Halfway Homeowners: Eviction and Forced Relocation in a Florida Manufactured Home Park

The last four decades of US housing policy have seen a shift from the federal allocation of affordable housing as a public good to the neoliberal model of private and for‐profit provision of affordable housing. This shift warrants a study of the link between the interests that now shape low‐income housing markets and the stability of the housing they provide. Nowhere are the effects of this shift more evident than in the homes of the 20 million Americans living in manufactured housing, which is installed largely on the private lands of for‐profit developers who can close mobile home parks and force residents to move themselves and their homes with as little as 30 days' notice. This ethnography of mass eviction in a Florida mobile home park examines state regulations intended to protect residents of closing parks and analyzes how private interests shape the implementation of these policies.     

Legal anxieties and end-of-life care in nursing homes

Many persons spend their final days as nursing home residents. It has been suggested that one set of factors powerfully and unfavorably influencing the quality of end-of-life (EOL) care provided in American nursing homes involves the anxieties that nursing home providers experience regarding potential negative legal entanglements and repercussions associated with the provision of EOL care to their residents. This article critically examines the hypothesis that the quality of EOL medical care provided in nursing homes often is skewed in a perverse way because providers are driven unduly by legal apprehensions. The author offers practice and policy recommendations for trying to resolve or mitigate the tension present between legally defensive practice (real or perceived) by nursing homes, on one hand, and ethically optimal EOL care, on the other.     

REINTEGRATIVE SHAMING AND COMPLIANCE WITH REGULATORY STANDARDS*

Australian nursing home inspection teams are partitioned into those with an enforcement ideology supportive of reintegrative shaming, those who believe in being tolerant and understanding when confronted with noncompliance with the law, and those with a more stigmatizing ideology toward noncompliers. Nursing homes visited by teams with a reintegrative shaming ideology display significantly improved compliance in the period following the inspection. Nursing homes visited by inspection teams with a more stigmatizing attitude toward noncompliance display an approximately equal drop in compliance. The performance of homes visited by tolerant and understanding inspection teams falls between these two extremes. A more specific test of the theory shows that when interdependency exists between the nursing home and the inspection team, reintegrative shaming has a stronger positive effect on improving compliance. In nursing homes with no link between the home and the inspection team, reintegrative shaming has no effect on compliance levels. These effects demonstrate both the importance and the limitations of reintegrative shaming as a theoretical concept worthy of further empirical investigation.     

The Limits of the Economic Analysis of Regulation: An Empirical Case and a Case for Empiricism*

Can the tools of the economic analysis of law be used to identify the optimal level of stringency in regulatory standards? Data on the costs of nursing home regulatory compliance suggest that in this domain such models could only produce wildly false estimates of the optimal level of stringency. Among the reasons for this are that: (a) actual costs of compliance explain only 19 percent of the variance in the subjectively expected costs that should inform rational choices; and (b) while there is a powerful effect of expected cost on compliance disaggregated by standard, this is not a monotonic increasing effect but a parabolic relationship. The reason for the finding that almost half the nursing homes lie on the wrong side of the turning point of this parabola is that these homes tend to be run by managers who are “disengagers” from the regulatory culture. Their behavior is not to be understood in terms of rational game playing but in terms of dropping out of the regulatory game. The disengagers are in the regulatory system but not of it and certainly not economically calculative about it.     

Regulatory Styles,Motivational Postures and Nursing Home Compliance*

Using Kagan and Scholz (1984) typology of regulatory noncompliance, this study examined the perceptions of regulators and of regulatees toward the regulatory encounter to predict subsequent compliance with nursing home quality of care standards. Appraisals of both regulators and regulatees were not driven by motivational analyses of each other's actions, but rather by assessments of performance and social group identity. The regulators saw nursing homes in terms of one evaluative dimension ranging from responsible and not in need of intervention through to irresponsible and needing intervention. The corresponding reactions of nursing home managers involved seeing the regulators as cooperative and sympathetic through to police-like and coercive. On both sides of the regulatory encounter, criticism and reactions to criticism swamped nuanced analyses of motivational underpinnings and rational decision models in explaining compliance. The motivational complexity underlying the Kagan and Scholz typology was, however, apparent in the self-reported motivational postures of managers toward the regulatory process. The postures of managerial accommodation and capture to the regulatory culture were associated with compliance. Over time, resisters to the new regulatory regime became more compliant, particularly those whom inspectors judged as best left alone to adjust. In contrast were managers whose response to the regulatory process was disengagement. Their organizations experienced deterioration in compliance. The study fails to find that certain kinds of regulatory strategies such as deterrence, education and persuasion work better than others across the sample or with specific groups. Extant models focus excessively on how to play the regulatory game without recognizing the potential for players dropping out of the game. Understanding reasons for disengagement and processes for reengagement are fundamental to the application of behavioral decision theory models to the regulatory context.     

