\u3cem\u3eSocial Work and Aging in an Aging Society: Education, Policy, Practice and Research.\u3c/em\u3e Barbara Berkman and Linda Harootyan (Eds.).

Book note for Barbara Berkman and Linda Harootyan (Eds.), Social Work and Health Care in an Aging Society: Education, Policy, Practice and Research. New York: Springer Publishing Co., 2003. $ 52.95 hardcover

Political Economy, Moral Economy and the Medicare Modernization Act of 2003

Through the lens of political and moral economy, I examined the dominant values and actors in the legislative process of the Medicare Modernization Act of 2003. In my content analysis of federal hearings, I found that witnesses from government agencies, Congress and think tanks had almost equal presence at the hearings. Witnesses who were invited by Congress to testify at the hearings expressed twice as much support for private interests than for the general Medicare population or low-income beneficiaries. Few expressed concern for the uninsured population. Witnesses offered almost four times as many expressions of support for market rationalism than social insurance and three times as many than for improving Medicare\u27s solvency/sustainability. The 2008 presidential candidates are split between support for social insurance and support for the private market. Medicare advocates will need to devote extraordinary efforts to significantly counterweigh the strength and influence of market rationalists

Social Security Privatization: An Ideologically Structured Movement

We document the cumulative change in expressions of support for Social Security\u27s social insurance ideals to privatization,from the late 1970s through 2007. Social Security\u27s basic structure and principles generally were supported by the United States government and in amendments to the original Act of 1935. However, in the 1980s market arguments began to proliferate in government alongside pension privatization projects by international governmental organizations and conservative think tanks. Although in 1983 Commission members concluded the Social Security system is sound in principle.. and... structure, four members wrote a supplemental statement that emphasized market rationalism. By 1994 dissension in Congress was apparent. The history of Social Security privatization reveals an increasing ideological alignment on the political agenda among transnational organizations, financial institutions, conservative think tanks, Congress, Presidents, and the Social Security Commission and Board of Trustees. Our research denotes the ideological alignments that formed thefoundation for a politically motivated social movement

Feasibility and effects of preventive home visits for at-risk older people: Design of a randomized controlled trial

Abstract Background The search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol. Methods/Design The study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and potential modifiers. Fidelity is being addressed and measured across several domains. Discussion Feasibility indications to date are positive. Although the protocol has some limitations, we expect to learn enough about the intervention, delivery and effects to support a larger trial with a more stringent design and enhanced statistical power. Trial Registration ClinicalTrials.gov ID NCT0098528