The body as existential midpoint—the aging and dying body of nursing home residents

The human body has been the object of extensive attention in the social sciences, recently receiving increasing interest from social gerontology as well. However, the issue of old bodies and particularly the body in the fourth age of life remains relatively under-researched. The need to give emphasis to the subjective experiences of the oldest old during their final phase of life has been pointed out. This article is based on data obtained from ethnographic fieldwork carried out on a nursing home ward, and explores and analyses how the residents talk about and regard their own aging and dying bodies. The focus is on the link between the disintegrating body, aging and death in an institution-based care context. It was found that the body is the central entity through which the residents experience daily life, through pain, through the caring process, through diminished physical and cognitive functions, and as such constitutes the existential nucleus of their being. The article includes a discussion on how these experiences also elucidate the way in which the body is a mediator for issues seldom acknowledged such as existential needs.     

Predictors of Nursing Home Admission: A Social Work Perspective

Abstract

Institutionalisation of geriatric patients is a growing trend in ageing societies, such as Singapore. Earlier studies focused on the sociodemographic profile and attributes of nursing home residents and applications, but neglected to address the predictors of nursing home admission from a social work perspective. The present retrospective study identifies independent risk factors that predispose a patient to a nursing home discharge from a general rehabilitation ward in a community hospital in Singapore, with a multidisciplinary emphasis on clinical intervention. Factor analysis results reinforced findings that functional impairment and dementia are consistent predictors of nursing home admission. Multivariate logistic regression analysis showed that positive predictors of nursing home admission include older age, length of hospital stay, low socioeconomic status, dementia, and functional disability. Social work interventions include early referrals to the medical social worker, so that options for social and family support can be explored prior to deciding to place patients in a nursing home. Other interventions include suitable family therapy and counselling for patients and their families.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Early childhood education and care use: Differences by race/ethnicity and age

This article describes factors that predict the use of early childhood education and care among Latino families, as compared to non-Latino black and non-Latino white families in the United States in two age groups (0–2 and 3–5 years old). Using National Household Education Survey data, this study presents a framework and examines the association of numerous child and family characteristics with the number of hours children spend in care, the number of care arrangements, and the type of care used. Multinomial logit results show that once preexisting differences between Latino and black families and between Latino and white families are equalized, differences in the type of care are often eliminated. Findings suggest that the observed enrollment patterns of Latino children are due in part to their over-representation in families that are poorer, have lower levels of maternal education, and have lower levels of maternal employment.     

Investments in young children among low-income families

This article examines low-income parents’ monetary investments in their young children, asking how low-income families are able to afford spending on children. We investigate parental spending on child care and on goods in the home that may provide enrichment for young children. We find little evidence that households make spending trade-offs for either type of good. Instead, our results suggest that low-income households that can afford child care may be poor only temporarily and that they spend primarily when they are unable to avoid doing so because of family work patterns. For enrichment goods, parental education is a stronger predictor of spending.     

Jokes and routines make everyday life a good life—on ‘doing family’ for young people in foster care in Sweden

The aim of this article is to identify inclusion practices in foster families by studying the everyday life of young people entering various types of foster family. Structure and warmth in the family stand out as important dimensions of everyday life. What is not so evident in previous research is the way emotional ‘warmth’ is created. In particular, joking, gentle teasing and laughing, which in this paper stand out as important inclusion practices, seem to be rather unknown aspects in foster care, as is the importance of doing things together in everyday life. The young people's contributions in creating a good family atmosphere are visible in the study, as is their capacity to adapt to a new family. Daily routines normalise the adolescents' everyday life. Negotiations make them part of important decisions, and may strengthen them as social agents. Foster parents' positive attitude towards birth family facilitates birth parents' support to their children. In this case study, mixed qualitative methods are used: interviews, network maps, ‘beepers’ and video recordings in the foster home.     

