Medicaid and Nursing Home Choice: Why Do Duals End Up in Low-Quality Facilities?

We provide empirical evidence on the relative importance of specific observable factors that can explain why individuals enrolled in both Medicare and Medicaid (duals) are concentrated in lower quality nursing homes, relative to those not on Medicaid. Descriptive results show that duals are 9.7 percentage points more likely than nonduals to be admitted to a low-quality (1-2 stars) nursing home. Using the Blinder–Oaxaca decomposition approach in a multivariate framework, we find that 35.4% of the difference in admission to low-quality nursing homes can be explained by differences in the distribution of observable characteristics. Differences in education and distance to high-quality nursing homes are important drivers, as are health status and race. Our findings highlight the need for creative policy solutions targeting the modifiable factors to reduce the disparity.

Spatial Strategies of American Megachurches

The megachurch is one of the most recognizable and characteristic religious spaces in the modern United States. Super-sized, consumer oriented, and blandly contemporary, megachurches have become popularly identified with a host of middlebrow American cultural stereotypes. Yet these congregations have proven themselves to be a leading force in the practice of contemporary evangelicalism, their numbers, average size, and evangelistic reach growing dramatically over the past forty years. Building on nearly a century of experimentation, modern megachurches have hit upon a highly successful formula for attracting and retaining attendants. Through a careful calibration of worship style, sermonic messaging, institutional identity, and programming offerings, their market share has swiftly multiplied. As a result, megachurches now dominate the practice of contemporary Protestantism, setting new standards for how a church should look, sound, and feel and establishing the mantra of “church growth” as the widely adopted aim and purpose of modern ministry. Spatial strategies have been at the core of these growth efforts. Megachurches draw explicitly from the architectural idioms of contemporary shopping malls, corporate complexes, sports arenas, and television studios as a means of making themselves immediately familiar and inviting for the average congregant. They provide a great array of on-site amenities and specialized interiors to appeal to diverse constituencies who may be searching for different attributes in a church home. Choice is therefore incorporated as a spatial principle, permitting attendants to self-design their worship experience and opt in to the level of commitment they feel prepared to offer. Megachurches also typically take an aggressive posture toward their spatial milieus, treating their immediate environs as an active mission field. They regularly deploy lay volunteers to canvass local neighborhoods and encourage members to network on behalf of the church. They encourage the pursuit of new member growth, even if it comes largely from congregational switching rather than recruitment of the “unchurched.” Megachurches thus tend to dominate the religious ecology of their suburban habitats, outcompeting smaller churches for members and money. Research on the megachurch subculture has primarily been conducted by sociologists and ethnographers, but a bevy of commentary by theologians, ethicists, historians, and journalists has emerged to supplement that social scientific focus and place the megachurch in wider context. Within that growing literature, four lines of inquiry frequently recur: What defines and differentiates the megachurch? What are the historical and cultural sources for its formulation? What explains its rapid rise to prominence in the modern moment? And what does the rise of the megachurch represent for communities of faith, for both insiders and outsiders to the movement? In the round, the varied answers to these interrogations paint a picture of a hotly contested institution, whose definition, origins, and meaning are debatable. Yet there is little doubt that the spatial strategies of megachurches, so frequently admired, imitated, and condemned, can help us address these questions and therefore merit further exploration and understanding.

Locating gendered work practices: a typology

Purpose Unequal workplace gender outcomes continue to motivate research. Using the prism of work-life-(im)balance, the purpose of this paper is to show how identity salience and motivation contribute to a subject position that for many reproduces socially gendered practices of workplaces. Design/methodology/approach After initial inductive computer-assisted text analysis, the authors innovatively move to deductively analyse data from focus group and semi-structured interviews of 18 female and 19 male Australian managers in the financial and government sectors. Findings The authors find that a gendered sense of reflexivity is virtually non-existent among the female Australian managers and professionals interviewed in this research. The inductive stage of critical discourse analysis revealed a substantial difference between men and women in two concepts, responsibility, and choice. These form the axes of the typological model to better explain how non-reflexive gendered workplace practices are “performed”. Practical implications This empirical research provides a foundation for understanding the role of choice and responsibility in work-home patterns for women. Social implications The absence of a reflexive gender-based understanding of women’s work-home choice is explained in Bourdieusian terms. Originality/value By not specifically using a gender lens, the authors have avoided the stereotypical understanding of gendered workplaces.