The welfare state, the individual and the need for care: older people's views

The aim of this qualitative study was to study how older people experience aging and reflect on their need for care in the Swedish welfare context. Sixteen people were interviewed, aged between 77 and 92 years. Staying healthy and independent in their everyday lives were prized values for the informants. Some brushed aside thoughts of being in need of home help services in the future and others had a more reflecting attitude. The informants did not want to burden either society or their children. Through mass media and the experiences of their neighbours, they had gained a negative impression of eldercare. They were uncertain if there would be any helping hand of good quality in the future. On the other hand, informants who already had home help thought that it was helping them to maintain independence in everyday life and they were also satisfied with the help they received.     

Experiencing breast cancer in the context of mental illness in New Zealand

ABSTRACT

This study aimed to explore the experiences of women with mental illness who had also experienced breast cancer diagnosis and treatment, in particular, to identify barriers and facilitators to cancer treatment. Semi-structured interviews were conducted with ten breast cancer survivors who had had contact with secondary mental health services prior to their cancer diagnosis. Thematic analysis was used to identify key themes. Participants described positive experiences of cancer treatment, expressing surprise at both how well they coped with diagnosis and treatment and how well they were treated by services. Many contrasted this with their less positive experience of mental illness and mental health services. The women interviewed were active participants in their cancer treatment and did not report feeling stigmatised because of their mental health experiences. A lack of connection between cancer and mental health services was described, but this was not regarded as necessarily a bad thing. This study begins to counter the stereotypes of the difficult patient or the person unable to understand and cooperate in their own care which are prevalent in the literature. Further work is needed to understand the reasons for disparities in cancer outcomes.     

The Single Assessment Process in Primary Care: Older People's Accounts of the Process

Recent government policies have been active in addressing socialinclusion and active participation of older people in many aspectsof societal life. Independence and well-being animate thesedevelopments and are evident in the emphasis on person-centredservices within the single assessment process for older people(Department of Health, 2002b). Drawing on a feasibility study of the Single Assessment Processas a ‘case-finding’ approach, this paper presentsfindings drawn from older people’s accounts of this experience.These accounts indicate the potential of the process for identifying‘low-level’ need, whilst raising issues of accessto formal services and resource constraint; also they underlinethe importance of understanding how older people seek ways ofmanaging their own health and well-being, whilst continuingto contribute to the social cohesion of society by providingsupport to their peers and to younger generations. Interdependence, it is suggested, rather than dependence shouldunderlie any approach to assessing older people’s needs,if we are to appreciate and build upon the complexity of olderpeople’s strategies for actively managing their lives.     

Home as a risk environment: Negotiating the boundaries of homes and social relationships in services for people using illicit drugs

This study focuses on how clients using illicit drugs are supported in managing the boundaries of their homes to avoid the risks that social relationships may have on their daily lives at home. The data consist of 14 client–worker encounters audio-recorded in 2017 in a Finnish home-based service for people using drugs. Discursive interaction analysis and geographies of home were applied to examine how boundaries of homes are negotiated in relation to social relationships and how the home is constructed as a risk environment in the interactions of the service. The results highlight that the tensions between home and social relationships can be complex in the context of illicit drug use. Managing the boundaries of the home and social relationships deserves special attention among welfare services to promote their client's right to privacy and attachment to a home environment. This is also important for preventing the risk of homelessness.     

Public Attitudes to Problem Definition and Problem Solving: A Pilot Study

Summary An attempt is made to discover how people define their problemsand on what basis they decide when, and from where, to seekhelp. The focus is upon legal problems since the study formspart of a wider project concerned with the provision of legalservices. Ignorance and misinformation concerning the availabilityof both social and legal services, combined with apathy andresignation on the part of many who need help, are importantfactors determining the non-use of services. Nor can people'sneeds be neatly categorized as social or legal. The overlappingnature of their problems exists at a structural as well as anindividual level; many of the legal problems experienced byindividuals arise from inequalities in the social and economicstructure of society.     

Early access and use of housing: care leavers and other young people in difficulty

This paper presents findings from a study of how care leavers access and use housing services, and what they said had helped them to do so. The sample comprised 80 care leavers, and, for comparison, a group of 59 young people (termed ‘in difficulty’) who met certain criteria of disadvantage. Care leavers were found to have fewer crisis transitions and less experience of homelessness, together with a much higher level of autonomy and support in their first accommodation, relative to other young people in difficulty. Several factors are identified that, from the care leavers' point of view, contributed to their better access and use of housing services, including having family and friends to turn to, and leaving care teams that negotiated on their behalf with housing services. The paper concludes that care leavers had more positive housing experiences than other young people in difficulty, helped by the improved preparation for independence and ongoing support available to them from leaving care teams.     

