This study draws upon student evaluations across 3 years of service learning (SL) courses at a large, urban, faith-based university identifying issues of greatest concern to students. Analysis of qualitative responses revealed perspectives on the limits, pitfalls, and barriers to successful SL student work in the community replicated over the 3 year timeframe. Over 2,200 written responses were coded and tested for reliability for each of 3 years. The top three comments SL students were most likely to express included: (1) concern about their placement in the community, for example, that sites were not prepared or that further goal-setting, communication and training by the university was necessary; (2) that the university's choice of sites may have been ill considered; and, (3) that there were problems with time and scheduling. Ongoing assessment of students' perspectives on their placement experience identifies practices that can enhance their learning and contributions toward building stronger communities.

This study explores whether poverty areas of Chicago have fewer nursing home beds and unique staffing patterns. Using 1990 census data and Illinois's 1994 Long-Term Care Facility Survey, census tracts were compared by need for long-term care, bed supply, and nursing home characteristics. While facilities cluster on the north side, and the number of beds follow the elderly, the supply of beds per elderly is actually greater in tracts with high proportions of poverty, disability, and African American residents due, in part, to the predominance of larger facilities. Ironically, economic segregation may work together with Medicaid's policy of serving the poorest to increase the supply of beds to those who might otherwise remain unserved. Nursing homes in the poorest communities have high percentages of Medicaid residents, are larger, and employ fewer staff per resident; homes with a high Medicaid population are more likely to employ LPNs, which may reflect labor supply differences.

Health policy makers must actively address racial and ethnic differences in access to long-term care or risk reinforcing the effects of poverty and segregation. In order to ensure that Latino elders living alone are not going without needed care city leaders must promote a range of culturally sensitive alternatives to nursing home care within Latino communities while promoting geographic mobility for African Americans.

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