Social-economic context of parent care: explaining Chinese caregivers' psychological and emotional well-being

This paper explores Chinese familial caregivers' depression and subjective burdens among the current caregivers. Data were collected in 1997-1999 with 110 caregivers who were then taking care of physically dependent parents or parents-in-law. Regression analyses were conducted to assess the factors that influence caregivers depression and subjective burden. Findings suggest that family and individual economic conditions are related to caregivers' depression. Caregivers' involvement in caregiving tasks is associated with caregivers' subjective burden. Poorer self-perceived health is related to higher report of caregivers' depression. The author argues that poorer health and unemployment at the time of drastic social and economic changes in China may have created psychological and emotional anxieties and depression for caregivers. The lack of financial and social stability may have deleterious effect for current caregivers in the future when they grow older and have to be cared for by their one-child generation children.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

We care about care: advice by children in care for children in care,foster parents and child welfare workers about the transition into foster care

Twenty children in foster care, ages 8 to 15 years, provided advice to children in care, foster parents and child welfare workers about ways to assist service delivery during the transition into foster care. The children discussed the importance of tending to experiences such as foster home expectations, the importance of time and information, the new foster/parent–child relationship, coping with stress, the ability to be engaged in decision‐making, the benefits of foster care and the need to build a trusting and personal relationship between children in care and their caregivers. The importance of listening to children's experiences of the transition into foster care and incorporating their advice into future research, policy and practice will be discussed.     

Quality of Life for the Elder

Abstract

Data from the Parent Health Supplement of the 1991 interview wave of the Panel Studies of Income Dynamics were used to examine the changes in care arrangements for elderly parents (N = 1,028). Following the onset of their dependency, more than 60% of elderly parents experienced at least one form of institutionalization (hospital or nursing home). A majority of those who remained in the community also experienced changes in living/care arrangements, often moving in with someone or having someone move in with them. The findings confirm those of previous studies that health-related need factors and race are significant determinants of institutionalization immediately following the onset of dependency. But availability of caregivers and other enabling factors are also significant determinants of care settings used following hospitalization.     

Child Care Caregiver Sensitivity and Attachment

Changes in child care caregivers' sensitivity and in children's attachment security were examined in three studies. Study one involved 55 children enrolled in community based child care. There was no intervention in these sites. Caregiver responsive involvement and children's attachment security did not change over time or when children changed caregivers. Study two involved 71 toddler age children enrolled in family child care homes. The caregivers of these children were enrolled in a family child care training project. Six months after the training security scores increased and caregivers of children who became secure or remained secure were more sensitive following training. Study three involved 36 children enrolled in center-based child care. Children were observed before and after selective staff replacement and in-service training to increase caregiver sensitivity. Six months following intervention security scores increased and caregivers of children who became secure or remained secure were more sensitive following training.     

Becoming involved in raising a relative's child: reasons, caregiver motivations and pathways to informal kinship care

Interviews with 207 informal kinship caregivers describe a dynamic process that influences how children come to live with a relative other than their parent. This process involves three overlapping and often simultaneously occurring factors: (1) the reasons the children's parents were unable to care for them; (2) the caregiver's motivation for assuming responsibility for the child; and (3) the pathways or routes that children took to the caregiver's home. Understanding these factors and their mutual and simultaneous influence is important as we shape policies, programs and interventions to support families as they consider whether to care for a relative's child and once they assume this responsibility.     

Filipinas as Residential Long-Term Care Providers

Summary

This exploratory study investigated reasons why Filipinas in Hawai'i have become the primary caregivers of elders in residential care homes and if they thought their children would follow them in this profession. A random sample of 173 Filipina care home operators (CHO), of which 95% were first-generation immigrants, was interviewed using telephone survey methods. Data were collected: to profile caregivers; to identify motivations for becoming a care home operator; and to gauge if they or their children would continue in this line of work. The sample was composed of middle-aged Filipina CHO with training and experience in elder care who concurred that the job fit their cultural values. About a third also felt that this job was open to immigrants and helped them buy a house. Twenty percent or less felt discriminated against because of this work. Although half the sample felt that women were better caregivers than men, only 38% felt that caregiving was primarily the responsibility of women. Almost 90% planned to continue with this work, but only 12% said it was likely that their children or grandchildren would become CHO, supporting the notion that choosing this profession had less to do with cultural values and gender expectations than with economic opportunities available to the current cohort of CHO. Given these findings, Hawai'i's capacity to meet future residential long- term care needs is discussed.     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Aging and Elder Care in Japan: A Call for Empowerment-Oriented Community Development

