Objectives: Describe and evaluate a method for assessing whether physical restraint prevalence differs by timing and frequency of data collection and to determine the minimum period of observation necessary to provide accurate prevalence estimates on both Intensive Care Unit (ICU) and medical–surgical units. Design: Two-period, cross-sectional design with repeated observations in year 1 for 18 consecutive days and in year 2 for 21 consecutive days with method modifications. Setting: 400-bed urban teaching hospital. Participants: All beds on general medical, surgical, and intensive care units. Measurement: Direct observation of patients, nurse interview, and medical record review conducted by trained observers. Results: There were no significant differences in mean restraint use prevalence rates comparing: (a) morning and evening periods; (b) weekdays and weekend days; and (c) observation periods of 7, 14, or 21 consecutive days or for 7 days using every 3rd day on either medical–surgical units or ICUs. Analyses using data from an increasing number of days of observation indicates that the mean prevalence rate stabilizes after 16 days. There were larger mean differences for comparisons on ICU–ventilator units and lack of significant differences may be due to low statistical power. Conclusion: Direct observation by trained observers, supplemented by nurse report and medical record documentation over brief monitoring periods, results in accurate, nonintrusive, cost-efficient estimates of physical restraint prevalence. As few as seven consecutive or nonconsecutive days in measuring restraint prevalence is sufficient to obtain accurate estimates, although the number of days may vary depending on patient mix and unit type.

Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this article examines the applicability of Felson’s Routine Activities Theory to a national probability sample of older homeless individuals. Results indicate that the relative protection that women often have from most crimes is not transferred to the older homeless woman who is more likely than her male counterparts to be the victim of sexual assault but equally as likely to be the victim of theft and physical assault. Likewise, the protection often noted afforded by age against victimization is also not seen among the homeless. The research demonstrates that being male and having mental and physical health problems as well as substance abuse problems increases the likelihood of victimizations among the homeless population, in general. When predictors of victimization were considered for the 50 and older sample, these predictors remained the same except that the gender remained significant only for sexual assault. These findings are consistent with and supportive of utilizing Felson’s Routine Activities Theory to understand and explain victimization among the older homeless population.

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

Case mangers must deal with the ever-changing makeup of their client population as well as those who provide managed services to these clients. There is great ethnocultural diversity in the elder population, and statistics contend that it will only increase with time. Similarly, the majority of long-term-care providers have been consistently female and of color. Providing culturally competent services becomes more complex when long-term-care providers and clients possess different identities, countries of origins, and social statuses. This article examines a framework that addresses the complex, multidimensional, and bidirectional process that occurs between providers and consumers of any cultural makeup called cultural responsiveness.

There is little literature about the relationships of older women who live alone and the paid, nonprofessional helpers who assist them. Studies of interpersonal trust have focused on the vulnerability of the trusting person and actions of the trusted person. The actions of the trusting person, or empirical indicators of trust, have had little attention. Our purpose was to describe the actions of older women that were indicative of their trust in nonprofessional home-care helpers. In a descriptive phenomenological study of 25 older widows, a subsample of 11 women who had hired nonprofessional helpers reported actions toward the helpers that we deemed markers of trust. The overarching marker of trust was keeping my eyes off of the helper, with five subsidiary markers, including allowing the helper to enter my house at will. Findings extend empirical knowledge about trust, raise new questions about interpersonal theories of trust, and suggest further areas of study.

This article is about the importance of retaining a focus on the humanity of older adults while rendering care to them through community and long-term care services. It is written from my experience as a director of a community service (Adult Day Health Care [ADHC] program), a program officer at a foundation devoted to improving health care for older Americans, a researcher who spent years conducting interviews with staff workers in long-term care services, and from the perspective of a professional and personal caregiver and friend to many elders living in the community—in their own homes and in nursing homes. From these diverse professional and personal roles and perspectives, I have learned that the formation of authentic human relationships, which go beyond the routine medical, nursing, and social work approach to care, can play a vital role in healing and addressing loneliness in elders—and transform the lives of their personal and professional caregivers as well. A focus on humanity need not cost money or place a heavy demand on the worker. In fact, it can be one of the most cost-effective approaches to improving quality in health care, attracting workers to the field of long-term care, and boosting the morale of both caregivers and care recipients.