Three issues in long term care and aging health policy: In-hospital mortality from fall related-injuries, the relationship between formal and informal personal care, and consumer experiences of nursing home care.

摘要

This dissertation presents a multi-faceted examination of important aspects of long term care and aging through both quantitative and qualitative methodologies. Taken together these three papers provide an investigation of diverse facets of health care provided to older adults. The variety of research methods and populations utilized in the studies demonstrate the many ways to understand diverse older Americans and their experiences with the American health and long term care system.;Three analyses (logistic survey regression, ordinary least squares regression with instrumental variable analysis, and qualitative inductive analysis) were conducted on three datasets (Health Cost and Utilization Project, Community Care Assessment Tool, and focus group transcripts) focusing on three populations (hospitalized, community dwelling, and institutionalized older persons).;Results from the first study revealed that hospitalized older-old, men, and people of color had higher odds of death following a suspected fall compared to younger-elderly, women and Whites. The second study findings concerning the relationship between formal and informal care indicated that factors associated with informal caregivers carry the heaviest impact on informal care utilization. In the final qualitative study of nursing home quality, consumer narratives resulting from focus group discussions in high and low performing nursing homes provided insight into consumer perspectives of quality of nursing home care. High and low performing facilities differed in residents' and families' expectations of service levels and quality of care provided. These results indicate that the current regulatory system may contribute to disparities due to differing expectations between consumers in high and low performing homes.;This research includes reports on three studies designed to provide a broad inspection of long term care and aging in the United States through exploring health care for older adults at three points in the health care system -- the home, the hospital, and the nursing home. Taken together, each piece of research points to a sobering conclusion. No matter which part of the health care system is accessed, older people are faced with potentially inadequate and inappropriate care. These results provide a spring-board for further inspections of health care access, quality and cost for older persons in the United States.