'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.     

Catering to sex,sexual, and gender diversity: An exploratory study on the effects of LGBTI awareness training on aged care staff in Tasmania,Australia

The Australian National LGBTI Ageing and Aged Care Strategy seeks to address the lack of recognition of older lesbian, gay, bisexual, transgender, and intersex (LGBTI) adults living in aged care. Awareness training for aged care staff forms a crucial part of this strategy, but the impact of such educational programs are yet to be examined. In this article, we examine the effects of LGBTI awareness training on staff working in an Australian aged care facility. These staff perceived the awareness training as valuable, but the outcomes from it were limited. Therefore, we indicate changes that are necessary to support the translation of training into practice.     

Perceived barriers to accessing health services among people with disabilities in rural northern Namibia

People living with disabilities (PWD) face unique problems in dealing with conventional healthcare facilities. We investigate the experiences of PWD as they access healthcare facilities in rural Namibia. More specifically, we investigate structural–environmental and process barriers to accessing health facilities. The study relied on semi-structured interviews and purposive sampling. The results showed PWD find it difficult to walk to health centers for treatment due to lack of transport, money to pay for treatment and toilet facilities and the distance is too far for people with lower-limb disabilities. There is a need to consider the unique issues affecting access to healthcare for people living with disabilities to achieve equitable access to healthcare services.     

Understanding the complex negotiations in fulfilling the right to independent living for disabled people

The independent living agenda has become dominated by a rights focus that has helped drive national-level shifts in setting norms and changing mind-sets. This paper is concerned with examining how rights are utilised by service providers in the process of facilitating independent living. Drawing on an empirical study of providers in Ireland, the paper identifies the strategies being used to put rights into practice. The findings show that in the process of creating a well-managed support arrangement for each individual, providers often take a delicate approach to using rights, and sometimes dilute their guiding principles when engaging in ongoing complex negotiations between individuals, families, staff and volunteers. The disabled people's movement can contribute to the shared learning required in enabling managers handle this process better, rather than solely rely on an abstract call for rights.     

Meaning as outcome: Understanding the complexity of decision-making around residential placement in aged care

Abstract

Changes in aged care and health policy have introduced an increasingly complex assessment, resource option, and economic and regulatory context for decision-making regarding relocation to residential care. This paper reports on a study exploring residential placement from the perspective of spouses who place a long-term partner in an aged care facility. It highlights the importance of understanding the meaning of such decision-making for the spouse who remains at home and explores the ways in which the placement is constructed as either a continuation of, or a refusal to, care for a long-term partner. The paper draws out the implications for social work practice and identifies the challenge to merge knowledge of resource packages, care options and financial arrangements with a concern with the processes of decision-making and the emotional and symbolic aspects of such decisions.     

Rights discourses in relation to education of people with intellectual disability: towards an ethics of care that enables participation

In this paper we argue that human rights approaches for intellectually disabled people have failed to recognise the complexity of rights claims made by and on behalf of this group. Drawing on a research project into discourses of education for intellectually disabled people in the Eastern Cape, South Africa we discern three rights discourses; namely, rights to full participation, rights to special services and rights to protection. These draw off a social model, a medical model and a protective model, respectively. We note that these discourses may be set up in contestation with each other. However, we argue that they can be seen as complementary if viewed within an ethics of care that enables participation. Within this conceptualisation, participation is viewed within relations of care but is subject to a critique that examines the role of context and disciplinary power in constructing dependency.     

Exploring the specific needs of an understudied group: Children with intellectual disability in residential child care

Children and adolescents who live in out of home care in the child protection system are considered to be vulnerable to manifesting mental health disorders as well as other types of difficulties. This risk is greater in the case of children who display any type of disability. The aim of this study is to profile the state of health and well-being of a group of children presenting intellectual disability who live in residential care in a Spanish autonomous community and to compare these results with their non-disabled peers.     

Promoting choice and control in residential services for people with learning disabilities

This paper discusses the gap between policy goals and practice in residential services for people with learning disabilities. Drawing on a nine month ethnographic study of three residential services, it outlines a range of obstacles to the promotion of choice and control that were routinely observed in the culture and working practices of the services. Issues discussed include conflicting service values and agendas, inspection regimes, an attention to the bigger decisions in a person's life when empowerment could more quickly and effectively be promoted at the level of everyday practice, problems of communication and interpretation and the pervasiveness of teaching. We offer a range of suggestions as to how these obstacles might be tackled.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

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。     

The influence of the economic crisis on quality of care for older people: system readiness for innovation in Europe

The aim of this study is to examine the influence of the recent economic crisis on the quality of long-term care for older people in Belgium and the Netherlands. A mixed-method approach was applied, primarily focused on conducting semi-structured qualitative interviews with health professionals working in a management role in organizations providing long-term care for older people. The results show that Dutch organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a sound system readiness. At the same time, Belgian organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a favorable sociopolitical context. Comparing two countries allows for reciprocal lesson-drawing. The conclusion drawn in this study is that a sustainable long-term care system requires above all stability and structure.     

Using photography to understand change and continuity in the history of residential care for older people

The Last Refuge by Peter Townsend is a seminal study of residential care for older people. The fieldwork was carried out in the late 1950s and the data are now deposited in the National Social Policy and Social Change Archive at the University of Essex. We have undertaken research, funded by the ESRC, which has revisited Townsend's work and some of the homes he studied in order to conduct an overtime comparison. In this paper we focus on Townsend's use of photography and our subsequent use of photography in our revisiting study. We argue that although Townsend did not analyse his photographs, they were significant data for use in his arguments critiquing residential care. They were, however, the product of a different socio‐historical context to our own and as such posed considerable practical and ethical challenges for us when attempting to use this aspect of his methodology for an overtime comparison. We argue that despite the resulting constraints, photography was an important part of our methodology, enabling comparisons and illuminating historical patterns in residential care for older people.     

Evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) in Western Australia: barriers to better service provision

This paper details a 2009-2010 evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) commissioned by the Disability Services Commission (DSC) in Western Australia (WA). The program, run by the Multiple Sclerosis Society of WA (Inc.) provides in-home care and supports and respite for people who are under the age of sixty-five and diagnosed with a rapidly degenerative neurological condition. In 2009, the identified barriers to the better provision of services included: shortage of quality out-of-home respite providers, and convoluted paperwork requirements to qualify for the program. Some service providers were unaware of the program and so were not referring them into the NCCCP, a number of service providers were unwilling to refer their clients into the program, neurologists were unwilling to give a final diagnosis for a client, that would enable them to qualify for the service, there was a general lack of knowledge about what services were available in the general community, and existing equipment pools were under-resourced. In 2010, the study found that most of the issues had been addressed however, out-of-home respite services were still very limited especially in rural areas, and the eligibility criteria for entry to the program is confined to those 65 years and under. This paper discusses the issues that still remain with the program as examples of barriers to better provision of services.     

Deaf Workers in Restaurant,Retail, and Hospitality Sector Employment: Harnessing Research to Promote Advocacy

ABSTRACT

A quarter-century after the passage of the Americans with Disabilities Act (ADA, 1990 Americans with Disabilities Act (ADA). (1990). P.L. 101–336, 105 Stat. 327, 42 U.S.C., 12101 et. seq. [Google Scholar]), workplace accommodation is still a struggle for deaf employees and their managers. Many challenges are the result of communication barriers that can be overcome through much needed—although often absent—advocacy and training. This article highlights the literature on the employment of deaf individuals in the United States service industries of food service, retail, and hospitality conducted from 2000 to 2016. Exploring dimensions of both hiring and active workplace accommodation, suggestions are made for how social work advocates can harness information and strengthen their approaches for educating managers and supporting workers.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.     

Increasing access to quality child care for children from low-income families: Families' experiences

Identifying effective strategies for increasing access to quality care for children from low-income families has important implications for society. This study examined the effectiveness of expanding child care assistance for low-income families (capping expenses at 10% of income and raising eligibility to 200% of the federal poverty line) to purchase quality care. Mixed methods documented families' experiences (N = 181) and capitalized on a natural experiment when families lost assistance. Results pointed to improved access to quality care for children from low-income families by: 1) helping low-income families continue utilizing quality providers when incomes dropped, and 2) enabling others to begin utilizing quality providers. Perceived impacts were greatest for families with higher incomes (within the eligibility range), and for those with children ages five and younger. Additionally, parents were able to pay providers the full rate that they charge for care, which may help quality providers continue serving low-income families.     

Innovations in care for children separated from parents: Transitioning from residential to family models of service

Research suggests that children develop best in families, but millions currently reside in residential care centers. Many residential care centers have transitioned their programmes from a to a family care model. Using a mixed methods design, the current study examined (1) antecedents to transition, (2) key elements in the process and (3) outcomes of transitioning models of care. Participants included 39 non-government organizations that had fully or partially transitioned to family care. Programmes collectively served 12 325 children and 29 499 families in 22 countries annually. Data revealed programmes perceived the change in the model was better for the families and children served.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.     

From dependence to interdependence: towards better outcomes for young people leaving state care

Young people leaving out of home care are arguably one of the most vulnerable and disadvantaged groups in society. Compared to most young people, they face particular difficulties in accessing educational, employment, housing and other developmental and transitional opportunities. Care leavers have been found to experience significant health, social and educational deficits including homelessness, involvement in juvenile crime and prostitution, mental and physical health problems, poor educational and employment outcomes, inadequate social support systems and early parenthood. These poor outcomes reflect a number of factors including ongoing emotional trauma resulting from experiences of abuse and neglect prior to care, inadequate support while in care, accelerated transitions to adulthood and lack of guaranteed ongoing financial and other assistance to help facilitate this transition. Young people leaving care do not currently receive the ongoing support that a good parent would be expected to provide for their children. Using relevant literature from the USA, UK and Australia, this paper examines the factors that contribute to these poor outcomes and potential policy and practice reforms that may lead to better outcomes for care leavers. Copyright © 2006 John Wiley & Sons, Ltd.     

The barriers to the effectiveness of culturally sensitive practices in health and social care services for Chinese people in Britain

This paper studies the problem that health and social care practitioners, intending to satisfy their ethnic minority users’ cultural preferences, end up providing services against their wishes. In particular it points out that this problem is caused by over-emphasising two key assumptions of ethnic minority groups. The first assumption is that all members of the same ethnic minority group organise their health and social care according to their cultural principles. The second assumption is that their cultural principles are monolithic. Demonstrating that these two assumptions may not necessarily be applicable to all ethnic minority groups, this paper discusses the diverse strategies used by Chinese people in Britain to organise their health and social care, and the differences between their two important cultural principles, Taoism and Confucianism. In order to demonstrate to professionals and the Government that they should not over-emphasise these two assumptions and that they need to pay attention to ethnic minority groups’ diverse needs, the paper suggests that different ethnic minority groups may need to unite to increase their influence in the service provision process. However it also warns that this tactic may lead to the subordination of minority group interests in the articulation of those large groups.