Structural and operational factors affecting quality of patient care in nursing homes

This article inquires into structural and operational characteristics of nursing homes that have predictive power for the quality of direct patient care provided to their residents. Data are from nursing homes in the Phoenix, Arizona, metropolitan area. The data were analyzed using multivariate linear regression. Findings of policy interest are that, other things equal: (1) for-profit facilities provide lower levels of care than do nonprofit facilities; and (2) distantly headquartered chain operations provide lower care levels than locally owned facilities. These factors should be considered in long-term care planning and regulation.     

Special report on reimbursement. HCFA enacts new enforcement remedies covering nursing facilities

While the regulations are revolutionary in their use of "substantial compliance," the interpretation and application of HCFA's new remedial scheme are still uncertain, as states are given broad discretion in defining important terms and in applying and interpreting the criteria to select remedies. Further complicating the issue is the fact that some states, including California, intend to seek waivers from HCFA to substitute their own state enforcement systems for most, if not all, of the new federal system. Based upon these uncertainties, the enforcement of nursing facility standards will likely be in a state of flux for some time to come.     

Is a public reporting approach appropriate for nursing home care?

Publicizing quality information has been used as a quality improvement strategy in the acute care sector for more than a decade. Despite research showing mixed results of these efforts, publicly reporting quality measures is currently being pursued as a quality improvement strategy for nursing homes. Designed to empower consumers to make informed choices and to stimulate provider competition on quality, nursing home public reporting began in 1998 with the Nursing Home Compare Web site and has received greater emphasis in the 2002 Nursing Home Quality Initiative, both directed by the federal government. Focusing on the response of three key stakeholder groups across settings of care-consumers, providers, and purchasers-I identify several challenges that nursing home reporting must overcome to be successful. I conclude that publicly reporting quality measures for nursing homes will have a harder time promoting quality improvement than for acute care settings, where results have been disappointing thus far. In addition to the conceptual analysis, I evaluate whether the quality information reported on Nursing Home Compare had any impact on nursing home occupancy rates following its release. Using a pre/post-release design, I find that the effect of public reporting on nursing home occupancy rates has been minimal thus far. Although some estimates of effect are statistically significant and in the hypothesized direction, they all suggest very small effect sizes. It is unclear whether the absence of a larger reporting effect to date is specific to Nursing Home Compare or whether it inheres to the broader task of using quality information to promote change in the nursing home care sector.     

Profits,pressure and corporate lawbreaking

While neglect, exploitation, denial of human rights and abuse of nursing home residents can be found in both non-profit and for-profit nursing homes, substantially higher non-compliance with the law is found among for-profits. A significant source of non-compliance is pressure on senior management from proprietors to reach financial goals that can only be attained by cutting corners on quality of care. This source of non-compliance is stronger among for-profits than nonprofits in a sample of 410 Australian nursing homes. These data therefore supply more systematic support for what, has been a communplace observation in the corporate crime literature: that pressure for lawbreaking comes from the top down and from profits.     

Professionalism, Organizations, and Compliance

Earlier studies haw shown that professional orientations are related to individual compliance with laws and regulations. However, no quantitative studies have focused on compliance at the organizational level and the professional orientations of the chief executive officer. Studies on dues and law breaking at the individual level have focused on professional orientations, but within an organization there are other aspects of professionalism that will be of import in determining the organization's compliance with the law. We posit that professionalism is a more complex notion for individuals located in an organizational setting. Utilizing data collected from 410 Australian nursing homes, which are characterized by a flat management structure, the data show that of three aspects of professionalism—orientation, values, and autonomy—it is professional autonomy that directly affects organizational compliance. However, the data do suggest that the relationship between professional orientations and organizational compliance are mediated by the complexity of the organization. Organizational culture is also shown to be an important factor in explaining compliance with the law.     

