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This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the gendered, raced, and citizenship-based expressions of their work roles.

This quantitative intersectional study draws on two nationwide datasets from the US National Center for Long-term Care Statistics, a division of the Centers for Disease Control and Prevention, the National Nursing Assistant Study (NNAS), and National Home Health Aide Survey (NHHAS).

Workplace context was the strongest predictor of workers’ health risks and working conditions. Physical injuries affected more than half of facility-based workers annually compared to less than 10% of home-based workers. Facility-based workers are more likely to report insufficient time for tasks, lower job satisfaction, and less respect and appreciation from patients. Home-based workers may be more likely to experience emotional distress, be offered fewer benefits, but experience fewer injuries, due to the better relative health of their patients and having more time for client care. Women reported more injuries and more time pressure than men across racial and citizenship groups within the same work setting.

There are limitations to the NHHAS and NNAS public-release data file data. We are unable to fully capture citizenship, some racial/ethnic categories, workers over age 65, supervisory workers, facilities with fewer than three residents, and facilities not certified with Medicare or Medicaid. The exclusion of these questions, workers, and contexts is a weakness of the present study.

Analyses draw on data from the first nationally representative sample surveys of home health aides and nursing assistants in the United States. Direct care workers are an important population to capture through intersectional research since care work is done predominantly by multiracial women and immigrants. This research also underscores the importance of workplace contexts in shaping the labor performed and the workers’ experiences.

Over the last few years, many corporate planning departments have been pared to the bone. Companies no longer have whole teams devoted to market and competitor analysis. Often they have just a few people in the finance department who put together the annual plan. Yet top executives still need advice on market and competitor issues before they make the big decisions. Consultants are useful when a major issue needs to be addressed but usually cannot often provide day‐to‐day support without breaking the bank. How can business leaders get the support they with only a small planning function?

Long-term care has increasingly been subject to mechanisms to manage care in order to control costs and meet institutional demands for cost containment and efficiency. Fundamentally, managed care seeks to limit access to services that are deemed costly, intensive and/or long-term. However, long-term care by definition requires continuity of care across diverse service sectors. In order for managed long-term care to work, these sectors must be well integrated and able to share information about client needs. In this paper we examine the growth of managed care in the long-term care sector. We have collected data from long-term care agencies in adjoining counties (one urban, the other suburban) at three points in time (1997, 1999, and 2001) and are in a position to describe changes in the types of agencies providing long-term care, and the degree of managed care penetration in our sample. We also collected data on administrators’ evaluations of managed care, and their perceptions of the effect of managed care on services and service system integration. We conclude by discussing the future of long-term care.

In the mid 1980s, amidst a massive restructuring of U.S. capital and a retrenchment of the welfare state, little attention has been paid to the ill‐defined “nonprofit” or “voluntary” service sector in the American economy. The Filer Commission on Private Philanthropy and Public Needs characterised it in 1975 in the following way:

We examine the association of for-profit (FP) and nonprofit (NP) economic incentives in hospice care providers with financial and nonfinancial metrics of management performance. Controlling for quality of patient care and differences in cost-efficiency, we find that FP providers (1) selectively admit patients with longer life-prognoses and billable days and hence lower average costs per day, (2) employ a lower average cost/skill mix of workers, and (3) have higher CEO compensation and profit. The NP providers admit more patients with the less profitable life-prognoses attributes, have lower CEO compensation, and reinvest their net earnings under the non-distribution constraint. While the profit incentive may be needed to attract providers into this rapidly growing and underserved market, the NP providers return a lower cost per patient served from the taxpayer's perspective.

This paper examines the association of charitable donations with quality of care proxies for nonprofit hospice providers in the United States (US). An estimated 1.45 million patients received hospice care in the US in 2008. Medicare hospice spending exceeded $10 billion in 2007 and is expected to more than double over the next 10 years. Using Guidestar and Medicare Hospice Cost Report data, we find donations are positively associated with proxies for nurse and social worker quality of care, but not with our home-health aide quality proxy. This research adds to our understanding of charitable contributions in hospice provider organizations.

Citizens today are inundated with quantitative information in an information-rich world. However, students rarely get the opportunity to use mathematics to explore social issues— a concept known as Social Mathematics. Social Mathematics should be an important part of students’ K-12 experiences and is fundamental in preparing our students for active citizenship in a democratic society. This feature makes the case that social mathematics is an important but often neglected area of social studies and mathematics education, and improving students’ knowledge in this area requires the collaborative efforts of both social studies and mathematics teachers. A variety of strategies and resources for interdisciplinary collaboration between social studies and mathematics teachers is provided.

Hospitals and health‐care facilities are among the most complex, costly, and challenging buildings to design, construct and manage. To become a health facilities manager of a hospital or other medical centre in the USA, one requires knowledge not only of how to manage people, but also of how to deal with government agencies and all kinds of regulations and inspections. The hospital facility must cope with the idea of being open 25 hours a day, and having staff to control 365 days a year.

This article aims to discuss the relevancy of different instruments used to gather information on homecare service quality from multiple stakeholders and the challenges encountered when trying to blend their views for prioritizing areas needing improvement.

The study centers on four homecare agencies: one public, one private for‐profit and two not‐for‐profit services, implementing continuous quality improvement (CQI) programs. Various instruments were tested with random and convenience elderly service user, family caregiver and front‐line worker samples. Instrument evaluation included operational effectiveness and agency manageability.

A qualitative approach, centered on small stakeholder samples, is fairly effective at assessing service quality, yet demands a strong commitment from agencies in personnel time and resources, as well as the necessary skills. Small‐size, private homecare providers seem less‐well equipped to handle comprehensive assessments without external support. More importantly, assessments have to be done strategically, such that timing and work needed does not undermine program viability.

The approach and instruments tested have practical implications for decision makers and homecare organization managers interested in CQI.

The article systematically evaluates quality assessment and priority‐setting instruments applied to various stakeholders and homecare settings.