Old-Age Homes and Services

Summary

Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve non-aged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.     

Toward a Definition of Assisted-Living

The purpose of this research was to identify the concept of assisted-living (A.L.) by the physical characteristics of the setting, services offered therein, and functional competence of residents and to ascertain its position within an existing continuum of care typology. Ten A.L. facilities in southeastern Florida participated in this study. Photographic documentation, informal interviews, and promotional literature generated the data for content analysis. Response to a survey questionnaire provided additional information. Findings show that physical characteristics of facilities focus on creating a residential milieu. Services include meals, personal care, medical assistance, housekeeping, utilities, social activities, scheduled transportation, and security. Residents are semi-independent. They do not require skilled care. Placement of A.L. within an existing continuum of care typology is considered to be on the same level as homes for the aged, also called adult homes or personal care homes. From this standpoint A.L. is considered to be an old concept made new.     

The Effect of Care Setting on Elder Abuse: Results from a Michigan Survey

This study compares abuse rates for elders age 60 and older in three care settings: nursing home, paid home care, and assisted living. The results are based on a 2005 random-digit dial survey of relatives of, or those responsible for, a person in long-term care. Nursing homes have the highest rates of all types of abuse, although paid home care has a relatively high rate of verbal abuse and assisted living has an unexpected high rate of neglect. Even when adjusting for health conditions, care setting is a significant factor in both caretaking and neglect abuses. Moving from paid home care to nursing homes is shown to more than triple the odds of neglect. Furthermore, when computing abuse rates by care setting for persons with specified health conditions, nursing homes no longer have the highest abuse rates.     

Quality of Life in Nursing Homes

Abstract

The Nursing Home Reform Act (NHRA) of 1987 established nursing home requirements and dually emphasized quality of care and quality of life outcomes. We researched elders' perceptions of quality of life in nursing homes using focus groups. Analysis revealed four major themes important to residents: generativity, spiritual well-being, homelike environment, and privacy. Themes were used to analyze the disparity between NHRA's goal of dual emphasis and the dominance of quality of care in the treatment of frail elders living in nursing homes. Policies and procedures must be developed that promote decisional control in everyday matters of an older person's life.     

Recent developments in institutional elder care in China: changing concepts and attitudes

This study examines recent developments in institutional care for Chinese elders and attitudinal changes toward institutional care in Tianjin, China. Based on studies in 12 elder home sites and survey interviews with 265 older residents, this study compares institutional differences between government and non-government-owned elder homes, and examines elders' evaluations of elder homes' quality and their level of willingness to stay in elder homes. Findings suggest that government-owned elder homes still enjoy institutional and bureaucratic privileges in funding, staffing, and insurance. Elders' overall evaluation of elder home quality was high. Elders' former living arrangement and financial ability were related to their willingness to stay in the elder home. The unfair competition between governmental and non-governmental elder homes is likely to hinder the development of elder home industry in the free-market system and foster a growing gap between the rich and poor elders in their capability and decisions in elder home care. As adult children become increasingly unavailable due to the one-child policy and geographic mobility, institutional care for aging parents is likely to become one of the major options for parent care.     

Child care assistance and nonstandard work schedules

Child care is a necessary work support for many American families, but can be prohibitively expensive for those with low incomes. The federal government provides assistance through direct child care subsidies, but only a fraction of eligible families are in receipt. One factor that may limit access to child care assistance is work schedule. Research suggests that mothers with nonstandard work schedules use relative care more and day care centers less than those with standard work schedules. Research also shows that child care subsidies are disproportionately used for day care centers. This suggests that mothers who work nonstandard schedules may be less likely to receive child care assistance, but little empirical work addresses this question directly. Using data from a cohort of urban, unmarried mothers, this study explores the direct and indirect relationship between work schedule and receipt of child care assistance. The findings suggest that nonstandard work schedules reduce the odds of receiving child care assistance; a relationship mediated entirely by less day care center use among nonstandard schedule workers. The results imply that more flexible child care assistance is needed to meet the needs of these workers, possibly provided outside of the direct-subsidy system.     

An Exploratory Study of Preparation for Future Care Among Older Latinos in Utah

Preparation for future care by 62 Latino elders was examined and compared to an Anglo sample of 288 elders residing in Utah. Latino older adults preferred relatives for help and assistance, but 91% of them (versus 41% for the Anglo sample) did not have any concrete plans for either short-term or long-term care. Logistic analyses show that age and knowledge of services are significantly related to planning for care, but education and filial obligations are not. Furthermore, ethnicity significantly predicted long-term care planning when its interactions with age and knowledge of services are accounted for. Knowledge of services and age played a greater role in facilitating preparation for future care for Latinos than for Anglos.     

