发表于:2017-11-23 00:15 [只看楼主] [划词开启]





Finding the Right Home—and Contentment, Too

  [A] When your elderly relative needs to enter some sort of long-term care facility—a moment few parents or children approach without fear—what you would like is to have everything made clear.

  [B] Does assisted living really mark a great improvement over a nursing home, or has the industry simply hired better interior designers? Are nursing homes as bad as people fear, or is that an out-moded stereotype (固定看法)? Can doing one’s homework really steer families to the best places? It is genuinely hard to know.

  [C] I am about to make things more complicated by suggesting that what kind of facility an older person lives in may matter less than we have assumed. And that the characteristics adult children look for when they begin the search are not necessarily the things that make a difference to the people who are going to move in. I am not talking about the quality of care, let me hastily add. Nobody flourishes in a gloomy environment with irresponsible staff and a poor safety record. But an accumulating body of research indicates that some distinctions between one type of elder care and another have little real bearing on how well residents do.

  [D]The most recent of these studies, published in The journal of Applied Gerontology, surveyed 150 Connecticut residents of assisted living, nursing homes and smaller residential care homes (known in some states as board and care homes or adult care homes). Researchers from the University of Connecticut Health Center asked the residents a large number of questions about their quality of life, emotional well-being and social interaction, as well as about the quality of the facilities.

  [E]“We thought we would see differences based on the housing types,” said the lead author of the study, Julie Robison, an associate professor of medicine at the university. A reasonable assumption—don’t families struggle to avoid nursing homes and suffer real guilt if they can’t?

  [F] In the initial results, assisted living residents did paint the most positive picture. They were less likely to report symptoms of depression than those in the other facilities, for instance, and less likely to be bored or lonely. They scored higher on social interaction.

  [G] But when the researchers plugged in a number of other variables, such differences disappeared. It is not the housing type, they found, that creates differences in residents’ responses. “It is the characteristics of the specific environment they are in, combined with their own personal characteristics—how healthy they feel they are, their age and marital status,” Dr. Robison explained. Whether residents felt involved in the decision to move and how long they had lived there also proved significant.

  [H] An elderly person who describes herself as in poor health, therefore, might be no less depressed in assisted living (even if her children preferred it) than in a nursing home. A person who bad input into where he would move and has had time to adapt to it might do as well in a nursing home as in a small residential care home, other factors being equal. It is an interaction between the person and the place, not the sort of place in itself, that leads to better or worse experiences. “You can’t just say, ‘Let’s put this person in a residential care home instead of a nursing home—she will be much better off,” Dr. Robison said. What matters, she added, “is a combination of what people bring in with them, and what they find there.”

  [I] Such findings, which run counter to common sense, have surfaced before. In a multi-state study of assisted living, for instance, University of North Carolina researchers found that a host of variables—the facility’s type, size or age; whether a chain owned it; how attractive the neighborhood was—had no significant relationship to how the residents fared in terms of illness, mental decline, hospitalizations or mortality. What mattered most was the residents’ physical health and mental status. What people were like when they came in had greater consequence than what happened one they were there.

  [J] As I was considering all this, a press release from a respected research firm crossed my desk, announcing that the five-star rating system that Medicare developed in 2008 to help families compare nursing home quality also has little relationship to how satisfied its residents or their family members are. As a matter of fact, consumers expressed higher satisfaction with the one-star facilities, the lowest rated, than with the five-star ones. (More on this study and the star ratings will appear in a subsequent post.)

  [K] Before we collectively tear our hair out—how are we supposed to find our way in a landscape this confusing?—here is a thought from Dr. Philip Sloane, a geriatrician(老年病学专家)at the University of North Carolina:“In a way, that could be liberating for families.”

  [L] Of course, sons and daughters want to visit the facilities, talk to the administrators and residents and other families, and do everything possible to fulfill their duties. But perhaps they don’t have to turn themselves into private investigators or Congressional subcommittees. “Families can look a bit more for where the residents are going to be happy,” Dr. Sloane said. And involving the future resident in the process can be very important.