三言二拍中的监生形象探析

在“三言”、“二拍”中,小说作者塑造的一系列监生形象,主要有以下三个特征:一、生性风流,贪恋女色。二、游手好闲,不务正业。三、贪图钱财,不择手段。监生形象所具有的这些特征之所以在小说中如此艺术地逼真地体现并得到当时社会上的广泛认可,一方面因为监生这一形象本身具有一定的现实性,是明代中后期相当一部分人通过金钱财物获取功名地位的真实写照,另一方面与作者本人的经历、作者的小说创作观及其社会舆论对监生种种劣行的态度与看法有很大关系。     

What do children think about their social worker? A Q‐method study of children's services

Understanding how children experience social work interventions is an important part of gauging whether what is provided is genuinely helpful. In this paper, we describe the findings from a research project using Q‐method, aimed at understanding what children involved with statutory services think about their social workers and how they experience the time they spend together. Using a pre‐existing practice framework, we explored skills including empathy, collaboration, and purposefulness from the point of view of children and young people. The participants in our study (n = 22) were insightful observers of social work practice, able to describe not only how they experienced time spent with their workers but also inferring differences in motivation and approach. In addition, workers who were described in similar terms by different young people were nevertheless experienced differently. This suggests not an archetypal “good social worker”—instead, there are skills that are good for specific children at specific times within the context of specific relationships.     

The Citizenship of Excluded Groups: Challenging the Consumerist Agenda

The language of consumerism suggests that through involvement in consumer processes, consumers can influence policy formation and service provision. This paper examines, as illustrative cases in Australia, how two groups of consumers, people with a mental illness and older people, engage with these consumer processes. It finds they critically evaluate the opportunity offered by consumer processes for inclusion in policy and programmes. Both people with a mental illness and interviewed older people indicated how they acted as "agents involved in interpreting their needs", despite finding that in consumer processes their needs were predefined. Rather than allowing themselves to be constructed as passive objects, they positioned themselves as active citizens, having agency not as individual consumers but through drawing on networks. The responses of both groups go some distance toward dismantling power differences between professionals and "consumers", suggesting that social policy and programmes for both people with mental illness and older people can and sometimes do develop in a context of greater inclusivity.     

Paying for Old Age: Can People on Lower Incomes Afford Domiciliary Care Costs?

The Labour government has made it clear that it will not countenance major changes in the financing of long–term care for older people in England and Wales. One consequence is that people on modest retirement incomes will continue to have to pay for elements of their care in their own homes. The government also implicitly assumes that people of working age, on average and below–average earnings, are expected to save in order to pay for long–term care. However, evidence about individuals' willingness and ability to save and to pay for long–term care is scanty. Accordingly, an interview survey of 100 people—today's and tomorrow's pensioners—was undertaken in June and July 2000. They were asked detailed questions about their financial circumstances, and about their ability to pay more towards their own health and social care costs, now and in the future. The results suggest that today's pensioners on average and lower incomes are experiencing difficulties in paying for care services in their own homes. Tomorrow's pensioners who are currently on average and lower incomes will struggle to pay for care services in their own homes. The results also support the view that people tend to overestimate their retirement incomes and do not understand how long–term care is financed. They think that the government can and should pay for long–term care.     

“Moving from transactional government to enablement” in Indigenous service delivery: The era of New Public Management,service innovation and urban Aboriginal community development

Over the last 40 years, Aboriginal Community Based Organisations have played a distinctive role in society in relation to urban Aboriginal peoples and their rights to self‐determination and community development in the Australian city of Newcastle. They have proven essential to advocacy, the maintenance of community development, and the creation of new Aboriginal social infrastructure (community organisations, facilities, services, and supporting infrastructure). Autonomy has been empowering for local Aboriginal people. Major reforms to the delivery of government social services, particularly government enablement of a new social service market based on New Public Management principles, threaten this success. This interpretive, qualitative case study illustrates the effects of social service market enablement. It draws on a case study of the effects of social service market enablement on urban Aboriginal Community Based Organisations in Newcastle, showing the antagonistic relationship between social service market enablement and Aboriginal community enablement and development. It ends with a discussion of how Aboriginal community development in this city could be re‐enabled in light of the Prime Minister's arguments in his 2017 Annual Parliamentary Closing the Gap speech providing particular value in the context of policy discussions about moving from transactional government to enablement in Indigenous affairs.     

The Hopes and Fears of Older Australians: for Self,Family, and Society

This study refutes negative ageist stereotypes of how older people view themselves and society by reporting on their freely expressed main hope and main fear for the future. Data were collected through a population based cross‐sectional telephone interview survey conducted in NSW in 1999/2000. Participants (n=8,881) were randomly selected community dwelling older Australians (65+). Analyses revealed that participants were more likely to express a hope than a fear, and that a sizeable proportion of their hopes and fears were focused outwardly to family, or more broadly to social and environmental issues both locally and globally. These latter hopes and fears indicate awareness, interest and concern on a wide range of issues outside self and family. Some differences by gender and age were identified but views varied considerably among individuals. These findings provide evidence to dispel the negative image of older people as a self interested undifferentiated group whose members become progressively fearful as they age, by revealing an altruistic and outwardly focused dimension.     

Beyond the Family Metaphor: Facility Caregivers Remembering Their Families

Hands-on caregivers in long-term care facilities often describe their work as being “like family.” The literature has not sufficiently explained what like family means. This qualitative study analyzes the reports of 23 facility caregivers about what they found rewarding in their work. Six participants described how they remembered family members while on the job. They remembered family members they cared for or wanted to care for. Family members who had passed away were also remembered by 2 of the 6 participants. Remembering family members allowed participants to feel close to their loved ones and see their work as giving back.     

Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life

Transitioning from military to civilian life is challenging for a substantial number of veterans. Successful transitions require veterans to function well in various well-being domains including employment, education, financial, health, and social relationships. There are many programs and services designed to assist veterans transition to civilian life. However, veterans rarely avail themselves of supportive resources. This study examined veteran nonuse of programs and services within the first three months of their transition to civilian life. Results revealed that male veterans often reported that they did not need programs. Female veterans and veterans from the lowest enlisted ranks were more likely to report that they did not know if they were eligible for support programs. A small percentage of veterans indicated they had not found the right program or did not know where to go to get help. Veterans need clear information about available programs, eligibility requirements, where to locate them, and how to identify which programs will benefit them. Future research should focus on what predicts veteran use of programs and services, how use changes over time, and how programs and services should be advertised/marketed to different veteran populations, particularly those at risk for poor transition outcomes.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

The dynamic,complex and diverse living and care arrangements of young New Zealanders: implications for policy

The living arrangements of young people in New Zealand are diverse and often complex. In this article we report the range of care and living arrangements of 209 15-year-old New Zealanders, 47 of whom identified as Māori. These young people were participants in the second generation of a cohort study. Data were collected from their parents via a life history calendar and analysed for variety and consistency of care arrangements, household membership and transitions. Few participants had a consistent pattern of parental care arrangements and most had experienced multiple changes in household composition and frequent changes of address. We conclude that the whānau/family lives of many young New Zealanders are complex and dynamic. These observations contrast with the conventional notions of family life that form the basis for New Zealand’s family policies. We argue that social policies and services impacting on young people need to reflect the lived reality of young people if they are to meet young people’s needs.     

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

ABSTRACT

Use of private social care services among older people is increasing in Finland. This study aims to understand why older people choose private care in a comprehensive tax-subsidized social care system and examines whether people choose private service as a free choice or a forced choice as well as what factors contribute toward making these choices. Data for this study (N = 1,436) were gathered in 2010 from people aged 75 and above living independently at home in two Finnish cities: Tampere and Jyväskylä. Data were analyzed with several quantitative tests: chi-squared tests, multinomial regression analysis, and qualitative content analysis (for the open-ended responses from the survey questionnaire). Findings reveal that people chose private services mostly because of the effortlessness involved in its use and of the need for additional services that are unavailable through municipality; for example, cleaning. Majority of the respondents performed a free choice to use private services. People who lived in a city center with a higher level of income and who needed more services were more likely to be constrained toward using private support. Major concern, due to diminishing public service provision, is about service accessibility of economically disadvantaged groups; therefore, more research is required to understand the effects of the growing care market in Finland.     

公共气象与服务民生——以日本气象服务为鉴

公共气象服务是基础性公共事业,在为国家战略、民生决策提供保障与支撑的同时,还要贴近民众,提供个性化、针对性强、适时的服务,树立气象事业＂决策国计、服务民生＂的理念。中国和日本同属东亚国家,两国在气象服务对象、气象的公益性等方面没有本质上的差别,差异在于体制不同,业务内容不完全一样。日本现代科学技术起步早、发展快,气象事业也是如此。应当借鉴日本在气象服务方面的成功经验,在我国公共气象服务方面深入开展多样化、细致化服务,为经济科学发展、民众安居乐业、社会和谐进步提供支持和保障。