Participants identified potentially avoidable reasons for hospital readmission as well as causes that require rethinking regarding how community support is targeted and delivered. Participant preference for aggressive care, inability to provide self-care, and lack of caregiver support suggest the need for new and innovative mechanisms to support seriously ill community-dwelling individuals.

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This research compared direct and indirect measures of ambivalence, 2 commonly used strategies for measuring intergenerational ambivalence between older parents and their adult children. Directly and indirectly measured ambivalence, corresponding to felt and potential manifestations of the construct, were contrasted with each other and across generations. Data were derived from 253 older parent–adult child dyads participating in the Longitudinal Study of Generations in 2005. Direct and indirect measures of ambivalence were moderately correlated with each other within each generation. Children expressed greater indirect ambivalence than their parents but were no different than their mothers or fathers in their levels of direct ambivalence. Multivariate regression analyses examining the relationship between each type of ambivalence with individual and relationship characteristics found differences in associations across equations. The results suggest that direct and indirect measures are related but represent 2 distinct conceptions of ambivalence. This research highlights the challenges in understanding the full complexity of intergenerational relations and suggests that both generational perspectives be considered in future research.

Context Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members’ or caregivers’ experiences of care. Objectives To evaluate the instruments currently in use to inform next steps for research and policy in this area. Methods We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS® for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. Results We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. Conclusion This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.

This report presents the most current national results from the National Study of Long-Term Care Providers, conducted by the National Center for Health Statistics to describe providers and services users in seven major sectors of paid, regulated post-acute and long-term care services in the United States.

This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers’ survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.

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