Assessment of multiple constructs of social integration for older adults living in nursing homes

ABSTRACT

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults’ in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ² = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

Chapter 7 Sexual Abuse of Older Women Living in Nursing Homes

Abstract

Aggregated data from APS case files of sexually abused older women between the agesof70 and 89living in nursing homes were collected over a five-year period, yielding a total of 50 substantiated cases. The most common types of sexual abuse involved instances of sexualized kissing and fondling and unwelcome sexual interest in the women's body. All alleged perpetrators were male; they typically were 70 years of age and older and residents in the nursing home. In only three cases was the alleged offender prosecuted in court and only one of these cases was the offender convicted. Implications of these data for future practice and research are discussed.     

Self-efficacy and psychological well-being of nursing home residents in China: the mediating role of social engagement

Abstract

The purpose of this study was to explore the role of self-efficacy and social engagement in psychological well-being of Chinese nursing home residents. A total of 307 residents completed the measurement of social engagement, self-efficacy and psychological well-being. The results showed that satisfaction with physical environment, social support, social activity engagement and self-efficacy were all positively correlated with psychological well-being. At the same time, social engagement partially mediated the effect of self-efficacy on psychological well-being. The results of this study should indicate additional actions for managers of nursing homes and social workers to improve the psychological well-being of older adults.     

THE ELDERLY BLIND IN NURSING HOMES

This article addresses a number of issues surrounding the problem of delivering services to elderly blind residents in nursing homes. It is pointed out that general public misunderstanding, blind service agencies' lack of resources and general nuising home problems like high staff turnover rates make it difficult to establish ongoing effective training programs. It is argued that rigorously evaluated trainings could solve some of the problems involved in coordinating the blind service system and nursing home network to establish a national in-service training policy on blindness for staff who work with elderly blind in nursing homes.     

Sexual Appetite

Abstract

This paper describes the sensual feeding exercise, a powerful therapeutic technique that reveals unconscious feelings operating within people's relationships. The exercise acts as a surrogate to sexual interaction, eliminating the pressure of genital sexual performance and thereby richly illuminating the emotional impediments to intimacy. Using this technique, the therapist instructs the members of a couple to feed one another, in a time and place of their choosing between therapy sessions. The couple has a spontaneous response to the exercise, different from the response elicited in discussing their sexual problem. The parallel between the process of feeding and the act of sex allows patients to learn a great deal about sexuality through non-threatening playful interaction. The paper reports on two treatment processes which led to greater emotional openness and expression in the couples' relationship, without improving sexual satisfaction. The sensual feeding exercise helpfully addressed the issue of sexual satisfaction by revealing the unconscious impediments to sexual expression.     

Facility Organizational and Facility Resident Characteristics in Nursing Homes Serving Residents With a Mental Health History

ABSTRACT

The prevalence of mental health disorders among nursing home residents has been noted. The purpose of this study was to identify characteristics among nursing homes serving residents with a mental health history. A retrospective, cross-sectional design was conducted using the 2003 national Online Survey, Certification, and Reporting facility data merged with the resident-level Minimum Data Set resulting in 2,499 nursing homes. Across facilities, 22% of the total residents had a diagnosis of a mental disorder not including any form of dementia. Among those with a mental health history, 53% of facility residents had depression and 37% had schizophrenia.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

Hospice Use by Older Adults Knocking on the Door of the Nursing Facility

Abstract

Since 1983, federal funding has been available for hospice services. However, research studies have found that hospice is underutilized by people with terminal illnesses and their families. Low-income older adults are particularly at risk for underutilization. This study examined utilization of hospice services by nursing home applicants in one Midwestern state. Characteristics of users and non-users, and potential barriers to hospice use were examined. Findings further document that hospice is underutilized, especially by the Medicaid population, and point to barriers to hospice utilization. Specific recommendations are made to help practitioners increase hospice access.     

Current Realities

This article reports survey data from nursing home professional social workers on their practice circumstances, prior education and training, and current training needs. This data supports the growing body of evidence that a significant portion of social work practitioners are unlikely to have received the depth of information and the specialized skills required to work with the aged and their families during their formal education. Assuming limited personnel and time, and the responsibility of many different persons for psychosocial care -the practice reality in nursing homes today-- this data can guide education and training efforts.     