What Does it Mean to Listen to People with Dementia?

A total of 19 people with dementia were interviewed as part of a study into unmet respite care need amongst caregivers and day-care attenders in Sheffield. Some important contextual debates associated with conducting social research with people with dementia are considered. These include informed consent, competency, and how the interests of caregivers and people with dementia are bound together. A form of process consent was used in conducting semi-structured interviews with day-care attenders. Day-care attenders spoke about 'being here' in a number of ways. These include their initial experiences, their sources of satisfaction and their sense of being in families. These substantive findings and the associated methodological insights suggest day-care attenders have important things to say as service-users if appropriate strategies for listening are employed. Service-providers can collaborate imaginatively with day-care attenders to actively explore how care might be shaped by the experiences of persons with dementia.     

The Long-Term Care Ombudsman Program and Complaints of Abuse and Neglect:

This historical summary demonstrates that concern about elder abuse and neglect in long-term care facilities has played a vital role in the development and expansion of the Long-Term Care Ombudsman Program (LTCOP). Some 15 years after the Older Americans Act mandated ombudsman services in all nursing homes, the 1989-1990 state LTCOP reports were analyzed for information about abuse and neglect of elders in nursing homes nationwide. Following a brief review of the nursing home abuse literature, this paper reports on the findings from the 1989-90 reports about complaints of abuse and neglect and their implications for future research.     

Housing Policy and the Elderly

Subsidized senior high-rise apartments have tended to neglect the needs of an increasingly aged and frail resident population. Research demonstrates that this population has greater unmet needs than elderly who reside in traditional community housing. This paper makes the case for enriched senior high-rise apartments as a viable alternative for elders who need assistance in order to maintain an independent lifestyle.     

Formal and Informal Community Care to Older Adults: Comparative Analysis of the United States and Great Britain

Support to frail elders is of international and growing importance. This article compared receipt of assistance with ADL limitations, home health help, any assistance received, and unmet needs in functionally impaired individuals aged 70 years old or older in the United States (n = 1847, 80% women, M _age = 80 years) and Great Britain (n = 1203, 57% women, M _age = 78 years). Informal and formal assistance levels were higher in Great Britain, and rates of unmet need did not differ across ADL domains measured. Receipt of formal and informal care were associated positively, which is consistent with both supplementary and complementary perspectives on the formal-informal care interface. Few individuals in either country received formal services alone. Results suggest that community-based formal support does not substitute for family help. Implications for family and economic policy are discussed.     

Foreign Domestic Workers and Home-Based Care for Elders in Singapore

As with other developed nations where rapid population aging has led to increasing health care and social care burdens, Singapore has searched for ways of paying for and providing long-term care for its increasing numbers of elders. The Singapore state, faced with the prospect of one-fifth of the population aged 65 or older by 2030, has reinforced its basic principle of rendering the family the “primary caregiving unit” and home-based care as the highly preferred option for eldercare. Our paper demonstrates why, despite the range of alternative care arrangements available or emerging on Singapore's eldercare landscape, the employment of live-in foreign domestic workers as care workers for the elderly has become one of the more common de facto modes of providing care for the elderly. In this context, we discuss the politics of eldercare in the privatized sphere of homespace and conclude with policy implications relating to the employment of foreign domestic workers as caregivers for the elderly.     

Urban American Indian/Alaskan Natives compared to non-Indians in out-of-home care

Historically, American Indian/Alaskan Native (AI/AN) children have been disproportionately represented in the foster care system. In this study, nationally representative child welfare data from October 1999 was used to compare urban AI/AN children to non-Indian children placed into out-of-home care. Compared to non-Indian children, urban AI/AN children were older, were more often male, came from poorer homes, and were more frequently placed into group homes/ residential placements. Urban AI/AN caregivers had a greater prevalence of alcohol abuse and mental health problems compared with non-Indian caregivers.     

Cost-containment,computers and confidentiality

The profession of social work has clear standards to follow in protecting confidentiality when a client discloses information in a psychotherapy session. These standards are examined in relation to an ever-increasing diresrefard for privacy as staff of managed care for mental health services and employee assistance programs gather and store information in computer databases, with the overall objective of cost-containment. Ethical principles are discussed and suggestions are made for safeguarding, the client's right to privacy.     