This article provides a brief overview of the situation of the elderly and their caregivers in Japan, including demographic changes in Japan, development and changes in long-term care policy that have targeted the poorly integrated community care system, and other challenges that the elderly and family caregivers face. Policy direction designed to address these issues is increasingly targeting care by the community versus support care by society (which was initially the main strategy). The potential of empowerment-oriented community development intervention strategies to decrease the gap between available institutional and formal community-based services and the needs of the elderly and their families in their efforts to meet late life challenges is described. The need for an increased role of social workers in community development interventions is explored and strategies are suggested.     

A Cross-Sectional Examination of the Association Between Dyspnea and Distress as Experienced by Palliative Home Care Clients and Their Informal Caregivers

This study examined the association between dyspnea and distress as experienced by both palliative home care clients and their informal caregivers as a unit of care. Cross-sectional analysis was conducted using the interRAI Palliative Care Assessment database. Responses from 6,655 individual palliative home care clients across six regional jurisdictions in Ontario, Canada were included. This study found that clients experiencing dyspnea were more likely to show overall signs of distress; report one or more signs of self-reported distress; and be at risk for depression when compared to clients who do not experience dyspnea. Caregivers of clients experiencing dyspnea were more likely to exhibit distress than caregivers of clients not reporting dyspnea. When indicators of caregiver distress and client distress were combined, 53% of the caregiver-client units exhibited distress. Social work practitioners should include a focus on distress within the care unit as a priority when care planning to meet the needs of persons nearing the end of life. Members of the care team should consider available treatment and management options tailored to meet both the client and their informal caregiver’s needs.     

Instability and caregiving in the lives of street‐involved youth from foster care

A large proportion of youth who become street‐involved have experience in foster care, and our sample of 92 street‐involved youth, aged 14–18 years, all had foster care experience. We report on (i) instability of guardians and home from birth to street involvement; (ii) the connection between perceptions about foster care and measures of well‐being; and (iii) the implications of these findings for understanding street‐involved youth and the role of foster care in their life. The average number of transitions per youth from birth to mid‐teens was nine. Youth with experience in permanent care first lived away from biological parents at age 8.5 years, and for those with temporary care experience, it was age 10 years. Foster care was one of many living situations and one of several sources of caregivers. If participants were satisfied with foster care, they were more likely to be currently hopeful and happy. Participants who experienced positive influences from at least one long‐term caregiver tended to have other positive caregiver experiences, and those with negative influences were more likely to also have a positive relationship with a female caregiver. Foster care was one of several ‘way stations’ in their lives, one whose meaning needs further study.     

Can cultural values help explain the positive aspects of caregiving among Chinese American caregivers?

This study used an adaptation of the caregivers' stress model to examine the positive aspects of caregiving with 113 Chinese American family caregivers who provided care to their elderly relatives. The hierarchical multiple regression analysis indicated that combination of caregiver background characteristics, stressors, and cultural values had direct effects on positive aspects of caregiving. Unlike previous studies in which cultural values were not measured, this study found that cultural values helped explain positive aspects of caregiving. Specifically, cultural values, caregiver's health, and caregiver's age predicted positive aspects of caregiving. Service implications are discussed based upon the findings.     