The experience of quality of life among older people

Although quality of life has been in the focus of attention for over a decade there are few studies available investigating, how the old and the oldest old experience their quality of life or what quality of life actually means for them? To illuminate this, eleven in-depth interviews were conducted with six women and five men (80+) living in their home. An interpretative hermeneutic phenomenological analysis revealed that quality of life in old age meant a preserved self and meaning in existence. Maintained self-image meant that the older people experienced a coherent life with an intact meaning. How quality of life was valued depended on the meaning the old people attached to the areas of importance as well as how they were evaluated. Additionally, areas not generally included when measuring quality of life became discernible. The meaning of home, how life was viewed, thoughts about death and dying, and telling ones story proved to be areas of importance for their perception of quality of life. Thus, indicating that older people's view of quality of life is more complex than some of today's most commonly used quality of life instruments capture and that quality of life assessment tools needs to measure beyond pure health indices. For nursing care the use of life review in everyday care, and an open way towards existential topics as well as a family oriented care along with preventive work helping people to remain in their own homes may enhance their experience of quality of life.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia

Purpose: To describe factors influencing decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Design and Methods: Individual interviews were used to collect data with 30 Chinese family caregivers of older adults with dementia in Taiwan. Data were analyzed using thematic analysis. Results: Factors influencing caregivers' decisional conflict included the Chinese value of filial piety, limited financial resources and information, placement willingness of the older adult, family disagreement, distrust of nursing home care quality, and limited nursing home availability. Factors influencing caregivers' decisional conflict post placement included disappointment with nursing home care quality and self-blame for the placement decision. Implications: Findings resulting from this study indicate that Chinese family caregivers experience decisional conflict during the nursing home decision making process as well as after the placement decision. It is important to provide appropriate decision support beginning before admission and across the trajectory of the older person's nursing home stay in order to decrease decisional conflict and facilitate a more positive decision making process for caregivers, family members, and older adults with dementia.     

Staff perceptions of staff-family interactions in nursing homes

Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6-month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff–family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff–family interaction positively. Findings suggest explanatory processes in staff–family interactions, while pointing toward promising interventions.     

Shaping social situations: A hidden aspect of care work in nursing homes

A significant aspect of care work in nursing homes involves dealing with emotional responses such as anxiety, fear, pain, depression and anger on the part of residents and their families. Previous care and nursing research on this topic centers around dyadic relationships and does not provide useful conceptualizations of how care workers actively deal with the social situations they encounter as part of their work. Drawing on ethnographic field work and interviews conducted in two Norwegian nursing homes, this article aims to describe and conceptualize a previously neglected aspect of good care work: the active shaping of social situations in order to lessen uneasy feelings of residents and their families. Three episodes of good work are described to illustrate how social situations can be shaped. Strategies include such actions as timing events, regulating one's presence, and composing social groups. The concluding section discusses some implications for nursing home management.     

New roles for families in child welfare: Strategies for expanding family involvement beyond the case level

This paper examines the strategies and approaches child welfare agencies used to integrate meaningful family involvement into their service delivery systems, under the Children's Bureau Improving Child Welfare Outcomes Through Systems of Care demonstration initiative. Through a series of retrospective interviews with child welfare agency staff, systems of care project staff, family members actively involved in implementing the systems of care initiative, and local program evaluators, researchers investigated the family involvement planning and capacity building activities of child welfare agencies during the initiative's implementation. Findings indicate that child welfare agencies' capacity building efforts primarily centered on human resource development, focusing on three areas: program staffing, family engagement, and agency buy-in. These findings illustrate the importance of developing the capacity of child welfare agency staff and family members before fully implementing family involvement programs and activities. Although more research is needed to document the impact of family involvement, the lessons learned from these grant communities' experiences provide critical information and can inform development of policies and practices to help child welfare and other child- and family-serving systems promote and implement meaningful and sustainable family involvement.     