NGO Development in Croatia

SUMMARY

This paper reports on the phenomenon of de facto interdisciplinary community practice to promote the growth and development of NGOs (non-governmental organizations) in Croatia. While there has been dramatic expansion in the role of NGOs in Croatian society, no academic discipline has taken the initiative to provide systematic professional training in community practice theory, methods, and techniques. This study examines the role of intermediate NGO support centers, which partially meet this need by offering consultation, training, technical assistance, mentoring, and coaching. One support center, the Center for Civil Initiatives (CCI), is examined in detail, while additional data is drawn from three similar organizations. Professional staff, outside consultants, and volunteers from these centers usually have expertise in a wide variety of practice areas and academic disciplines. However, they do not operate from an interdisciplinary paradigm or practice model. Core knowledge theories and principles embracing an interdisciplinary approach for work with NGOs should be developed within the Croatian system of higher education. Social work has strong potential to develop the theoretical and methodological knowledge necessary to establish an interdisciplinary practice model for NGO development in Croatia.     

Social networks of old people in India: research and policy

This article presents a comparative analysis of the available research on the social networks of older persons in India. Most of this research has been done in North Indian cities. The research foci of the available studies include network size, core networks and beyond, life course changes in networks, impacts of residency in old-age homes, gender differences, and joint and nuclear family residence. This research is discussed in terms of its policy implications. Because the research demonstrates that social networks are important for the welfare of older Indians, one can conclude that social policy that encourages the maintenance of robust networks throughout the life course may be worth pursuing. One aspect of policy is discussed. The analysis of the relationship between social network and gender suggests that current policies that can be seen as supporting gender inequality in terms of property may have a negative impact on the networks of older women.     

Does Child‐Care Quality Mediate Associations Between Type of Care and Development?

Studies document that, on average, children cared for in centers, as compared to homes, have higher cognitive test scores but worse socioemotional and health outcomes. The authors assessed whether the quality of care received explains these associations. They considered multiple domains of child development—cognitive, socioemotional, and health—and examined whether mediation is greater when quality measures are better aligned with outcome domains. Using the Early Childhood Longitudinal Study Birth Cohort, they found that children in centers have better cognitive skills and behavioral regulation than children in homes, but worse social competence and generally equivalent health (N = 1,550). They found little evidence that quality of child care, as measured by standard instruments (e.g., the Early Childhood Environment Rating Scale—Revised), accounts for associations between type of care and child developmental outcomes.     

Philanthropists,Professionals and Feminists: Refugee NGOs and the Empowerment of Syrian Women in Gaziantep,Turkey

The diversification of gender‐based priorities and the necessities of refugees have led refugee NGOs to launch activities specifically for women, or urged women‐only NGOs to take action particularly for refugee women in Turkey. Drawing upon a qualitative research in Gaziantep in Turkey, which host a large population of Syrian refugees, this study seeks to answer the question “How effective are NGOs in empowering Syrian refugee women in Turkey?” It is argued that NGOs working in the provision of assistance to refugees cannot be treated as a homogeneous group in terms of the degree and form of their influences on the empowerment of refugee women, and the individual NGO’s standpoints may shape their effects. Data from interviews with NGO representatives and Syrian women who have received support from NGOs indicate that the NGOs’ perceptions of women’s issues and their contribution to the empowerment of women are closely linked to their type.     

Long-Term Care

This study examines the redistributive effects of public pensions on old-age income inequality, testing whether public pensions function as the “great equalizer.” Unlike the well-known alleviating effect of public pensions on old-age poverty, the effects of public pensions on old-age income inequality more generally have been less examined, particularly outside Western countries. Using repeated cross-sectional data of elderly Koreans between 1998 and 2010, we applied Gini coefficient decomposition to measure the impact of various income sources on old-age inequality, particularly focusing on public pensions. Our findings show that, contrary to expectations, public pension benefits have inequality-intensifying effects on old-age income in Korea, even countervailing the alleviating effects of public assistance. This rather surprising result is due to the specific institutional context of the Korean public pension system and suggests that the “structuring” of welfare policies could be as important as their expansion for the elderly, particularly for developing welfare states.     

Support Network Connectedness in the Lives of Community-Dwelling Rural Elders and Their Families

Rural elders face challenges when accessing assistance from family, neighbors, and paid helpers. This support is essential to allow them to remain community dwelling as they develop physical challenges that limit their ability to care for themselves. This qualitative study followed a group of 16 rural elders with physical limitations for 1 year. In-depth interviews were conducted with them and eight members of their support networks, including five family members, to explore how rural older adults create and maintain support networks that allow them to remain community dwelling despite physical challenges that limit their self-care. The research question is, “How do members of the support network connect with each other to maximize the effectiveness of the network?” Family members coordinated assistance to maximize the abilities and availability of various network members. In addition, family members worked together with other family members, neighbors, and paid helpers to assist the elder. These strategies enhanced the ability of the network to assist the rural elder and also lessened the burden of care by dispersing it among network members.