Trans-incarceration: Reimagining confinement and the criminality of aging.

As the U.S. population continues to age and will require increasing levels of care, scholars continue to question what conventional methods of "custodial care" and rehabilitation accomplish for the individuals receiving them, relative to those providing them. To this end, critical discourse surrounding the spatial institutionalization of older adults argues that formal institutions of care and rehabilitation are simply alternative and synonymous forms of incarceration and imprisonment. Using semi-structured interviews with ten male residents of a Rhode Island nursing home and ten incarcerated males at the Rhode Island state prison's medium security unit, this work explores the following questions within the existing scholarship of the medical sociology of confinement and incarceration: In what ways are experiences of confinement alike for older adults living in prisons and for those living in nursing homes, and what do these similarities/differences imply about aging, disabled, and economically unproductive bodies as "deviant" and subsequently "criminal" as the traditional definition of the carceral space expands? Participant responses across the nursing home and prison settings fit into three categories, including "home as historical/home as negation," "institution as escape," and "self as non-human/self as non-agent." As a result, there exist thematic consistencies amidst the subjective experiences of older adults across settings of confinement that argue for a shared "criminality" socially assigned to an aging body.

Institutionalizing torture in Israel: The Firas Tbeish decision. A commentary by John W. Schiemann, PhD.

In her discussion of the court's dismissal of the IP, she says there "is a legal system that discredits the IP's potential while digging deeper into its own conception of torture.'' Shir has helped show that this is true more broadly of torture, beyond the IP. Indeed, I suspect the court may not view the IP as a "strange creature" causing "suspicion of the unfamiliar." Instead, it may be by now a very familiar creature that threatens torture's impunity in Israel, and what Shir shows is that the court has developed a systematic strategy to counter it. Torture is possible in Israel because the government and courts are complicit in deliberately creating a legal and institutional black hole where boundaries are ill-defined and obscure, and no light can shine.

What drives changes in institutionalised mental health care? A qualitative study of the perspectives of professional experts.

BACKGROUND: Since 1990, the provision of mental healthcare has changed substantially across Western Europe. There are fewer psychiatric hospital beds and more places in forensic psychiatric hospitals and residential facilities. However, little research has investigated the drivers behind these changes. This study explored qualitatively the perspectives of mental health professional experts on what has driven the changes in Western Europe. METHODS: In-depth interviews were conducted with twenty-four mental health experts in England, Germany and Italy, who as professionals had personal experiences of the changes in their country. Interviewees were asked about drivers of changes in institutionalised mental health care from 1990 to 2010. The accounts were subjected to a thematic analysis. RESULTS: Four broad themes were revealed: the overall philosophy of de-institutionalisation, with the aim to overcome old-fashioned asylum style care; finances, with a pressure to limit expenditure and an interest of provider organisations to increase income; limitations of community mental health care in which most severely ill patients may be neglected; and emphasis on risk containment so that patients posing a risk may be cared for in institutions. Whilst all themes were mentioned in all three countries, there were also differences in emphasis and detail. CONCLUSIONS: Distinct factors appear to have influenced changes in mental health care. Their precise influence may vary from country to country, and they have to be considered in the context of each country. The drivers may be influenced by professional groups to some extent, but also depend on the overall interest and attitudes in the society at large.

Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability.

