PAR is a viable method to stimulate creative resident-led reform ideas and initiatives in LTC. Residents' expertise has been overlooked within prominent culture change efforts that have developed and facilitated changes from outside-in and top-down. PAR may be incorporated productively within myriad reform efforts to engage residents' competence. PAR has indirect positive quality of life benefits as a forum of meaningful social engagement and age integration that may transform routinized and often ageist modes of relationships within LTC.

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Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.

Purpose – Intercountry adoptions (hereafter ICAs) in the USA are a form of sale of children. According to international policy, sale of children is an illicit social practice that involves improper financial gains by at least one party. Sale of children is a threat to legitimate ICA. The purpose of this paper is to analyse the policy and practice of ICAs in the USA, including pricing arrangements, demonstrate that US ICAs, which can have humanitarian aims and be legitimate forms of family development, comprise sale of children. Design/methodology/approach – Internet searches and e-mail inquiries were used to obtain ICA cost data for a randomised sample of 10 per cent of the agencies in the USA that facilitate ICAs. Findings – Cost information was obtained from only 25 per cent of the sample, suggesting lack of transparency in and available information about monetary costs of US ICAs. A range of US$12,000 to $40,000 suggests that US ICAs are expensive and costs vary. Large, undisclosed fees in the form of “required donations”, agency fees, and extensive foreign travel requirements imply third party economic gains are made through US ICA transactions. Practical implications – US ICA agencies should disclose costs and employ transparent practices. US policies regulating ICAs should be clarified and strengthened. The US Government should ratify, implement, and enforce major children’s rights international policy standards. Social implications – International demand for adopted children may encourage child trafficking, child laundering, and kidnapping for profit (see Smolin, 2005), putting children, adoptive families, and birth communities at risk of breaches of basic human rights. Originality/value – No study has offered systematic analysis of monetary costs of US ICAs and linked this analysis to policy and legitimacy of social practices.