A Caring Profession? The Ethics of Care and Social Work with Older People

The feminist ethics of care present a challenge to social workersto re-assess not only the place of care within professionalsocial work practice but also the way in which concepts of justice,autonomy and rights are conceptualized and ageing is understood.In this article, the arguments for an ethics of care are consideredin relation to social work practice with older people. It isargued that the feminist ethics of care offer useful insightsthat are relevant to the practice of social work, particularlywithin contemporary demographic, economic, political and organizationalcontexts, all of which have made the task more complex and confusing.     

The long arm of the welfare state shortened: Home help in Sweden

Old age care in Sweden expanded greatly in all areas in the 1960s and 1970s. In the 1980s, both institutional and in-home services have retreated. Little substitution between the two kinds of care can be observed. Cutbacks relative to demographic needs, and probably also to actual needs, have occurred, nationally and locally. Home help is analyzed as a metaphor for social services and welfare at large. The strategy has been to give priority to the frailest and oldest clients. Others often have to make do without any services. Also, current recipients of home help services now get different inputs: in the 1980s and earlier, 8 of 10 home help hours were used for homemaking (such as shopping, cooking, cleaning and laundry); in the 1990s about half is used for personal care of the clients.     

Caseworkers as a source of hope leading to perceptions of academic success for transitional age foster youth

Research among adolescent samples has consistently demonstrated that a hopeful mindset is associated with resilience and global well-being. Further, research suggests that hope is influenced from an early age from connections with supportive caregivers. However, because older youth in the child welfare system may lack supportive caregivers, alternative sources of hope may be needed. To test a theory that supportive child welfare caseworkers can serve as external sources of hope, we conducted a cross-sectional study of youth in the child welfare system from a single state (N = 149). Using surveys with established scales to measure the variables of interest, the study tested a structural equation model of (1) youth's external hope in their caseworker as a driver of (2) internal hope in themselves leading to (3) more positive perceptions of academic success. Perceptions of academic success were chosen as the final consequence of the model because academic success has been linked to many other variables of well-being across the lifespan. The results indicate that the proposed structural model fits the data well (χ² = 327.9, df = 150; P < 0.001; root-mean-square error of approximation [RMSEA] = 0.09 [90% confidence interval – CI: 0.076, 0.103]; comparative fit index [CFI]: 0.920; standardized root-mean-square residual [SRMR]: 0.05). The results indicate that youths' hope in themselves had origins in external hope in the caseworker. Moreover, the final consequence was an increase in perceptions of academic success. Such results have implications by revealing how case management services can positively influence foster youths' hope and thereby influence their academic success.     

The Coming of an Aged Society in Taiwan: Issues and Policies

For most advanced industrialized countries, an aging society has been a national issue since the 1970s. However, Taiwan was not aware of this issue until 1993, the year when the old‐age population reached 7.0%. As an aging nation under the definition of the United Nations, the Taiwanese government began to pay more attention to the aging population, and executed several policies in response to this demographic transition. First, this article examines Taiwan’s demographic transition from an aging society to an aged society, and its impacts. Second, it demonstrates the responses of Taiwan to the coming of an aged society and explores crucial issues that Taiwanese society is facing.     

Towards Understanding Variations in Social Care for Older People in England

Indicators of the public provision of old age social care are routinely recorded in England and have been used for diverse purposes including performance monitoring. Despite long‐term policy guidance promoting more homogeneous service provision, large variations can still be observed between local authorities (the providers of state‐funded social care). Our aim is to better understand such variations in a small selection of key aggregate indicators. Drawing on multiple data sources and pursuing a two‐step strategy, we first assess the explanatory power of a set of structural predictors and then add to the models a set of specific care management ‘process’ predictors. We find that structural factors beyond the control of local authorities explain a considerable share of the observable variation. The additional explanatory power of care management characteristics is small in comparison. Therefore, our findings suggest that caution must be taken when aggregate indicators of service provision are used for performance monitoring purposes, as a degree of autonomy over outcomes may be implied which in light of the empirical evidence is unrealistic. Past attempts to influence the aggregate pattern of service provision – apparently seeking greater ‘territorial justice’– are likely to have had adverse implications for service users and the uniformity of service delivery across England. Questions are raised about the adequate role of central government in a policy environment characterized by longstanding local government responsibility.     

Challenging behaviour in out‐of‐home care: use of attachment ideas in practice

Children in out‐of‐home care that demonstrate challenging behaviour are often thought of as ‘attachment disordered’. Our understanding of what this might mean for practice is not well developed. In this study, 92 South Australian stakeholders were interviewed about how they understood extremely challenging behaviour amongst school‐age children in out‐of‐home care. Participants consistently described behaviour as arising from attachment difficulties. Despite this, there were a variety of ways that a child's attachment needs were conceptualized, which appeared to be inconsistent with contemporary attachment theory. Thematic analysis yielded four implicit views about children's attachment: attachment as capacity that is limited, attachment as skill that children can learn and transfer to other relationships, attachment as unachievable for some children and an idealized view of attachment as a close and trusting relationship. These possible misconceptions about attachment and attachment needs and their relationship to the development of challenging behaviour are discussed in terms of attachment informed research and theory. The possible implications for placement practice and policy for children in out‐of‐home care are discussed.     