BACKGROUND: In the context of declining international assistance for ART scale-up in Sub-Saharan Africa, the institutionalization of ART programs through integrating them in the organizational routines of health facilities is gaining importance as a program sustainability strategy. OBJECTIVE: The aims of this study were; (i) to compare the level of institutionalization of ART programs in health facilities in Uganda and (ii) to explore reasons for variations in the degree of program institutionalization. METHODS: In Phase One, we utilized Level of Institutionalization Scales developed by Goodman (1993) to measure the degree of institutionalization of ART interventions in 195 health facilities across Uganda. The 45-item questionnaire measured institutionalization based on four sub-systems (production, maintenance, supportive, managerial) theorized to make up an organization assessed against two levels of institutionalization; routines (lowest) niche saturation (highest). In Phase Two, four health facilities were purposively selected (2 with the highest and 2 with the lowest institutionalization scores) for a multiple case-study involving semi-structured interviews with ART clinic managers(n = 32), on-site observations and document review. RESULTS: The two highest scoring health facilities had a longer HIV intervention implementation history of between 8 and 11 years. The highest scoring cases associated intervention institutionalization with sustained workforce trainings in ART management, the retention of ART-trained personnel and generating in-house ART manuals. The turnover of ART-proficient staff was identified as a barrier to intervention institutionalization in the lowest-ranked cases. Significant differences in organizational contexts were identified. The two highest-ranked health facilities were well-established, higher-tier hospitals while the lowest scoring health facilities were lower-level health facilities. CONCLUSIONS: The level of institutionalization of ART interventions appeared to be differentiated by level of care in the Ugandan health system. Interventions aimed at strengthening program institutionalization in lower-level health centers at the level of human resources for health could enhance ART scale-up sustainability.

Programas para combatir la soledad en las personas mayores en el ámbito institucionalizado: una revisión de la literatura científica / Programs to combat loneliness in the institutionalised elderly: a review of the scientific literature

La soledad es un problema que afecta a un porcentaje muy elevado de personas mayores, y que puede conducir a enfermedades físicas y/o mentales. El objetivo de este trabajo es presentar una revisión sistemática de los programas para combatir la soledad dirigidos a las personas mayores institucionalizadas. Se trata de investigaciones internacionales experimentales y cuasi-experimentales publicadas entre los años 2000 y 2016. Se analiza la calidad de la evidencia metodológica de cada uno de los estudios. Los programas incluyen intervenciones basadas en terapias asistidas con animales, contactos con familiares a través de videoconferencia, talleres de jardinería y/o horticultura, terapias de reminiscencia, terapias de humor e intervenciones cognitivas. Los resultados demuestran que los programas de intervención son efectivos para reducir el sentimiento de soledad. Se analizan las limitaciones metodológicas de los estudios y se recomiendan líneas futuras de investigación

Loneliness is a problem that affects a very high percentage of older people, and can lead to physical and/or mental illness. This article aims to present a systematic review of programs to combat loneliness directed towards the institutionalised elderly. Experimental and quasi-experimental articles published between 2000 and 2016 were included in the review. An analysis was carried out on the quality of the methodological evidence of each of the articles. The programs analysed included animal-assisted, contacts with families through videoconferencing, gardening and/or horticulture workshops, reminiscence therapies, humour therapies, and cognitive interventions. The results show that intervention programs are effective to reduce the feeling of loneliness. The methodological limitations of the studies are discussed and future research is recommended

The effects of movement stimulation on activities of daily living performance and quality of life in nursing home residents with dementia: a randomized controlled trial.

BACKGROUND: Nursing home (NH) residents with dementia experience a reduced quality of life (QoL), in part, due to a dependence in performing activities of daily living (ADL). Stimulating movement is associated with improvements in ADL performance. Therefore, movement stimulating interventions, such as ADL training and exercise, focus on optimizing ADL performance to improve QoL. This study aimed to evaluate the effect of three movement stimulating interventions on QoL and ADL performance in NH residents with dementia. METHODS: In this 6-month double parallel randomized controlled trial, the effects of ADL training, a multicomponent aerobic and strength exercise training, and a combined ADL and exercise training were analyzed in 87 NH residents with dementia. The Global Deterioration Scale was used to classify the severity of dementia. Participants were screened at baseline using the 6 minute walk test and Mini-Mental State Examination. The Qualidem, and the Care Dependency Scale and Erlangen ADL test were evaluated at baseline, and after 3 and 6 months to measure QoL and ADL, respectively. Multilevel analyses were adjusted for baseline performance, age, and gender. RESULTS: A 6-month ADL training positively affected overall QoL (p = 0.004) and multiple aspects of QoL, including care relationship (p = 0.004), positive self-image (p = 0.002), and feeling at home (p = 0.001), compared to care-as-usual. No benefits were observed of exercise on QoL. No benefits were observed of a combined ADL and exercise intervention on QoL. No effects were found of the three movement interventions on ADL performance. CONCLUSION: The results indicate that ADL training can improve QoL. The results contribute to the limited knowledge regarding the effect of movement stimulation on resident outcomes. Further large-scale studies are recommended.

