Unpacking barriers to quality care for Deaf people in residential aged care facilities

Residential aged care providers often face difficulties in meeting the needs of residents with a lifelong disability. In this article, I explore these issues from the perspective of signing Deaf residents. While previous studies have documented a number of issues around staff training and communication for Deaf residents, there remains a dearth of literature considering the root causes of these problems. Drawing on interviews with a variety of service providers, this article suggests a number of ways current practices might be improved as well as discussing funding changes required to ensure Australian Deaf residents do not fall through the cracks.     

Sustaining Low Pay in Aged Care Work

This article examines the ways in which employers in the Australian aged care sector justify and sustain low pay for work that is both highly skilled and in high demand. We build on a large body of feminist research that analyses why care work is devalued by showing how such devaluing is produced at the level of the organization. To do so we examine some of the specific discursive mechanisms that sustain low pay. We show that aged care employers actively reproduce a familial logic of care that represents paid aged care work as unskilled and natural for women and therefore not deserving of higher pay. We argue that in order to achieve their goals employers must develop and sustain an opposition between care as love‐centred and work as money‐centred, while upholding the notion that they provide quality care for care recipients.     

My Room,My Home,My Self

Abstract

The material culture of home cannot be supplanted in its entirety when moving into an aged care facility. When the time comes, the decision of what to take and what to leave behind is not simple. This article presents the balance between practical and emotional considerations in the choice and presence of personal objects in the rooms of residents. Intersubjective relationships between material objects in the room and the people who enter that space is viewed through a narrative lens. In this way, it is the materiality of the room-as-home for the self, which is key. Three major themes relating to the objects in the room of the older person were found to be: 1. Safety, 2. Family, and 3. Home. These themes emerged from ethnographic research in an aged care setting. Participants included residents, their families, care staff, and management of the facility. The article contributes to understandings of material objects as carriers of identity and meaning in an aged care facility.     

Trauma-informed care training in a child welfare system: Moving it to the front line

The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. We evaluated the impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (Caseworkers, Program Assistants and Other front-line staff). Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. We also found a significant increase in staff use of trauma-informed care practices at the three-month follow-up with little difference observed across staff groups. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed.     

Child Abuse on the Internet: Ending the Silence

The Melbourne Health (MH) Social Work Residential Care Team (RCT) was established in 2002 as a new and innovative approach to aged care. The service employs three full-time social workers and an Allied Health assistant with previous experience in aged care. The RCT works across the MH continuum of care with inpatients recommended for residential care. The service is predominantly patient- and family-focused, but is also consultative to meet the education needs of MH staff and the community. This paper discusses the MH Social Work Residential Care model, reviews data collected since RCT implementation and the benefits shown for patients, their families and interdisciplinary staff. This paper discusses pressures and factors that impinge on the ability to discharge patients to residential care and explores recommendations for ongoing clinical practice as well as recommendations that the RCT has submitted to management for further consideration.     

Doing Gender,Paying Low: Gender,Class and Work–Life Balance in Aged Care

This article examines how interactions between the doing of gender and class at institutional and organizational levels perpetuate inequality for aged care workers. In particular, it investigates how managers ‘do gender’ and class in relation to their care workers' work–life balance and the unintended consequences of this for aged care workers. The research data comprised interviews with female managers and aged care workers from four case studies in residential aged care in New Zealand. We argue that despite best intentions, the consequences of managers' doing gender and class results in continuing low wages, poor work–life balance and disempowerment at work for aged care workers.     

Christian Aid and LGBTI rights: breaking the silence

In recent years Christian Aid has begun to explicitly recognise and respond to discrimination faced by LGBTI people globally. A catalyst for this shift was the re-criminalisation of homosexuality in Uganda, Nigeria, and India in 2014, as well as partner reports of rising violence towards LGBTI people in Latin America and the Caribbean. However, breaking the silence on LGBTI issues within the organisation came predominantly through the emergence of an informal staff sexuality network. This article offers a critique of Christian Aid’s journey from being initially hesitant to engage with issues of LGBTI discrimination to recognising that as a faith-based development agency it can no longer remain silent. Taking such steps, however, has not been without challenges or risks.     

城市社区居家养老服务的发展思路与对策

随着老龄化时代的到来,需要照料的失能、半失能、失独老人总量不断增加,在当前传统家庭的养老功能不断弱化、机构养老服务能力滞后的形势下,居家养老服务模式成为解决养老问题的重大战略抉择。但目前居家养老服务总体而言尚处于起步和试点示范阶段,在居家养老服务资源凝聚、开拓,居家养老服务运作和软硬环境营造等方面,面临不少问题和困境,建议从资金、人力、设施、运作环境等方面来解决居家养老服务的发展问题。     

'I know I signed something': older people,families and social workers' understanding of the legal aspects of entry to residential care

This purpose of this paper is to report findings that older people are legally vulnerable when entering an aged care facility, that social workers lack knowledge of the legal aspects of this move and do not necessarily view this information as core to their practice. The structure of social work services mirror the disjuncture older people and their families experience at this time and this may, in part, explain social work's lack of attention to these issues. Although many social workers are in contact with older people, the profession in Australia has been slow to develop a knowledge base to support effective practice with this group.     