关于中国法定退休年龄的探讨

关于中国法定退休年龄问题,近年来引发了社会各界的广泛关注。本文分析了几个被广泛关注的因素:中国人口平均寿命与健康预期寿命变化,世界的退休年龄变化趋势以及退休年龄变化对于劳动力市场的影响。在此基础上,文章认为:当前女性法定退休年龄偏低,将导致女性退休后出现养老金低收益及"退而不休"现象。因而,建议中国应当提高女性退休年龄,并且应结合劳动力人口变化趋势,采用小步渐进的方式进行调整,以期在一定程度上优化劳动力市场供给。     

元稹明经及第确切年代考

许多文献记载,元稹年十五明经及第,但究竟是实岁还是虚岁,不同学者观点不一。大陆学者认为是虚岁,及第在贞元九年,而台湾学者张达人则认为是实岁,及第在贞元十年。证诸文献,十五应是虚岁,是元稹报名参加考试的时间,而实际及第则应在贞元十年。     

End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N?=?300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.     

家庭功能变迁中的养老选择

进入人口老龄化的中国正处于高速转型期。社会结构、社会的价值观念等都发生着剧烈的变化。而这一切又正冲击着家庭的养老功能,形成养老方式多样化的格局。不过无论这些养老方式走向何方,居住方式皆是养老选择的一项重要影响因素。     

Cash for care and care employment: (Missing) debates and realities

The introduction of cash‐for‐care (CfC) schemes in different European countries over the last years has responded to a plurality of strategies aimed at attending the rising demand and increasing costs of the long‐term care needs of an ageing population. The specific system of care provision in each country shaped the response given to those challenges, as well as the room for manoeuvre for policymakers when trying to transform the domain of care into a sphere where markets may play a larger role, partly relieving families, and also the state, from these responsibilities. Policy debates and scholarly analyses largely overlooked the contribution of these schemes to the creation and shaping of employment. This article provides a comparative analysis of how CfC‐based policies entail—alongside the regulation of informal care—a(n implicit or explicit) connection with care employment and may contribute to structuring employment relations in this sector. It looks jointly at the specific features of CfC and at the institutional context—welfare regime—in which they are embedded in order to assess the extent to which these schemes contributed (generally unintendedly) to a transformation of the care employment size and features in seven European countries.     

年龄间的社会分化和农村家庭养老制度的资源困境

本文关注的是中国农村社会和农村家庭中不同年龄和代际间的社会平等问题。文章描述了农村老年人的物质生活和社会生活状况,指出农村老年人群体性的相对贫困现状,以及老年人生活质量和社会经济地位的弱化与农村整体生活水平逐步提高之间存在结构性矛盾,认为农村以年龄和代际为界的社会分化业已形成。文章还通过对家庭养老制度面临的资源困境的分析,进一步解释了经济、社会和文化变迁是如何通过改变农村的家庭制度和家庭中的代际关系对老年人的生活及其权力和权利状况产生影响的。     

Give Them the Money: Is Cash a Route to Empowerment?

This article suggests it is important to unpack the notion of "empowerment" in community care so that the position of those who provide "hands-on" care is scrutinised alongside the empowerment of "users" of care. The particular case of the forthcoming Direct Payments legislation, whereby disabled people will be able to opt for cash rather than services and become employers of personal assistants, is considered. It is argued that both employers and employees in these care relationships are likely to be on low incomes, that the work is likely to be insecure and possibly unregulated, that there might be a problem of labour supply, and that in the long run, this form of employment might generate hardship for the workers so employed. Other forms of reconciling the interests of both users and "carers" are considered.     

The social networks of young people in Ireland with experience of long‐term foster care: some lessons for policy and practice

This paper presents findings from the first study of the social networks of a group of young people in Ireland who have experienced long‐term foster care. The study group was composed of two groups of young people, a group who were currently in care and a group who had left the care system. The central focus was to examine the impact of foster care on the social network experience of the young people. Findings indicated that foster care impacts on the young people's social network experience in the following ways: losing contact with extended family; a greater challenge in making and sustaining friendships; an impact on education; and an inability to maintain contact with groups and activities that are of significance. This paper also presents recommendations in relation to policy and practice, including the raising of awareness of the importance of a social network approach in working with young people with care experience.     

“Unexpected and Distressing”: Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care

The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.     

Breakdown of teenage placements in Danish out‐of‐home care

This study deals with the problem of breakdown in out‐of‐home placements for Danish teenagers. How often are these placements prematurely terminated against the requests and intentions of the child welfare authorities? Which factors seem to increase and decrease placement breakdown? The sample consists of 225 youths and 367 placements during the years 2004–2008. Among the 225 youths, 44% experienced a breakdown, and 33% of the 367 placements ended with a breakdown. A large proportion of the placement breakdowns (20%) occurred before 4 months, and within the first year, 62% of the placement breakdowns had taken place. Replacements took place in 61% of all placement breakdowns. The analysis showed that type of placement and number of youth at the same placement had significant association to placement breakdown, but variables based on the social worker's clinical assessment showed no association to breakdown. However, while the logistic regression model was significant, it explained only 6% of the variance. Earlier studies have indicated that breakdown is a substantial problem of child welfare in several other western countries, Denmark is no exception. These corresponding breakdown rates point out that no child welfare system yet have found a method to reduce breakdown substantially.     

Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.