家庭代际结构变化对社会公共服务体系构建的影响

家庭是社会的基本单元,其现状和变动对社会经济发展会产生直接而深远的影响。近20年来,上海的家庭代际结构发生了诸多变化。其表现在户均人口数持续缩小、空巢老人家庭数量增多、家庭代际关系发生变化、家庭模式呈现多样化等方面,这些都对上海的社会公共服务提出了新的需求和挑战。上海应在"政府支持引导、社区积极参与、供给主体多元、引入市场竞争"的总体思路下构建上海社会公共服务新体系;要优化社区养老模式,大力发展养老服务产业,培育公益性的社区公共服务组织,推进养老服务专业化队伍建设,发展幼托照护及教育事业。     

“It’s a Dignity Thing”: Nursing Home Care Workers’ Use of Emotions1

This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions—sometimes in ways consistent with organizational demands, and sometimes not—and they consistently found in their emotions a resource to manage the strains of their work lives.     

Caring for a demented relative at home: Effects on parent–adolescent relationships and family dynamics

Informed by a family systems perspective, the main purpose of this study was to identify changes in parent–adolescent relationships and in family dynamics when a family member with Alzheimer's or similar dementia moves into the household. The data, based on in-depth interviews with 17 adolescents, revealed that the care situation induces both positive and negative changes in family relationships. On the one hand, adolescents showed considerable empathy and respect for the parent who is the primary caregiver and reported that joint involvement in caregiving enhances adolescent–parent bonds. On the other hand, the adolescents lamented restrictions on their own and the family unit's activities due to the care situation. They also complained about spillover of caregiver stress on other family relationships and about parent-caregivers' focus of attention on the care recipient. These negative features strongly influenced adolescents' adaptation to the care situation. Overall, the results confirm the importance of a family systems perspective for understanding of and intervention in family caregiving for demented relatives. Family life educators should convey the importance of family dynamics in caregiving situations to their audiences, and family practitioners should be aware that an exclusive focus on the primary caregiver's problems may hamper adaptation of other family members (and especially adolescents) who are involved in the care situation.     

Reimagining Nursing Homes: The Art of the Possible

Long-term care (LTC) needs to be reconceptualized. The current efforts to reinvent the nursing home perpetuate a flawed model of care. The heritage of the nursing home as the dominant model for LTC needs to be reexamined. The basic LTC building blocks—housing, services, and medical care—can be combined in various ways to meet consumers' needs and preferences. We need innovative solutions that can offer reasonable service while recognizing the value of acceptable risk taking. Modest personal care should not come at the price of surrendering one's autonomy.     

Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families

Decision makers typically face uncertainty in determining whether the outcomes of promising child welfare interventions justify the investment. Despite repeated calls for cost analysis in child welfare, original studies that evaluate the costs and effects of child welfare programs have been limited. Moreover, no cost analyses have focused on family reunification programs that address the needs of substance-affected families. The purpose of this study was to evaluate the costs and effects of a federally funded implementation of the Strengthening Families Program (SFP), a 14-week family training curriculum, on time to reunification with a substance-involved child welfare population. Based on event history analysis, we find the typical child participating in SFP spends 190 fewer days in out of home care when compared to a propensity score matched comparison group of children in out-of home care receiving treatment as usual. Re-entry rates between the two groups were not significantly different at follow-up. At an average out-of-home care rate of $86 per child per day in this state, SFP saves approximately $16,340 per participating child in out-of-home care costs. From a cost–benefit perspective, every $1 invested in SFP yields an average savings of $9.83 in this Midwestern demonstration.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

Child Care Work: Intimacy in the Shadows of Family-Life

This study analyzes the relationships between child care workers and the families of the children they serve. Because paid child care operates in the borderlands of family, many workers develop intimate relationships—both emotional and physical—with the children they care for and their families. Based on three and a half years of participant-observation fieldwork, and in-depth interviews with child care workers, the researcher examines how worker's subjective meanings are shaped through daily interactions, through organizational processes found in child care centers, and by the gendering of child care as women's work. The child care workers in this study saw themselves in family-like relationship with the families they served. This designation as like-moms and pseudo-parents also meant that workers continually engaged in emotional labor—managing the intimacy they experienced as caregivers against the expectations placed on them as workers.     

Family Support in Nursing Homes Serving Residents with a Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes.