Being Occupied: Supporting ‘meaningful activity’ in care homes for older people in England

The benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care homes residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved

The passage to adulthood: Challenges of late adolescence

This chapter outlines the major developmental challenges likely to affect overall well-being during adolescence and emerging adulthood and discusses the personal and social assets needed to facilitate a successful passage through adolescence and into adulthood.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49326/1/179_ftp.pd

The Provider Monopoly Problem in Health Care

38 p.Health care providers with market power enjoy substantially more pricing freedom than comparable monopolists in other markets, and the reason, which is not generally recognized, is U.S.-style health insurance. Monopoly in health care markets, therefore, has redistributive effects that are especially burdensome for consumers. Significant allocative inefficiencies—albeit not the kind usually associated with monopoly—also result, particularly when the monopolist is a nonprofit hospital. We first note the need for a more aggressive antitrust policy for the health sector, one that effectively prevents the creation of new provider market power through mergers and other alliances. An immediate need is to prevent the formation of “accountable care organizations” that integrate providers horizontally to achieve market power and not just vertically to achieve efficiency. Because it is unlikely that courts or agencies could undo past mergers that bestowed providers with monopoly power, we also suggest some strategies for contesting existing monopolies. One strategy is to apply antitrust rules against “tying” arrangements so purchasers can contest providers’ profit-enhancing practice of overcharging for large bundles of services instead of trying to exploit separately the monopolies they possess in various submarkets. Another strategy is to use antitrust or regulatory rules to prohibit anti-competitive provisions, such as “anti-steering” or “most-favored-nation” clauses, in provider-insurer contracts. The provider monopoly problem is severe enough that we cannot exclude the more radical alternative of regulating provider prices