  [M] We all have our own ideas about what would bring our parents happiness. They have their ideas, too. A friend recently took her mother to visit an expensive assisted living/nursing home near my town. I have seen this place—it is elegant, inside and out. But nobody greeted the daughter and mother when they arrived, though the visit had been planned; nobody introduced them to the other residents. When they had lunch in the dining room, they sat alone at a table.

  [N] The daughter feared her mother would be ignored there, and so she decided to move her into a more welcoming facility. Based on what is emerging from some of this research, that might have been as rational a way as any to reach a decision.

36. Many people feel guilty when they cannot find a place other than a nursing home for their parents.

37.Though it helps for children to investigate care facilities, involving their parents in the decision-making process may prove very important.

38.It is really difficult to tell if assisted living is better than a nursing home.

39.How a resident feels depends on an interaction between themselves and the care facility they live in.

40.The author thinks her friend made a rational decision in choosing a more hospitable place over an apparently elegant assisted living home.

41.The system Medicare developed to rate nursing home quality is of little help to finding a satisfactory place.

42.At first the researchers of the most recent study found residents in assisted living facilities gave higher scores on social interaction.

43.What kind of care facility old people live in may be less important than we think.

44.The findings of the latest research were similar to an earlier multi-state study of assisted living.

 45.A resident’s satisfaction with a care facility has much to do with whether they had participated in the decision to move in and how long they had stayed there.

       [A] The lives of children from rich and poor American families look more different than they have in decades.

  [B] Well-off families are ruled by calendars. with children enrolled in ballet. soccer and after-school programs, according to a new Pew Research Center survey There are usually two parents, who spend a lot of time reading to children and worrying about their anxiety levels and hectic schedules

  [C] In poor families. however. children tend to spend their time at home or with extended family. the survey found They are more likely to grow up in neighborhoods that their parents say aren't great for raising children. and their parents worry about them getting shot, beaten up or in trouble with the law

  [D] The class differences m child rearing are growing, researchers say - a symptom of widening inequality with far-reaching consequences Different upbringings set children on different paths and can deepen socioeconomic divisions. Especially because education is strongly linked to earnings Children grow up learning the skills to succeed in their socioeconomic stratum. but not necessarily others

  [E] "Early childhood experiences can be very consequential for children's long-term social, emotional and cognitive development." said Sean F.Reardon. professor of poverty and inequality in education at Stanford University -And because those influence educational success and later earnings. early childhood experiences cast a lifelong shadow" The cycle continues: Poorer parents have less time and fewer resources to invest in their children. which can leave children less prepared for school and work. which leads to lower earnings

  [F] American parents want similar things for their children, the Pew report and past research have found: for them to be healthy and happy, honest and ethical, caring and compassionate There is no best parenting style or philosophy, researchers say, and across income groups, 92 percent of parents say they are doing a good job at raising their children. Yet they are doing it quite differently Middle-class and higher-income parents see their children as projects in need of careful cultivation, says Annette Lareau, a University of Pennsylvania sociologist whose goundbreaking research on the topic was published in her book "Unequal Childhoods: Class, Race and Family Life " They try to develop their skills through close supervision and organized activities, and teach children to question authority figures and navigate elite institutions.

  [G] Working-class parents, meanwhile, believe their children will naturally thrive, and give them far greater independence and time for free play They are taught to be compliant and deferential to adults There are benefits to both approaches Working-class children are happier, more independent, whine less and are closer with family members, Ms Lareau found Higher-income children are more likely to declare boredom and expect their parents to solve their problems Yet later on, the more affluent children end up in college and en route to the middle class, while working-class children tend to struggle Children from higher-income families are likely to have the skills to navigate bureaucracies and succeed in schools and workplaces, Ms.Lareau said

