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Long-term care (LTC) homes are highly regulated settings that provide care to people living with complex health conditions who are often at the end of their lives. Mental health and quality of life are important concepts in LTC given the inherent poor health and diminished autonomy of residents living in this setting. The COVID-19 pandemic had the potential to further compound these issues through lockdowns limiting movement within and outside of LTC homes, increased fear of severe COVID-19 infections, staff shortages, and impaired communication through personal protective equipment. However, the evidence describing the effect of the pandemic on mental health and quality of life is mixed, with some studies describing increased rates of mental health concerns and others presenting modest increases or decreases. Creative strategies to mitigate negative mental health consequences of lockdown included technology supported and window or outdoor visits, increased access to volunteers, and supports for families. However, the evidence in this area continues to evolve as subsequent waves of the pandemic progress. Future research may present new evidence about other strategies that became important in different stages of the pandemic.

The purpose of this chapter is to examine the consequences of closing institutions for people with disabilities and accommodating them in Supported Residential Services. Issues that had been raised by an advocacy movement included shortcomings in privacy, dignity, control and meaningful activity in institutions, which led to their closure. The study applied a quality of life measurement which was commensurate with the ethical paradigms of welfare, autonomy and communitarianism to investigate whether community living in supported residences produced fulfilling lives and better outcomes than the institutions they replaced. Twenty-seven people with a disability and/or mental health issue in Supported Residential Services in Victoria, Australia were interviewed using the ‘Lehman Quality of Life Questionnaire’. An investigation into the Quality of Life of one group of de-institutionalised residents revealed that issues remain. People in the Supported Residences appear to be no better off than when they were in institutions. The study identified that it was common for a resident to have no phone, no friends outside the residence, little or no family contact, no disposable money and no job. However, since there was no research conducted before de-institutionalisation, the impact of the policy change is difficult to determine. Applying ethical measures, such as the Capabilities approach, reveals that issues remain. Practical implications from this study are first, that positive measures need to be added to de-institutionalisation to achieve satisfactory outcomes and second, that policy makers would be better informed and likely more effective if data were collected before and after significant changes.

For frail older persons, gaining access to care is primarily in the context of long-term care institutions. Based on hypotheses derived from the theory of the total institution (Goffman, 1961) and anticipatory socialization theory (Merton & Kitt, 1950), linkages of intra-institutional and extra-institutional social ties with quality of life outcomes were assessed based on 168 residents’ self-reports of their life and problems experienced in long-term care (Kahana, Kahana, & Young, 1987). Findings reveal that lack of anticipatory socialization was a significant predictor of subsequent wellbeing, whereas the extent of social ties to the outside world did not predict subsequent wellbeing.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

In the space of 50 years, Saint-Quentin-en-Yvelines (SQY) has seen a variety of urban development contexts. In the 1970s, the initial master plan revolved around a hierarchical organisation of hubs, and the priority went to the economic question. It also created a specific public road system, along with housing districts endowed with a wide range of amenities to provide a new ‘way of life’. Fifty years later, a number of points typical of SQY’s specific urban nature can be identified. This chapter mentions three of them: an urban ‘dividing line’, the organisation of urbanisation into small towns (urban units) and the aesthetic and environmental qualities of the town. These urban planning qualities have been addressed by the recent Comprehensive Local Development Plan (2016–2018). However, other points such as public transport, driving conditions, nightlife and quality of the green spaces are the topics discussed by experts and citizens in the local conversation.

Chapter 16 is an introduction to systems thinking and analyzing the system dynamics of relationships within an organization or between organizations. Systems thinking builds on the propositions that (1) all variables or conditions have both dependent and independent relationships, (2) lag effects occur in relationships, (3) feedback relationships occur (e.g., A→B→C→A), and (4) seemingly minor relationships (i.e., “hidden demons”) have huge influence in causing a set of relationships (i.e., a system) to implode or explode. The propositions of building and testing a set of relationships apply in many contexts; this chapter examines systems thinking and system dynamics in one context as an introduction to this stream of case study research. Hall (1976) provides details of an advanced application of systems dynamics research – do not be fooled by the date of the study; Hall (1976) is an exceptional up-to-date case research study using system dynamics modeling. This chapter describes the issues and criticisms concerning golf, tourism, and the environment and considers how golf–tourism–environment relationships might achieve economic well-being for a region while avoiding vicious cycles of destruction to local environments and the quality of life of local residents. The examination proposes the use of systems thinking, cause mapping, and system dynamics modeling and simulations of golf, tourism, and environmental relationships to help achieve workable solutions agreeable to all stakeholders. Sustainable relationships that include golf, tourism, and environmental objectives require crafting government policies via stakeholder participation of all parties that such relationships affect – recognizing and enabling this requirement needs to be done explicitly – to reduce conflicts among stakeholders and avoid system failures.

The aim of this chapter is to reflect on some of the implications in doing fieldwork in a small and relatively isolated island community. In 2009, a Danish island in the Wadden Sea National Park, only reachable by motor vehicles when the tide is out, was selected to host one of the many events taking place during the biannual Wadden Sea Festival. The aim of the project was to create vanishing art depicting the quality of life (QoL) on the island by use of materials found in the island's natural environment. Prior to the implementation of the event and as a part of the project, the authors were invited to qualitatively investigate the QoL among island residents, specifically focusing on subjective well-being. Through a description of stakeholder connections and conflicts, a number of lessons are discerned and pondered upon. In addition to applying the case to demonstrate and discuss how researchers can investigate QoL in tourism and how research(ers) impact small communities, we also reflect on the unforeseen consequences and entanglements of a seemingly (because of its size) ‘straightforward’ field of research. It is argued that field studies in very small communities more easily expose not only ‘outside’ interference, but also controversies and conflicts between neighbours, within families and between dwellers and professions of multiple sorts. Consequently we argue that researchers must continuously reflect on their own role in and relations to the places and communities – the ‘cases’ – which they investigate.