Revisión de la educación médica en Chile: logros y desafíos / Review of medical education in Chile: achievements and challenges

La educación médica en Chile ha tenido un importante desarrollo en las últimas décadas. El esfuerzo de distintas instituciones, universidades, sociedades científicas y organizaciones públicas y privadas ha empujado su avance y la han posicionado en un alto estándar de funcionamiento. Esto permite a estudiantes de pre y posgrado el acceso a la formación en salud acorde a un país que quiere avanzar en dar a su población la mejor atención posible. Los avances en áreas de formación con nuevos currículos, el uso de evaluación docente, la acreditación nacional e internacional de los programas, el uso de simulación, la innovación docente y el liderazgo en iniciativas regionales auguran un futuro prometedor y los desafíos se centran en el desarrollo de nuevas estrategias para mejorar el acceso desde una red de instituciones aún dispar en su progreso y de una planificación que regule y potencie el trabajo de la red de educación médica en el ámbito nacional e internacional. El objetivo de este trabajo es detallar el estado actual de la formación médica en Chile y las áreas de trabajo que tienen las más importantes entidades de educación médica del país, destacando las áreas de mayor proyección para articular un proyecto de formación para las futuras generaciones de médicos en Chile

Chilean medical education has developed greatly in the last decade. Different institutions, such as universities, scientific societies and private and public organizations have pushed this development forward, and have allowed and encouraged the high standards at which Chilean medical education is now working. As a consequence undergraduate and postgraduate students have access to health related training that continues to raise the country's medical standard, and goes hand in hand with the country's aim of delivering the best possible health care to its population. Improved training standards, the development of new curricula, regular faculty assessment, national and international accreditation, the use of simulation, teaching innovation and leadership in regional initiatives hold a promising future. Future challenges center on the development of new strategies that allows a network of institutions, at dissimilar stages of progress, improved access to training. And a plan that regulates and enhances the work of the medical education network at a national and international level. The purpose of this paper is to detail the state medical education in Chile, as well as highlighting the most promising areas of development that the best regarded institutions in medical education in Chile are working on, thus articulating a training project for the future generations of medical doctors in Chile

Hable con ellos: cuidados narrativos en el marco de una atención centrada en la persona / Talk to them: narrative care within a person-centered care framework

El objetivo de este artículo es definir y destacar la importancia de ofrecer unos cuidados narrativos en la atención de las personas mayores que reciben cuidados en instituciones, destacando cómo suponen una mejor comprensión del modelo de la atención centrada en la persona (ACP) y valiosas estrategias para ponerlo en práctica. Para ello, en primer lugar describimos la relevancia del enfoque narrativo para la comprensión de la experiencia de la persona mayor que es cuidada en instituciones, tanto en sus aspectos individuales como en las relaciones que establece con los profesionales, y en los discursos institucionales que contextualizan esas relaciones. En segundo lugar, especificamos diversas formas en las que el uso de narrativas podría tener un impacto en la mejora de la calidad de la atención y el bienestar de las personas mayores que reciben cuidados en instituciones (AU)

The aim of this paper is to highlight the importance of narrative care in the attention of older people who receive care in institutions, underlining how its use provides a better understanding of the Person Centered Care (PCC) model and valuable strategies to put it into practice. To achieve this goal, firstly, we describe the relevance of a narrative approach for understanding the experience of the old person who receive care in institutions, with regards to individual aspects as well as to her/his relationships with professionals and the institutional discourse which contextualize these relationships. Secondly, we specify different ways in which the use of narratives could have an impact on the improvement of the quality of attention and well-being of older people receiving care in institutions (AU)

Family Involvement in Nursing Homes: Are Family Caregivers Getting What They Want?