  [H] "Do all parents want the most success for their children? Absolutely," she said "Do some strategies give children more advantages than others in institutions? Probably they do Will parents be damaging children if they have one fewer organized activity? No, I really doubt it "

  [I] Social scientists say the differences arise in part because low-income parents have less money to spend on music class or preschool, and less flexible schedules to take children to museums or attend school events Extracurricular activities epitomize the differences in child rearing in the Pew survey, which was of a nationally representative sample of l,807 parents Of families earning more than $75,000 a year, 84 percent say their children have participated in organized sports over the past year, 64 percent have done volunteer work and 62 percent have taken lessons in music, dance or art Of families earning less than $30,000,59 percent of children have done sports, 37 percent have volunteered and 41 percent have taken arts classes

  [J] Especially in affluent families, children start young Nearly half of high-earning, college-graduate parents enrolled their children in arts classes before they were 5, compared with one-fifth oflow-income, less-educated parents. Nonetheless, 20 percent of well-off parents say their children's schedules are too hectic, compared with 8 percent of poorer parents.

  [K] Another example is reading aloud, which studies have shown gives children bigger vocabularies and better reading comprehension in school Seventy-one percent of parents with a college degree say they do it every day, compared with 33 percent of those with a high school diploma or less, Pew found White parents are more likely than others to read to their children daily, as are married parents Most affluent parents enroll their children in preschool or day care, while low-income parents are more likely to depend on family members Discipline techniques vary by education level: 8 percent of those with a postgraduate degree say they often spank their children, compared with 22 percent of those with a high school degree or less

  [L] The survey also probed attitudes and anxieties. Interestingly, parents' attitudes toward education do not seem to reflect their own educational background as much as a belief in the importance of education for upward mobility Most American parents say they are not concerned about their children's grades as long as they work hard But 50 percent of poor parents say it is extremely important to them that their children earn a college degree, compared with 39 percent of wealthier parents

  [M] Less-educated parents, and poorer and black and Latino parents are more likely to believe that there is no such thing as too much involvement in a child's education Parents who are white, wealthy or college-educated say too much involvement can be bad Parental anxieties reflect their circumstances High-earning parents are much more likely to say they live in a good neighborhood for raising children While bullying is parents: greatest concern over all, nearly half of low-income parents worry their child will get shot, compared with one-fifth of high-income parents They are more worried about their children being depressed or anxious

  [N] In the Pew survey, middle-class families earning between $30,000 and $75,000 a year fell right between working-class and high-earning parents on issues like the quality of their neighborhood for raising children,participation in extracurricular activities and involvement in their children's education

  [O] Children were not always raised so differently The achievement gap between children from high- and low-income families is 30 percent t0 40 percent larger among children born in 2001 than those born 25 years earlier, according to Mr Reardon's research People used to live near people of different income levels;neighborhoods are now more segregated by income More than a quarter of children live in single-parent households - a historic high, according to Pew - and these children are three times as likely to live in poverty as those who live with married parents Meanwhile, growing income inequality has coincided with the increasing importance of a college degree for earning a middle-class wage

  [P] Yet there are recent signs that the gap could be starting to shrink In the past decade, even as income inequality has grown, some of the socioeconomic differences in parenting, like reading to children and going to libraries, have narrowed.

36. Working-class parents teach their children to be obedient and show respect to adults.

37. American parents, whether rich or poor, have similar expectations of their children despite different ways of parenting. 

38. while rich parents are more concerned with their children’s psychological well-being, poor parents are more worried about their children’s safety.    

39. The increasing differences in child rearing between rich and poor families reflect growing social inequality.

40. Parenting approaches of working-class and affluent families both have advantages.

41. Higher-income families and working-class families tend to live in different neighborhoods.

42. Physical punishment is used much less by well-educated parents.

43. Ms. Lareau doesn’t believe participating in fewer after-class activities will negatively affect children’s development.

44. Wealthy parents are concerned about their children’s mental health and busy schedules.

45. Some socioeconomic differences in child rearing have shrunk in the past ten years.














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