A young woman places her hand over the hand of an older woman holding a cane.

Scripps Gerontology Center research fellows study effects of social services on patient outcomes

John Bowblis and Amy Roberts discuss data they see on a computer screen.
John Bowblis (left) and Amy Roberts (right) are working with Medicare data to determine whether social services staffing affects patient outcomes.

Wellness is about much more than physical health. Even people in top physical condition can experience the ill-effects of depression, isolation. Those things can have an even greater impact on people with a recent illness or injury. Sometimes, these so-called psychosocial factors can even be the difference between temporary and permanent nursing home care.

“Most people who go into a nursing home are short-stay residents,” says John Bowblis, associate professor of economics and Endres Associate Research Fellow in Miami University’s Farmer School of Business and a research fellow with the Scripps Gerontology Center. “Residents go to a nursing home for rehab after some type of hospitalization, and the goal for most of those people is to go back home.”

With physical and psychosocial functioning so intertwined, whether a patient is, in fact, able to return home depends not just on the nursing services these facilities provide, but also on the social services. Yet, while there are many regulations for professional nursing staff in nursing homes, there are few for social services staff. In practice, according to a study by the Centers for Medicare and Medicaid Services (CMS), the typical nursing home resident has about 3 hours of contact with CNAs, LPNs, and RNs each day, but only about 6 minutes of contact with social workers.

Whether changes in public policy related to social services staff might lead to better outcomes for patients is a question Bowblis and his collaborator, Amy Roberts, also a research fellow with the Scripps Gerontology Center and assistant professor of family science and social work, would like to answer. The pair are currently leading one of the first national studies to assess the impact of social services staffing in nursing homes.

The data Bowblis and Roberts are working with comes from CMS’s Minimum Data Set (MDS), merged with the Certification and Survey Provider Enhanced Reporting (CASPER) system. Together, these data sets document every Medicare fee-for-service admission to a nursing home, along with the staffing characteristics of those facilities. Bowblis applies statistical methods to this data to identify statistical relationships between social services staffing data and patient outcomes. Roberts then helps interpret the practical implications of those insights for organizational and public policy.

One concern for Roberts is credentialing. “Nursing homes do not always hire licensed social workers but instead hire unlicensed paraprofessionals for social services positions,” she says. “In this study, we want to see if having qualified social workers in such positions leads to better psychosocial functioning for residents.”

Bowblis and Roberts expect to have the first results of their study sometime this summer, with publications and presentations to follow. When their findings are released, policy wonks will not be the only ones paying attention. Advocacy groups, including the Retirement Research Foundation – which provided the $50,000 grant to fund Bowblis and Roberts’ study – and professional organizations, such as the National Association of Social Workers, will take note as well.

The same is true for nursing home providers. “Nursing homes don’t necessarily want to spend money on this type of staff,” Bowblis says of social workers. “But they’re willing to do things that produce good returns on investment. If managers know that hiring qualified social workers is going to get patients back into the community, they know that will enhance the quality of their services and attract more people to their facility. That’s a good thing.”

For Roberts, that kind of win-win-win for patients, providers, and society would be a natural extension of a win-win research partnership. When she and Bowblis met at a networking event at the Scripps Gerontology Center, they quickly realized their individual areas of research – his on the quality of care provided by facilities and hers on residents’ quality of life – could complement each other.

“The interdisciplinary work we’re doing together is innovative and mutually beneficial,” Roberts says. “Teaming up has worked out even better than we’d hoped.”

Written by Heather Beattey Johnston, Associate Director of Research Communications, Office for the Advancement of Research and Scholarship, Miami University.

Hands photo by Government of Alberta, via Flickr, used under Creative Commons license. Photo of Bowblis and Roberts by Scott Kissell, Miami University Photo Services.

Looking south across Chambers Street at the central portico of Tweed Courthouse (which now houses the NYC Department of Education) on a sunny morning.

Educational researcher examines forces driving demand for charter schools

Map of New York City. Shown as data points on the map are 2010-2013 Charters, Prior Charters, Bottom 20% of Average Satisfaction, Middle 60% of Average Satisfaction, and Top 20% of Average Satisfaction. There are three obvious clusters of "Bottom 20%" data points that contain very few "2010-2013 Charters" data points and very few "Prior Charters" data points, indicating that there is little correlation between parental dissatisfaction and charter school location. Text: Legend. 2010-2013 Charters. Prior Charters. Avg. Satisfaction (1Q). Bottom 20%. Middle 60%. Top 20%.
In their analysis, Saultz and his colleagues found little correlation between parental dissatisfaction and new charter openings, as this map shows.

Economic principles of supply and demand suggest that charter schools would locate in areas where parents are not satisfied with their current schools. But new research by Miami University’s Andrew Saultz suggests that charters may not be responding primarily to parental satisfaction, at least in New York City.

Saultz, who is an assistant professor in the Department of Educational Leadership, worked with two collaborators from Michigan State University to test assumptions about where new charters locate in New York City. New York City is an ideal location for this study because its Department of Education surveys parents annually to assess their satisfaction with local schools, and NYC has a thriving charter sector. Published in the September issue of the Journal of School Choice, the results of the study suggest that charter schools may be more focused on student achievement and student demographics than parental satisfaction when deciding where to start a new school.

By applying geographical information systems (GIS) data to data from the U.S. Census, the New York State Report Card, and New York City Department of Education parent surveys, the researchers were able to map out correlations between three assumed drivers of charter school demand – high poverty rates, low academic performance, and high levels of parental dissatisfaction – and the actual location of existing and newly opened charter schools.

Saultz and his team found that only low academic performance was strongly associated with new charter schools opening in an area. Meanwhile, high poverty rates were weakly associated with new charter school openings. Parental dissatisfaction seemed to have little, if any, effect on where new charter schools chose to locate.

The researchers expected to find that parental dissatisfaction heavily influenced charter school location. “Educational leaders are really interested in what parents think,“ Saultz says. So finding that parental dissatisfaction is not a factor “might mean charter school officials don’t access the data. It might mean that other factors are higher priority for them. We don’t know.”

Saultz suspects the answer might transcend economic theory. “I think a lot of people that go into opening charter schools are very mission-driven,” he says. “They want to improve performance, and they are intentionally locating in high-poverty, low-performance areas because those are the people they want to serve.”

That makes sense in New York City, where a charter school receives the same amount of money per student, regardless of its location. Under such a funding model, there is little conflict between mission and economic reality. If anything, locating in an economically depressed area might actually be the better fiscal choice. A charter school receives no public money upfront to support building or site acquisition. Those costs can be high in a real estate market as expensive as New York’s.

“I think one part of this story is that you can’t just magically place a school anywhere. As you think about percent poverty in an area, real estate is most likely cheaper there as well. And so, in addition to mission, there might be some kind of practical reasons charter schools are locating where they are,” Saultz says.

But Saultz is not content with conjecture. “The next thing we need to do,” he says, “is go in and talk with people who’ve opened charters to find out what data they look at and what their priorities are as they make that decision about where to locate.”

As charter schools increasingly become part of public school reform plans, that information will surely prove valuable in informing educational policy.

Written by Heather Beattey Johnston, Associate Director & Information Coordinator, Office for the Advancement of Research & Scholarship, Miami University.

Parental satisfaction with traditional public schools and new charters figure by Andrew Saultz, Dan Fitzpatrick & Rebecca Jacobsen, used with permission of the authors. Image of Tweed Courthouse (home of the NYC Department of Education) via Wikimedia Commons, in the public domain.