The provision of person-centered care for nursing home residents with dementia suggests the need for family caregiver involvement. In this article, we argue that optimal family involvement differs by family caregiver and therefore depends on the degree to which family caregivers consider their own involvement to be important. In this Canadian study, we compare the importance that 135 family caregivers of residents with dementia place on 20 kinds of involvement with the degree to which they perceive opportunities for involvement. Family Involvement Congruence Scores are calculated in three ways: those for whom involvement is important, those for whom involvement is not important, and an overall congruence score. Congruence scores varied by involvement type. These scores show promise for use in future research on family caregiver involvement and as tools for use by facilities as they endeavor to meet family caregiver expectations for involvement.

Hospital information system institutionalization processes in indonesian public, government-owned and privately owned hospitals.

The Hospital Information System (HIS) could help hospitals as a public entity to provide optimal health services. One of the main challenges of HIS implementation is an institutional change. Using institutional theory as the analytical lens, this study aims to explain the institutionalization of HIS as an instance of e-health initiatives in Indonesia. Furthermore, this paper aims for hospital management and researchers to improve the understanding of the social forces that influence hospital personnel's HIS acceptance within an organizational context. We use case studies from four public, government-owned hospitals and four privately owned (public and specialty) hospitals to explain the HIS institutionalization process by exploring the three concepts of institutional theory: institutional isomorphism, institutional logic, and institutional entrepreneurship. This study reveals that differences exist between public, government-owned and private hospitals with regard to the institutionalization process: public, government-owned hospitals' management is more motivated to implement HIS to comply with the regulations, while private hospitals' management views HIS as an urgent requirement that must be achieved. The study findings also reveal that various institutional isomorphism mechanisms and forms of institutional logic emerge during the process. Finally, three factors-self-efficacy, social influence, and management support-have a significant influence on the individual acceptance of HIS.

The Avahan Transition: Effects of Transition Readiness on Program Institutionalization and Sustained Outcomes.

BACKGROUND: With declines in development assistance for health and growing interest in country ownership, donors are increasingly faced with the task of transitioning health programs to local actors towards a path to sustainability. Yet there is little available guidance on how to measure and evaluate the success of a transition and its subsequent effects. This study assesses the transition of the Avahan HIV/AIDS prevention program in India to investigate how preparations for transition affected continuation of program activities post-transition. METHODS: Two rounds of two surveys were conducted and supplemented by data from government and Avahan Computerized Management Information Systems (CMIS). Exploratory factor analysis was used to develop two measures: 1) transition readiness pre-transition, and 2) institutionalization (i.e. integration of initial program systems into organizational procedures and behaviors) post-transition. A fixed effects model was built to examine changes in key program delivery outcomes over time. An ordinary least square regression was used to assess the relationship between transition readiness and sustainability of service outcomes both directly, and indirectly through institutionalization. RESULTS: Transition readiness data revealed 3 factors (capacity, alignment and communication), on a 15-item scale with adequate internal consistency (alpha 0.73). Institutionalization was modeled as a unidimensional construct, and a 12-item scale demonstrated moderate internal consistency (alpha 0.60). Coverage of key populations and condom distribution were sustained compared to pre-transition levels (p<0.01). Transition readiness, but not institutionalization, predicted sustained outcomes post-transition. Transition readiness did not necessarily lead to institutionalization of key program elements one year after transition. CONCLUSION: Greater preparedness prior to transition is important to achieve better service delivery outcomes post-transition. This paper illustrates a methodology to measure transition readiness pre-transition to identify less ready organizations or program components in advance, improving the likelihood of service sustainability. Further research is needed around the conceptualization and development of measures of institutionalization and its effects on long-term program sustainability.

Rehabilitation, Education, and the Integration of Individuals with Severe Brain Injury into Civil Society: Towards an Expanded Rights Agenda in Response to New Insights from Translational Neuroethics and Neuroscience.

Many minimally conscious patients are segregated in nursing homes, and are without access to rehabilitative technologies that could help them reintegrate into their communities. In this Article, we argue that persons in a minimally conscious state or who have the potential to progress to such a state must be provided rehabilitative services instead of being isolated in custodial care. The right to rehabilitative technologies for the injured brain stems by analogy to the expectation of free public education for children and adolescents, and also by statute under the Americans with Disabilities Act and under Supreme Court jurisprudence, namely the leading deinstitutionalization case, Olmstead v. L.C. ex rel. Zimring.

