Changes in Characteristics, Needs, and Payment for Care of Elderly Nursing Home Residents: 1999 to 2004

Focuses on changes in trends in the population of elderly nursing home residents, including characteristics of their healthcare needs and insurance coverage

Chronic Disease and Co-Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending

Compares spending patterns for people enrolled in both Medicaid and Medicare with multiple chronic and mental conditions with those for other beneficiaries and examines underlying factors. Explores challenges and policy implications of reform provisions

Unheimliche Nachbilder der Katastrophe

Thomas Klinkert und Günter Oesterle, Hrsg., Katastrophe und Gedächtnis, linguae & litterae 25 (Berlin: De Gruyter, 2014), 445 S

La Bibliothèque nationale de France et le camp Austerlitz. La narration d’un espace traumatisé chez Sebald

L’essai se propose d’analyser la dimension fantasmagorique d’une superposition qui s’est créée dans l’espace urbain parisien, la Bibliothèque nationale de France (site de Tolbiac) étant construite à l’emplacement d’un ancien camp nazi. Bien que le camp nazi et la Bibliothèque soient des réalités tout à fait différentes, il y a des similitudes inquiétantes qui apparaissent grâce à cette constellation involontaire. Plusieurs discours sont pris en considération : d’abord une série de textes critiques – polémiques et éloges – sur la Bibliothèque nationale qui, d’une manière latente, comportent une mémoire inconsciente d’un camp ; et ensuite un texte littéraire – le roman Austerlitz de W. G. Sebald – qui, à sa manière et avec les moyens de la fiction, met en récit la dimension spectrale de ce lieu.Der vorliegende Essay analysiert die phantasmatische Dimension einer Überlagerung, die sich in Paris durch den Bau der neuen Pariser Nationalbibliothek am Ort eines einstigen nationalsozialistischen Lagers ergeben hat. Obwohl das Lager und die Bibliothek ganz unterschiedliche Realitäten sind, wird in dieser unwillkürlichen räumlichen Konstellation ihre beunruhigende Nähe zur Frage. Verschiedene Diskurse werden genauer untersucht : erstens eine Reihe von kritischen Texten – Polemiken ebenso wie Lobreden – über die Nationalbibliothek, die in sich auf latente Weise die unbewusste Erinnerung an ein Lager tragen ; zweitens ein literarischer Text – der Roman Austerlitz von W. G. Sebald –, der auf seine Weise und mit den Mitteln der Fiktion die gespenstische Dimension dieses Ortes zu erzählen weiß

Rebel rule: a governmentally perspective

Much of the recent literature on rebel governance and violent political orders works with ‘centred’ and instrumental understandings of power. In this view, power is seen as exercised over subjects, and as situated in rebel rulers, governance institutions, or ruling networks. Drawing on the study of the armed groups known as ‘Mai-Mai’ in eastern Democratic Republic of the Congo, this article instead adopts a governmentality perspective on rebel governance. It demonstrates how Mai-Mai groups rule not only through direct imposition but also, more subtly, by shaping people’s subjectivities and self-conduct. We identify four clusters of techniques of Mai-Mai rule that relate respectively to ethnicity and custom; spirituality; ‘stateness’; and patronage and protection. We argue that a governmentality perspective, with its focus on rationalities and practices of power, offers a fine-grained understanding of rebel rule that moves beyond common binaries such as coercion versus freedom. By showing its relevance for the analysis of rebel rule in the eastern Congo, our findings further strengthen the case for applying a governmentality perspective to non-Western political orders

Rethinking rebel rule: how Mai-Mai groups in eastern Congo govern

Around the world, vast amounts of people live in areas marked by rebel presence. A growing body of scholarly work examines “rebel governance”, which has emerged as an interdisciplinary field of study. Scholars in this subfield typically share a desire to go beyond stereotypical images of rebels as violent savages or as greedy warlords. By focusing on how rebels govern, these scholars wish to show that rebels are engaged in creating forms of order rather than disorder

Similarities and differences between continuous sedation until death and euthanasia: professional caregivers' attitudes and experiences: a focus group study

Background: According to various guidelines about continuous sedation until death, this practice can and should be clearly distinguished from euthanasia, which is legalized in Belgium. Aim: To explore professional caregivers' perceptions of the similarities and differences between continuous sedation until death and euthanasia. Design: Qualitative data were gathered through focus groups. Questions pertained to participants' perceptions of continuous sedation. The focus groups were recorded and transcribed verbatim. Analyses were conducted by a multidisciplinary research team using constant comparison analyses. Setting/Participants: We did four focus groups at Ghent University Hospital: two with physicians (n = 4 and n = 4) and two with nurses (n = 4 and n = 9). The participants could participate if they were ever involved in the use of continuous sedation until death. Results: Although the differences and similarities between continuous sedation until death and euthanasia were not specifically addressed in the questions addressed in the focus groups, it emerged as an important theme in the participants' accounts. Many caregivers elaborated on the differences between both practices, particularly with regard to patients' preferences and requests, decision-making and physicians' intentions. However, some stated that the distinction between the two sometimes becomes blurred, especially when the sedating medication is increased disproportionally or when sedation is used for patients with a longer life expectancy. Conclusions: The differences and similarities between continuous sedation until death and euthanasia is an issue for several Flemish professional caregivers in their care for unbearably suffering patients at the end of life. Although guidelines strictly distinguish both practices, this may not always be the case in Flemish clinical practice

Is Care for the Dying Improving in the United States?

Background: Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies. Objective: The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011?2013. Methods: The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent. Results: A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011?2013. Respondents from deaths in 2011?2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95). Conclusions: Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140119/1/jpm.2015.0039.pd

Late Transitions and Bereaved Family Member Perceptions of Quality of End‐of‐Life Care

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146458/1/jgs15455.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146458/2/jgs15455_am.pd