Using Generational Intelligence to Examine Community Care Work between Younger and Older Adults

Exploring the factors that contribute to sustainable forms of an intergenerational relationship is becoming an important conceptual and practical challenge, not least because of the growing need for an aged care workforce that is both motivated and suitably trained. Generational intelligence is a means of examining interaction between younger and older people which has been applied to community care settings. Dimensions of generational intelligence include recognising and valuing generational differences, finding common ground, plus negotiating social and practical outcomes from the situation. A case study plus a series of qualitative interviews are used to examine the value of this approach both as a means of exploring the processes involved in generational exchange and in providing recommendations for work preparation and training. It is suggested that intergenerational relations have been a missing factor in the understanding of sustainable care and that in future, service delivery should not simply be analysed as comprising professional and lay perspectives but also as containing generationally distinctive perspectives that require negotiation.     

Non-parental childcare,time pressure and the gendered division of paid work,domestic work and parental childcare

What impact does out-sourcing childcare have on the time parents spend on paid work, domestic work and childcare, and how they share these tasks between themselves? Using data from the Australian Bureau of Statistics (ABS) Time Use Survey (TUS) 2006 we investigate the effects of formal and informal non-parental childcare on the time use of couples with children aged 0–4 years (N=348). We examine associations between non-parental care and (1) couples' combined time in paid work, domestic work and childcare, (2) parents' time separately by gender in paid work, domestic work and childcare (subdivided by activity type) and (3) parents' self-reported time pressure. Total workloads (the sum of paid work, domestic work and childcare) are neither higher nor lower when non-parental care is used, either for households combined or for each gender separately. The way time is spent, and how activities are divided by gender does differ, however. For mothers the use of any non-parental care and more hours in formal care is associated with more paid work hours, less childcare time and higher self-reported time pressure. Fathers' time is more constant, but they report higher subjective time pressure with increasing hours of formal non-parental care.     

Migrant Care Workers or Migrants Working in Long-Term Care? A Review of Australian Experience

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.     

Diversity training for the community aged care workers: A conceptual framework for evaluation

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older people’s experience of healthcare.     

Community Aged Care Case Managers Transitioning to Consumer Directed Care: More Than Procedural Change Required

Abstract

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Work Satisfaction and Intention to Leave Among Direct Care Workers in Community and Residential Aged Care in Australia

Turnover in the Australian aged-care workforce is lower than in the United States but is still of concern. This research examined the effects of worker satisfaction, worker characteristics, work conditions, and workplace environment on intention to leave, using data from a 2007 national census of the aged-care workforce. A probit model was used to estimate the probability of care workers leaving their jobs in the next 12 months. While workers were satisfied, overall, with their work, improving some components of satisfaction and converting casual contracts to permanent work would reduce intention to leave. To these ends, a shift in focus is required away from worker characteristics and the nature of care work to job conditions and organizational matters amenable to management and policy action.     

Awareness of Elder Abuse Among Community Health and Social Care Staff in Northern Ireland: An Exploratory Study

ABSTRACT

This article reports on one of the first surveys of multi-disciplinary staff awareness of elder abuse in this region of the United Kingdom (UK). Forty staff from eight professional groups in the Southern Health and Services Board area were surveyed about their knowledge of elder abuse, the types of help they thought they could offer the abused and the abuser, and the level of abuse in their current caseload. Thirty-five per cent of respondents had cases of physical, psychological, financial, and sexual abuse as well as care-giver neglect of people aged 65 and over in their caseloads. The findings suggest that while staff had differing levels of awareness of elder abuse, further training is necessary.     

Informing employees in small and medium-sized firms about training: Results of a randomized field experiment

We mailed brochures to 10,000 randomly chosen employed German workers who were eligible for a subsidized occupational training program called WeGebAU, informing them about the importance of skills-upgrading training in general and about WeGebAU in particular. Using survey and register data, we estimate effects of the informational brochure on awareness of the program, on take-up of WeGebAU and other training, and on subsequent employment. The brochure more than doubles awareness of the program. There are no effects on WeGebAU take-up, but participation in other (unsubsidized) training increases among employees aged under 45. Short-term labor market outcomes are not affected.     

Touch in residential child care: staff’s bodies and children’s agency

This paper concerns the significance of touch in the everyday life of those living and working in residential child care. Public and professional awareness about child abuse has focused attention on the bodies of children and their vulnerability – but the same cannot be said of the bodies of staff members who touch children. This ethnographic study of a Scottish residential child care unit shows such touch to be central to the everyday participation of children and young people in care. On the basis of participant observation, the paper analyses how care workers influence the agency of children and young people by bringing their own bodies into their relationships with them. Based on a relational understanding of care, the paper elaborates on how tender and restraining forms of touch form part of care workers’ professional repertoire of actions. The analysis of various instances of touch in terms of sociology of the body shows how staff members can help to shape children and young people’s opportunities for participation with their own bodies. In conclusion, the paper therefore argues for a professional and reflexive engagement with bodies rather than a general avoidance of touch between care workers and young people.     

Dementia Patients’ Transition to Residential Aged Care: Carers’ and Social Workers’ Experiences

Many people with dementia eventually require residential aged care, frequently preceded by a hospital admission. Family carers often find the process challenging and disempowering, as they are expected to move their family member to residential aged care quickly. This article reports on findings from a small Australian qualitative study focusing on the provision of information, support and resources, and discusses the findings in relation to person-centred care and critical social work. Social workers completed an online survey and participated in focus groups, and carers were interviewed. The research found that carers valued the information, support, and resources provided by social workers and other hospital staff. They needed time to adjust to the dementia diagnosis and wanted a supportive person to talk to about the written information. The social workers wanted an improved approach to the preparation and communication of information, and a more consistent approach to family meetings.