From Juvenile Offender Institutions to Residential Treatment Centers: Evidence of the Shifting Paradigm to Improved Youth and Community Outcomes.

Hundreds of thousands of youth are held every year in U.S. juvenile justice detention centers and incarceration facilities. Increasingly it is known that these facility placements are at best ineffective and at worst lead to additional youth recidivism outcomes. What is most concerning, though, is that a majority of these incarcerated youth have one or more mental health/substance abuse disorders, special education disabilities, or maltreatment victimization histories-comorbid situations that negatively impact their involvement with the juvenile courts. In this article the authors summarize the epidemiology of these youth problems within the juvenile justice system. The authors then compare the outcome evidence for the youth placed in juvenile justice facilities with those placed in residential treatment centers, finding significant advantages to addressing the problems through rehabilitative efforts. Recognizing that there are a small number of serious youthful offenders who will need placement, their analysis finds that the juvenile courts must continue (or in many instances begin) reshaping their detention and incarceration facilities reliance on punishment toward a rehabilitative residential model.

'You can't be forcing food down 'em': Nursing home carers' perceptions of residents' dining needs.

Malnutrition is a life-threatening condition among older people living in nursing care homes. This qualitative analysis of interview data from five care staff aimed to understand their perceptions of 'caring for' residents' nutritional needs. Tensions in the delivery of care and institutionalisation and disempowerment were identified. Despite carers' good intentions, they often failed to recognise the importance of the psychosocial aspects of mealtimes. Staff shortages, routine-driven, medically based working practices and residents' resistance to institutionalisation emerged as barriers to quality caregiving. The findings indicate that the relational aspects of care are constrained by social, structural and ideological contexts.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part I. The course of deinstitutionalization - the activity of Basaglia's group]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc I. Przebieg deinstytucjonalizacji - dzialalnosc grupy Basaglii.

Psychiatric reform in Italy consisted of the implementation of legislative changes derived from anti-institutional experiments conducted by Franco Basaglia and his group in the 60's and 70's of the 20th century. The activity of Basaglia's group was an integral part of the European reform movement of that time, which profited from the economic, cultural and political prosperity for changes in psychiatry. Italian antipsychiatry has led to the most radical experiment in deinstitutionalization in history. It involved the whole public sector of psychiatry and across a quarter-century resulted in a grand social debate on the situation of the mentally ill and the need for systemic change of their treatment and care. Inspired mainly by phenomenological analysis, Basaglia opted for close emphatic contact with the mentally ill. While the British, French and American anti-psychiatrists contested the psychiatric care system as such, the Italian radicals made an approach to disassemble it from the inside and successfully gained social support for the process of deinstitutionalization. Basaglia promoted his ideas across Europe, including the World Health Organization (WHO) forum.

[Deinstitutionalization in Italian psychiatry - the course and consequences Part II. The consequences of deinstitutionalization]. / Deinstytucjonalizacja psychiatrii wloskiej - przebieg i skutki Czesc II. Skutki deinstytucjonalizacji.

The Italian mental health care is based on Law 180 (it. Legge 180), also called Legge Basaglia, from the name of the author of the reform, Franco Basaglia. It was adopted on May 13th 1978. The new legislation resulted from the actions of a strong anti-psychiatric movement and it brought about a major change in the organization of psychiatric care. The reform and its consequences were widely studied by the researchers, especially in the United Kingdom and the United States of America. The authors point out many successes of the reform, especially in its beginning. They seek the sources of its failure in a faulty and incomplete implementation. Legge Basaglia completely changed the structure of mental health care in Italy, finally bringing psychiatry back to medicine and the general hospitals, as well as promoting community-based psychiatry. Deinstitutionalization in Italy was not related to an increase in compulsory psychiatric hospitalizations, suicide attempts by the mentally ill, nor did it raise the number of crimes committed by them. It also did not cause common trans-institutionalization, with the transfer of patients to the private sector, as predicted by its opponents.