Elderly chinese and their family caregivers' perceptions of good care: a qualitative study in shandong, china

This study aims to understand what older Chinese people with chronic illness and their family caregivers perceive to be good care, and to compare perspectives of those living in rural and urban areas. We conducted semistructured interviews with 24 care recipients and 23 caregivers in Shandong, China. Two major themes were identified: (a) filial piety as the standard, and (b) modifying cultural ideals to meet reality. There was overall consistency in perceptions of study participants. Variations between rural and urban elders' perceptions appear to reflect differences in socioeconomic development and institutional structures.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

Mosaic of difference: enhancing culturally competent aging-related knowledge among social workers

The professional literature has not adequately addressed the behavioral and social factors that contribute to different coping outcomes for African American elder caregivers as compared to non African Americans. Awareness and understanding of these unique experiences would better prepare professionals to work with such clients. This study examines the predictors of emotional distress among 46 African American women who provide care to dependent elderly parents. Multivariate statistical analyses show that elder caregivers' rating of quality of life, their years of caregiving, as well are their poor heath constitute significant predictors of risk for depression. The results of the study provide support for the inclusion of more culturally appropriate measures of caregiver distress, and provide insights to inform social work practice, policy and research concerning African American female elder caregivers in the 21st century.     

Filipinas as residential long-term care providers: influence of cultural values, structural inequity, and immigrant status on choosing this work

This exploratory study investigated reasons why Filipinas in Hawai'i have become the primary caregivers of elders in residential care homes and if they thought their children would follow them in this profession. A random sample of 173 Filipina care home operators (CHO), of which 95% were first-generation immigrants, was interviewed using telephone survey methods. Data were collected: to profile caregivers; to identify motivations for becoming a care home operator; and to gauge if they or their children would continue in this line of work. The sample was composed of middle-aged Filipina CHO with training and experience in elder care who concurred that the job fit their cultural values. About a third also felt that this job was open to immigrants and helped them buy a house. Twenty percent or less felt discriminated against because of this work. Although half the sample felt that women were better caregivers than men, only 38% felt that caregiving was primarily the responsibility of women. Almost 90% planned to continue with this work, but only 12% said it was likely that their children or grandchildren would become CHO, supporting the notion that choosing this profession had less to do with cultural values and gender expectations than with economic opportunities available to the current cohort of CHO. Given these findings, Hawai'i's capacity to meet future residential long-term care needs is discussed.     

Are there differences in standard of care for the elderly? A comparative study of assistance decisions in Stockholm

According to Swedish law, an elderly dependent person is entitled to public services in the form of home help in ordinary housing or a place in special housing — i.e. sheltered housing, a residential home or a nursing home. There are no explicit rules for how much home help a person is entitled to given dependency and other factors, nor are there any explicit criteria to guide the admission to special housing. A study was performed in ten districts in Stockholm in order to determine whether there were systematic differences between the districts with regard to the allotment of care and services to the elderly. It was found that there were in fact significant differences that could not be explained by variations in dependency or other factors of importance for the allotment decision. A minor part of these differences was connected to the different background and experience of the assessing person.     

Attitudes to prioritization in selected health care activities

The aim of this study was to measure attitudes to health care prioritization in various Finnish population groups. Three study groups were established: 1) the general public (n=4260); 2) politicians (n=1427); and 3) medical and social work professionals (n=1055).
The following background data were obtained: sex, year of birth, marital status, number of children, education, profession, personal income, self-perceived health, and how subjects viewed their own future and whether they were satisfied with their lives. Information on activities involving prioritization of health service was elicited by presenting a list of 16 health care activities. Respondents evaluated these activities as 1) more important than average, 2) of average importance, or 3) less important than average (indicated as numbers 1-3).
The response rate was 59.3%, and 57.2% (n=3858) of the original sample was accepted for analysis. The politicians and profes-sionals showed almost identical attitudes. All groups prioritized treatment of life-threatening diseases among children. The general public prioritized high-tech surgery more highly than professionals or politicians. Alternative medicine and cosmetic surgery were the two least important activities. All groups agreed about prioritization of serious diseases among children, care of dying patients, prevention, surgery which helps people to perform their everyday tasks, and home care for the disabled elderly. Professionals and politicians prioritized mental health more highly than the population. The general public prioritized intensive care for premature babies with a low birth weight (less than 800 g). Professionals prioritized family planning more highly than politicians and the population. The results resemble those obtained in Britain, indicating that attitudes towards priorities in health are similar between Britain and Finland, and that the respondents' professions determine attitudes more strongly than does cultural background.