites aged 65 and over. Hypotheses are suggested for future research, and methodological issues are discussed.

This essay asserts that seasonal and permanent migration may be connected, although there is no direct evidence for this relationship in the current research literature. We draw circumstantial and incomplete evidence for this proposition from findings of a recent survey of Canadian snowbirds in Florida and a parallel study of Canadian-Americans using the 1980 census public use sample migrant file. Other researchers are encouraged to settle the issue by including appropriate items in surveys of snowbirds that would determine whether or not some of the permanent migrants from the same origin serve as an unofficial reception committee for winter visitors, providing for them a socially receptive place to "nest" for the season.

Older English-speaking Canadian seasonal migrants to Florida (N = 2046) were surveyed during the winter of 1986. They are users of two health care systems and are generally in good health. When they do need to use health care resources, however, they show a distinct preference for the Canadian system. There is a sensitivity to health concerns, especially among the older of the migrants. This sensitivity generates considerable precautionary behavior including pretravel visits to their Canadian family doctors, stocking up on drugs before the trip, and taking out health insurance for Canadians traveling abroad. The behavior is strategic in that it is both intentional and oriented to contingencies. Cost of health care may be a motivating factor because such strategic behavior is inversely related to income in this relatively affluent migrating population. The flock of Canadian snowbirds is not likely to place exorbitant demands on the U.S. health care system.

In the current literature on parent care, the assertion is made that modern women at some time in their lives may expect to be sandwiched between responsibilities to old parents and their other commitments. This article presents the distribution for a random sample of 163 women aged 40 to 69 with respect to combinations of variables or commitment configurations that have been identified in the literature as contributing to women's being "caught in the middle." In addition, the lifetime caregiving experiences and the likelihood that those who have not yet been caregivers will be "caught" are examined for a subsample of the women. The argument is made that adult children rather than caregivers to frail parents are the appropriate population on which to focus if the incidence and prevalence of the involvement of adult children in parent care are to be ascertained.

This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.

The predominant theoretical perspectives in social gerontology reflect a normative bias toward adjustment of aging individuals to the society. This bias is reinforced through the methodological predelictions of most gerontologists. We outline the premises of a radical scholarship for gerontology which would provide an alternative, illustrating from selected works. A radical scholorship in gerontology would avoid the individualistic and adjustment biases, and would recognize that life in society is characterized by conflict, negotiation and compromise over politico-economic and other interests. Methodologically, it would seek to explicate the interests and aspirations of the aged in their own terms, and as relevant in the socio-historical context.

Most research on socialization for old age, including that of Rosow, Neugarten, and Riley, reflects a normative bias. An alternative perspective on later life is put forth from the symbolic-interactionist tradition in sociology. The concepts of career and status passage reflect an imagery of humans capable of exercising choice and negotiating their way through life. Later life is seen as a unique status passage in that it is inevitable, irreversible, and does not lead to any subsequent status. Controlling the passage therefore assumes great importance.

This study focuses on selected aspects of the social networks of older Canadians who are seasonal migrants to Florida, using a large respondent pool solicited from the readership of a newspaper serving the Canadian population in Florida. Findings such as the high rate of home ownership and the geographic stability of their Florida destination indicate the degree of integration in Florida. The respondent's contact with family members is relatively high while in Canada but considerably lower when in Florida. However, for a minority of respondents, a seasonal migration brings them closer to family members. This reduction of family contact is compensated by new friendships formed in the predominantly age-homogeneous residential environment of Florida. It is clear that older Canadians who winter in Florida have strong social networks when they are away from home.

In postgraduate medical training the heavy and irregular workloads are thought to result in fatigue and a potential decrease in the quality of care provided by interns and residents. We investigated these concerns among Ontario interns and residents. Information from 1805 house staff in all specialties and different years of postgraduate education suggested a relation between hours of work, fatigue and concerns about the quality of care.