Characteristics of institutionalized young onset dementia patients--the BEYOnD study.

BACKGROUND: People with Young Onset Dementia (YOD) have specific needs for care. These people eventually require institutional care, usually delivered by institutions designed for the elderly. The Dutch network of care organizations delivering specialized YOD care offers a unique opportunity to obtain more knowledge of this special population. METHODS: Our cross-sectional study collected data from 230 people with YOD in eight care homes providing YOD specialized care. Data collected: demographic data, disease duration, dementia subtype, comorbidity, dementia severity (Global Deterioration Scale - GDS), neuropsychiatric symptoms (NPS; Neuropsychiatric Inventory - NPI, Cohen Mansfield Agitation Inventory - CMAI), disease awareness (Guidelines for the Rating of Awareness Deficits - GRAD), need for assistance (hierarchic Activities of Daily Living (ADL) scale - Resident Assessment Instrument - Minimum Data Set (RAI-MDS)). RESULTS: The mean age of the residents with YOD in care homes was 60 years and 53% of them were men. There is a large variety of etiologic diagnoses underlying the dementia. Dementia severity was very mild to mild in 18%, moderate in 25%, and severe or very severe in 58% of the participants. The prevalence of NPS was high with 90% exhibiting one or more clinically relevant NPS. Comorbidity was present in more than three quarters of the participants, most frequently psychiatric disorders. CONCLUSIONS: The institutionalized YOD population is heterogeneous. NPS occur in almost all institutionalized people with YOD, and frequency and severity of NPS are higher than in late onset dementia (LOD) and community-dwelling YOD patients. Care should be delivered in settings accommodating a mixed male and female population, with appropriate, meaningful activities for all individuals. Further research is needed on NPS in YOD, to enhance quality of life and work in specialized YOD-care.

La atención integral del paciente con enfermedad de Huntington: Claves en situación de crisis y en situación de final de vida. El continuum asistencial / No disponible

Un paciente con la enfermedad de Huntington es un paciente crónico complejo y muchas veces se comporta como un paciente geriátrico, que requiere un enfoque amplio e integrado para ser atendido en todas las etapas de la enfermedad. Es prioritaria la continuidad de la atención que asegure su enfoque multidisciplinario, tanto en la situación inicial y de estabilidad, como en situación de crisis y de final de la vida. Hay una necesidad urgente de crear recursos de institucionalización residencial adecuados para estos pacientes

A patient with Huntington's disease is a complex chronic patient and often behaves like a geriatric patient, which requires a comprehensive and integrated approach for treatment at all stages of the disease. Priority is continuity of care to ensure its multidisciplinary approach, both in the initial situation and stability, as in crisis and the end of life. There is an urgent need for adequate resources for these patients institutionalization

Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services.

OBJECTIVES: To examine, in beneficiaries with long-term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2-year effects of service type on those health outcomes. DESIGN: Secondary analyses of the existing LTCI data set from 2008 to 2010. SETTING: South Korea. PARTICIPANTS: LTCI beneficiaries with dementia aged 65 and older (N=31,319). Participants were divided according to the service type that they were receiving home care (HC), institutional care (IC), and combined care (CC). MEASUREMENTS: A LTC approval checklist was used to determine the level of LTCI coverage of each participant and to assess cognitive function, behavioral symptoms, and physical function. Linear mixed models and multiple regression models were used. RESULTS: There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three service types (P<.001) and overall improvements in those outcomes over 2 years in the three groups (P<.001). After limiting the sample to those who had received LTCI services for the full 2 years (2008-2010) and adjusting for baseline characteristics, individuals receiving HC were more likely to have better cognitive and physical function than those receiving IC or CC but were likely to have more behavioral symptoms 2 years after the LTCI enrollment (P<.001). CONCLUSION: LTCI service type (HC, IC, CC) predicted cognitive function, behavioral symptoms, and physical function at 2-year follow-up in beneficiaries with dementia. Further research is necessary to examine the effect of LTC services on health outcomes in a longer observational cohort.