Where We Die: County-level Disparities and Constrained Choice at the End of Life

Individual-level choice has become a fundamental and pervasive logic within research and policy focused on improving end-of-life care. This includes choosing the setting in which death is to occur (e.g., site of death including home, hospital, and nursing home). However, there is considerable geographic variability in site of death across the US, suggesting that where you live matters for where you die, beyond just individual choice and preference. This dissertation relied on an ecological framework to analyze geographic disparities in site of death and empirically investigate how death is shaped in different contexts in the US and how this has changed over time. This research utilized a unique combination of restricted population-level death certificate data (1991-2017) and county-level datasets focused on the social, economic, healthcare, political, and religious characteristics of counties. Analyses were restricted to older adults (65 years of age and older) who died of natural causes to isolate a pervasive and similar dying experience. Several innovative methods were employed, including multilevel modeling and latent class growth analysis. Despite a national trend depicting a decrease in hospital death and an increase in home death, findings from this dissertation suggest considerable variation in site of death across counties in the US. Additionally, the county where death occurred mattered substantially for the likelihood of dying in a particular setting. Finally, site of death was shaped by the characteristics of the context in which death occurred, including the county-level economic and healthcare environments. For example, counties with high and stable home death rates were more likely to have poorer economic circumstances and a lack of healthcare resources. Despite an emphasis on choice at the end of life, I argue that heterogeneity in geographic context across counties makes choice related to site of death an illusion for many people. Continued reliance on the choice discourse will only detract from identifying and diminishing geographic disparities in site of death. Moving forward, it is imperative for research and policy focused on end-of-life care to consider how choice is embedded within local contexts.</p

Oregon Community-Based Care Survey 2016: Adult Foster Homes

This report describes adult foster homes in Oregon. An adult foster home (AFH) is a type of licensed community-based care (CBC) setting that provides residential, personal care, and health-related services, primarily to older adults. The study collected information from adult foster homes to achieve the following four main goals. Describe adult foster home characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers may use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process

Large Americano, Extra Masculine: How People Do Gender at the Coffee House

This research examines the way in which customers in an urban cafe “do gender.” This research expands existing literature on doing gender in organizational settings by making the customer the focus of the analysis of gender presentations in public spaces. The findings are based on ethnographic research that was conducted over the course of eight weeks in an urban Northwestern city in the United States. My findings suggest that male and female customers most commonly performed hegemonic masculinity and emphasized femininity, respectively. These performances were further pronounced when analyzed in the context of heterosexual relationships, where accountability for gender presentations became even more salient. The way that customers interacted with employees reinforced already normative presentations of gender

Family socioeconomic status and children’s screen time

ObjectiveThis mixed-methods study examined whether higher-socioeconomic status (SES) children’s digital technology use adhered to contemporaneous pediatric guidelines, how it compared to lower-SES children, and why, as analyses showed, higher-SES children’s technology use far exceeded pediatric recommendations.Background2013 American Academy of Pediatrics (AAP) guidelines recommended limited “screen time” for children. Higher SES families tend to follow guidelines, but digital technology use—simultaneously a health behavior and a pathway for building human capital—has complex implications.MethodQuantitative analyses provide new nationally representative estimates of the relationship between social class and 9- to 13-year-old children’s technology time (including television), device access, and parenting rules (2014 PSID Child Development Supplement, N = 427). Qualitative analyses of 77 longitudinal higher-SES parent interviews articulated explanatory processes.ResultsHigher-SES children used technology as frequently as others and in excess of recommendations. Their device access, activities, and agency in adhering to rules, however, differed from others. Qualitative analysis uncovered processes that helped explain these findings: parents’ ambivalence about technology and perception that expert guidance is absent or unrealistic, and children’s exercise of agency to use technology facilitated by “concerted cultivation” parenting styles, led to higher-SES individualistic parenting practices that supported children’s increased non-television technology use.ConclusionCultures and structures related to children’s technology use are in flux, and classed norms and understandings are emerging to construct relevant class-based distinctions around parenting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/173071/1/jomf12834.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/173071/2/jomf12834_am.pd

Resident and Community Characteristics Report 2014: Assisted Living, Residential Care, Memory Care

This report provides an overview of community-based care settings in Oregon. The results presented here are derived from surveys completed by 243 facilities serving 9,485 residents. Key changes between the 2008 OOHPR survey and 2014 include: Compared to 2008, the number of facilities increased by 13%, with the largest growth in MCCs (41%). The proportion of for-profit facilities and facilities managed by a third party increased from 2008 by 8%. The acuity level of residents increased on most measures compared to 2008. Compared to 2008, residents across all three community types required more assistance with ADLs and used more health services. Residents of MCCs required the most assistance with ADLs and use of health services, which is similar to 2008. The percent of residents who used hospice services increased from 2008 by 2%. The percent of residents who visited the hospital or an emergency department increased from 10% in 2008 to 28% in 2014. The percent of residents using Medicaid increased from 2008 by 10%

Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care

This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that provide residential, personal care, and health-related services, primarily to older adults. The study collected information from assisted living, residential care, and memory care communities to achieve the following four main goals. Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers might use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process (Oregon Department of Human Services, n.d.). In addition, as possible, comparisons are made to national surveys of residential care and assisted living conducted by the National Center for Health Statistics. Because of state variation in licensure categories, the national surveys combine residential and assisted living settings and use the term residential care to describe both. It should also be noted that regulatory standards and the types of residents that can be served in AL and RC settings vary by state, as well

Resident and Home Characteristics Report 2014: Adult Foster Homes

In collaboration with the Aging and People with Disabilities program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging conducted this research study of adult foster homes (AFH) throughout the state of Oregon. The Oregon legislature appropriated funds for DHS to collect information from these community-based care providers that will allow DHS, providers, and the public to better understand resident characteristics and adult foster home services. This report summarizes findings from the first state-wide survey of licensed adult foster homes in Oregon. The survey goals were to: describe resident health-related needs, service use, and demographic characteristics; describe AFH provider characteristics (e.g., number of years as a provider, professional training); describe adult foster homes (e.g., occupancy, monthly charges, staffing); and provide a baseline for future surveys. In addition, this information about AFHs can be compared to the recently completed summary of assisted living, residential care, and memory care facilities completed by Portland State University’s Institute on Aging. Both surveys, along with a report that summarizes characteristics of Medicaid clients based on data provided by DHS and a report recently completed by Oregon State University on nursing facilities in Oregon, provide an important overview of community-based care settings in Oregon that can be used by policymakers, providers, and consumers