The Institute for Senior Action

Abstract

Since 1977, the Joint Public Affairs Committee for Older Adults (JPAC) has been educating and mobilizing older adults to take an active role in the public policy decisions affecting their lives. Recognizing the need to better train its members in the techniques of social action and in an effort to familiarize recent retirees with the world of senior advocacy, JPAC founded a comprehensive leadership training program called the Institute for Senior Action in 1994. JPAC's 10-week training Institute integrates critical aging policy issues with practical grassroots applications for action. In addition to honing the skills of longtime community activists, the Institute serves as a vehicle for recent retirees and others to become more involved in social action.     

The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Comparing Perceived Quality of Life in Nursing Homes and Assisted Living Facilities

Abstract

Residents 65 years old and older living in nursing homes (NH) and assisted living facilities (ALFs) were matched on a scale of functional ability: The Sickness Impact Profile for Nursing Homes (SIP-NH). Of the 97 NH and 100 ALF residents who were evaluated using the SIP-NH, 43 pairs, matched by level of disability, were formed. Each member of the 43 pairs was administered two quality of life instruments: the Ferrans and Powers Quality of Life Index (QLI), as well as a single direct question regarding quality of life. Matched pair t-tests revealed no differences in quality of life scores, contrary to the hypothesis that the matched residents in nursing homes would have perceptions of a lower quality of life than residents of assisted living facilities.     

Family Trajectories and Terminations in Conditional Cash Transfer Programs: The Case of Chile's Ethical Family Wage Program

ABSTRACT

On an international scale, conditional cash transfer (CCT) programs have rapidly expanded. Since their boom in the 1990s newer modalities have emerged, incorporating some innovative components. The following study sought to examine one particular CCT program heralded as innovative due to its psychosocial and socio employment accompaniment components: Chile's Ethical Family Wage program. Utilizing administrative data from the Ministry of Social Development this exploratory study sought to examine family trajectories in the program with a particular focus on those families who were terminated from the program due to not meeting conditionalities. Findings from the study indicate that the program deviates sharply from its theoretical implementation. Furthermore, the probabilities of program termination increased in those families headed by younger adults, female and single-headed households, households with higher levels of education as well as larger families. However, a greater number of children decreased the probabilities of program termination as was homeownership. Implications of the findings for policy and practice are discussed.     

“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care

Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.     

Lessons Learned From the First-Year Evaluation of a Small-Scale Home Visitation Program

ABSTRACT

Home visitation programs to prevent child maltreatment are offered in many communities. Agencies in these communities want to help families in need while under increased pressure to provide effective services. Funding is limited and competitive; some agencies might choose to limit funds spent on supervision, training, and evaluation as a way to provide more direct service. In this article, we use an implementation science framework and the results of an evaluation of a small home visitation program to underscore the importance of ongoing training and supervision, attention to fidelity, and program evaluation. The evaluation included 17 families entering the program during 21 months. Evaluators visited families in their homes at the beginning of the program and again 10 months later. Like many other well-intended, small-scale programs, this one “borrowed” from evidence-based models and expanded enrollment criteria in an attempt to better serve families. Findings from the evaluation suggest that the program, as it was carried out, was not effective at reducing parenting behaviors known to be associated with child maltreatment. We offer advice to funding and community agencies based on these findings and implementation science. Future evaluation research must pay greater attention to fidelity and implementation.     

A PROBLEM SOLVING MODEL FOR IN-SERVICE TRAINING

With the increasing use of nursing homes to care for the frail elderly and the recruitment of poorly trained staff, in-service training has become a crucial need. This article presents a problem solving model for in-service training that the social worker can use to increase the effectiveness of staff in dealing with nursing home residents and their families.     

Informal Caregivers of Institutionalized Dementia Residents

When older adults are placed in nursing homes, care- giving responsibility continues, despite long held beliefs to the con- trary. Although the American family is in transition, bonds of care- giving and of filial responsibility are strong and persist into old age. Knowledge about characteristics of caregivers who have actually placed their relative in a nursing home is limited. The purpose of this study is to examine whether demographic and facility-related char- acteristics as well as knowledge about dementia and participation in support groups and workshops are signif~cant predictors of burden in caregivers of institutionalized dementia residents. Sixty-seven per- cent of caregivers of residents in a dementia unit in a nursing home participated in the study. Overall, the regression explained 68% of the variance in burden and was highly simcant statistically. In- formation gained from this study will assist social workers in mak- ing referrals to nursing homes or in direct practice with cognitively impaired nursing home residents and their families.