Modernizing Medicaid eligibility criteria for children with significant disabilities: moving from a disabling to an enabling paradigm

Children with significant disabilities may qualify for Medicaid benefits, regardless of household income, if their state elects to offer the Tax Equity Fiscal Responsibility Act (TEFRA) option. However, a significant number of children with serious medical problems presently are being denied eligibility for, or terminated from, this Medicaid program. This Article describes the ways in which the existing health insurance system inadequately meets the needs of children with significant disabilities, recounts the history and development of the TEFRA Medicaid coverage option, and analyzes the eligibility criteria used by the various states. It proceeds to consider how disability should be legally defined in the health care context and proposes reforms to modernize the eligibility standards so that these benefits can be more effectively, efficiently, and fairly allocated. To accomplish this goal, the federal statute and regulation that define disability, as well as corresponding state laws, must be reformed so that the law can keep pace with advances in modern medical science, and people with disabilities are not, in effect, penalized for receiving currently accepted preventative care that maintains health but will never cure the underlying disease.     

The Simplest Explanation Is Best: How Ockham's Razor Severed Insureds’ Hopes of Indemnification Following Hurricane Katrina

In 2005 Hurricane Katrina ravaged the Gulf Coast and many residents filed claims under their homeowners’ policies. Insurers denied these claims on the grounds that flood damage was expressly excluded from coverage, and homeowners filed suit against their insurers. At trial, these plaintiffs argued that the casualty loss of their homes was attributable to wind rather than flooding. Commentators refer to these cases collectively as the “Wind vs. Water” debate. This article discusses prominent “Wind vs. Water” cases before ultimately proposing federal legislation forbidding insurers from issuing homeowners’ policies unless prospective insureds first obtain federal flood insurance as a prerequisite.     

Enforcement of Civil Rights Law in Private Workplaces: The Effects of Compliance Reviews and Lawsuits Over Time

Has federal antidiscrimination law been effective in moving women and minorities into management? Early studies show that government affirmative action reviews improved the numbers, and rank, of blacks, but evidence of what has happened since 1980 is sparse. There is little evidence that civil rights lawsuits improved the employment status of women or African Americans. We examine establishment‐level effects of compliance reviews and lawsuits on the percentage of women and blacks in management. We find that compliance reviews, which alter organizational routines, had stronger and more lasting effects than lawsuits, which create disincentives to discriminate. We also find that deregulation was more consequential for compliance reviews than for lawsuits: Compliance reviews initiated in the 1980s were less effective than those initiated in the 1970s. Not so for lawsuits. Compared to lawsuits, compliance reviews appear to have a greater capacity to elicit lasting organizational change, but their effects are mediated by the regulatory environment.     

Medicare and Medicaid programs; civil money penalties for nursing homes. Final Rule

This final rule will revise and expand current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in compliance with Federal participation requirements in accordance with section 6111 of the Affordable Care Act of 2010.     

CRIMINOLOGICAL THEORIES AND REGULATORY COMPLIANCE*

Four traditional criminological theories—opportunity, control, subcultural, and differential association—are tested for their explanatory power in accounting for organizational compliance with regulatory laws. The primary data source is interviews with 410 chief executives of small organizations. Partial support is found for each theory; certain key concepts of each theory have a significant effect on regulatory compliance, net of a variety of characteristics of the nursing home, the residents in the home, and the inspection team. The results show that blocked legitimate opportunity has a significant effect on regulatory compliance, as does the structure of illegitimate opportunity. There is also an effect on compliance of participation in business subcultures of resistance to regulation. Belief in laws increases compliance with those laws as does differential association with or attachment to the upholders of the law. Overall, however, control theory and differential association lack explanatory power, and the explanatory power of subcultural theory is modest. Only opportunity theory explains a credible proportion of variance in compliance as a standalone theory. The significant effect of some but not all of the measures for each theory, coupled with the lack of significant explanatory power by three of the four theories, suggests the need for theoretical integration.     

Governance and community benefit: are nonprofit hospitals good candidates for Sarbanes-Oxley type reforms?

Recent investigations into the activities of nonprofit hospitals have pointed to weak or lax governance on the part of some of these organizations. As a result of these events, various federal and state initiatives are now either under way or under discussion to strengthen the governance of hospitals and other nonprofit corporations through mandatory board structures and practices. However, despite policy makers' growing interest in these types of governance reforms, there is in fact little empirical evidence to support their contribution to the effectiveness of hospital boards. The purpose of this article is to report the results of a study examining the relationship between the structure and practices of nonprofit hospital boards relative to the hospital's provision of community benefits. Our results point to modest relationships between these sets of variables, suggesting considerable limitations to what federal and state policy makers can accomplish through legislative initiatives to improve the governance of nonprofit hospitals.     

Standards of compliance for abortion-related services in family planning services projects. Office of Population Affairs, OPHS, DHHS. Final rules

The rules issues below revise the regulations that apply to grantees under the federal family planning program by readopting the regulations, with one revision, that applied to the program prior to February 2, 1988. Several technical changes to the regulation are also made to remove and/or update obsolete regulatory references. The effect of the revisions made by the rules below is to revoke the compliance standards, promulgated in 1988 and popularly known as the "Gag Rule," that restricted family planning grantees from providing abortion-related information in their grant-funded projects.     

Protecting Homebuyers in Low‐Income Communities: Evaluating the Success of Texas Legislative Reforms in the Informal Homeownership Market

Among low‐income homebuyers, a contract for deed (CFD) has been a widely used but risky and informal mechanism for purchasing a home or lot. This article examines a series of major consumer protections adopted by the Texas Legislature from 1995 to 2005 and whether this legislation shaped the behavior of sellers who historically relied on CFDs in Texas colonias. Tracking changes in the use of CFDs between 1990 and 2010, we show that developers responded to the legislative reforms by shifting away from CFDs and into other forms of seller financing. At the same time, developers have adopted a series of workarounds to the legislation (presumably legal), leaving low‐income buyers vulnerable to rapid repossession by the developer. In contrast, the impact of the legislation on low‐income residents selling their homes has been minimal. These consumer‐to‐consumer transactions remain highly informal, with ongoing reliance on the now illegal, unrecorded CFD.     

Holding back the tide: policies to preserve and reconstruct health insurance coverage in Maryland

Over the past decade, state officials have pursued a variety of strategies to protect and expand health insurance coverage for their residents. This article examines the course of action in Maryland, where new initiatives were shaped around the state's unique hospital payment system and its reimbursement of uncompensated care, an evolving Medicaid and children's health program, and regulation of the small group health insurance market. Several important patterns emerge from the Maryland experience. First, even the most incremental initiatives--programs intended to aid a few thousand beneficiaries--bring into play the very issues that hamper comprehensive reforms: who is deserving of mutual aid and what is the proper role of government versus private entities in administering that aid. In Maryland, these issues generate conflict not only between Democrats and Republicans but also urban and rural interests. Second, all of the important reforms of the past decade were undertaken primarily in reaction to federal policy initiatives. Contrary to rhetoric lauding states as the "laboratories of democracy," the political impetus for reform and basic policy options emerge from interaction between federal and state debates. Third, even with budget surpluses and Democrats in control of the governorship and legislature, Maryland did not move aggressively toward universal health insurance. Now, with a much weaker economy and a new, Republican governor, the primary challenge will be to prevent further erosion of insurance coverage. The Maryland experience reiterates that each step toward greater health security, no matter how small, is a major technical and political challenge and that it will be difficult if not impossible to rely on states to secure coverage for all Americans in the foreseeable future.     

Civil Asset Forfeiture Laws and Equitable Sharing Activity by the Police

Research Summary

For several decades, critics have argued that civil forfeiture laws create incentives for law enforcement to increase departmental revenue by “policing for profit.” By using data on federal equitable sharing payments to nearly 600 local law enforcement agencies between 2000 and 2012, we examine the relationship between the characteristics of state forfeiture laws and equitable sharing payments to local agencies. Our results indicate that agencies in states with state laws that are more restrictive or less rewarding to police collect more in federal equitable sharing. This finding supports the critics’ argument that police behavior in regard to forfeiture activities is influenced by the financial rewards and burdens involved.

Policy Implications

Our results reveal that the findings of investigative journalism and case study research, that is, that police forfeiture activities are influenced by financial rewards, may be more generalizable to law enforcement than previously thought. Despite recent state‐level reforms, federal equitable sharing and most state forfeiture laws provide limited due process protections and have minimal accountability or reporting requirements. Concerns about the impact of civil forfeiture practices on perceptions of procedural justice and police legitimacy are discussed, and possible policy reforms are reviewed.