This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.

This study underscores the importance of the basic economics of job choice by low-income workers. Wages, fringe benefits, job security, and alternative choices of employment are important determinants of job tenure that should be addressed, in addition to training and organizational culture.

OBJECTIVES:In response to the need for an evidencebased review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes. DESIGN: Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia. RESULTS: Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated. CONCLUSION:Given the paucity of high-quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long-term care of people with dementia. J Am Geriatr Soc 61:1399-1409, 2013.Key words: dementia; structures; processes; nursing homes; residential care/assisted living; systematic review M ore than 5 million Americans have dementia.1 This number will rise to between 8 and 13 million by 2050.2 Dementia causes significant morbidity and mortality and creates a substantial burden on the people affected, caregivers, health systems, and society.1 It gradually erodes an individual's ability to make decisions, manage personal affairs, and eventually to perform simple tasks such as dressing, toileting, and eating. Weight loss, limited mobility, and frequent infections characterize the late stages of dementia. Unless another illness is fatal sooner, dementia will lead to death. The course of dementia from diagnosis to death is variable but typically is from 8 to 12 years. Costs of dementia care, including medical care and informal caregiver time, are estimated at more than $148 billion in the United States annually. 3Although family members provide the majority of care for people with dementia, increasing needs over time often lead to placement in a long-term care setting; dementia is the most common reason for entry into nursing homes (NHs) and residential care or assisted living (RC/AL), where together more than 1 million people with dementi...

Objective We examined the effect of functional disability on all-cause mortality and cause-specific deaths among community-dwelling US adults. Methods We used data from 142,636 adults who participated in the 1994–1995 National Health Interview Survey-Disability Supplement eligible for linkage to National Death Index records from 1994 to 2006 to estimate the effects of disability on mortality and leading causes of death. Results Adults with any disability were more likely to die than adults without disability (19.92% vs. 10.94%; hazard ratio = 1.51, 95% confidence interval, 1.45–1.57). This association was statistically significant for most causes of death and for most types of disability studied. The leading cause of death for adults with and without disability differed (heart disease and malignant neoplasms, respectively). Conclusions Our results suggest that all-cause mortality rates are higher among adults with disabilities than among adults without disabilities and that significant associations exist between several types of disability and cause-specific mortality. Interventions are needed that effectively address the poorer health status of people with disabilities and reduce the risk of death.

DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.