Volunteerism and Older Adults

Abstract

This study was designed to examine differences in care-giver and care recipient characteristics, caregiving and work demands and resources, and role strain among Black, Hispanic, Asian, and White employed family caregivers. Significant differences were found with respect to caregiver and care recipient characteristics, types of assistance provided, and workplace support. Minority caregivers were economically disadvantaged and provided higher levels of care. Whites reported higher levels of role strain than Black and Hispanic caregivers, after controlling for caregiver and care recipient characteristics, demands, and resources. The findings indicate that care giving policies and programs must be broadened to incorporate the strengths and needs of ethnically diverse caregivers. Family practitioners need to be able to assess the applicability and differential impact of particular interventions, policies, and benefits, and to design relevant programs for ethnically diverse care-givers and their families.     

An Exploration of Congruence in the Community Service Use Attitudes of Older Spousal Caregiver–Care Recipient Dyads

ABSTRACT

This study explored within-dyadic congruence in community service use attitudes of older spousal caregiver–care recipient couples. Primary data collection consisted of in-person, standardized survey interviews with 30 caregiver–care recipient pairs. The study employed the intraclass correlation coefficient (ICC) to examine within-dyadic similarities on caregivers' and care recipients' responses to 29 items from the Community Service Attitude Inventory (CSAI). To measure the degree of match between caregiver and care recipient pairs, ICCs were calculated for each dyad (n = 30) and ranged from ?.26 to .84, indicating variation in the degree to which caregivers and care recipients displayed congruence on community service use attitude scores. The distribution of the Index of Dyadic Similarity was highly negatively skewed (skewness = ?2.159), indicating overall patterns of similarity at the dyadic level of analysis. Service use preferences and values across the seven attitudinal domains (confidence in service system, wait-and-see attitude, concern for opinion of others, pride in family independence, rejection of government assistance, worry and fear about outside help, and preference for informal care) were similar between dyadically related individuals. Although the overall trend of dyadic similarity was notable in this sample, variation in the Index of Dyadic Similarity suggests the need for future dyadic-level research to better understand within-dyadic congruence on specific attitude constructs and in relationship to service use outcomes. Specific methodological challenges relevant to conducting dyadic-level primary research with older spousal couples are discussed.     

Do public services influence patterns of informal care? Informal networks and public home care in three Swedish municipalities

Whether an individual receives home care services depends on two factors: the functional disability of the care recipient and the caregiver's gender, when the living arrangements of the care recipient are controlled. Data from this longitudinal study of social networks and home care organization in 3 municipalities in Sweden show that care recipients with a severe disability received more home care services than others. In cases where the main caregiver lives together with the care recipient, the public services are adjusted to the family situation and are independent of the functional disability of the care recipient. Care recipients who live with the primary caregiver receive less formal help than do care recipients who live alone. When the primary caregiver does not live together with the care recipient, the public services are adjusted to the functional disability of the care recipient and are independent of the primary caregiver's gender. Care recipients supported by a male helper received more formal help than care recipients supported by a female helper. Those supported by a female helper received more informal help. Various models of relationships, supplementation and complementation between informal care and public services are discussed. The dependence on public home services is high. Assistance with basic activities of daily living is the first area requiring complementary contributions from the public services. A special type of kin independene was found, related to the function of public services in a modern and gender-equal society. The results provoke a discussion on research design as well as comments on welfare policy and gender equality in the transformation of the welfare state.     

The Association of Team Composition and Meeting Characteristics With Foster Care Placement Recommendations

ABSTRACT

Research shows that changing foster care placements is associated with negative outcomes for children. This study examines the extent to which Team Decision Making (TDM) can influence placement recommendations for children currently in foster care. Using administrative data from three sites, logistic regression models are fitted to estimate the association of team and meeting characteristics with placement recommendations. Controlling for demographic differences across sites, results show that caregiver attendance significantly reduces the likelihood that a child will be recommended to change placements, specifically, to less restrictive and more restrictive placements. Implications for practice and future research are discussed.     

Home-Based Palliative Care Study

Abstract

Purpose: To examine differences in site of death and costs of services by primary diagnosis for patients receiving home-based palliative care as compared to usual care at the end of life verity of illness, service use, and site of death.

Design and Methods: A nonequivalent group design was employed with 298 terminally ill patients diagnosed with cancer, CHF, or COPD enrolled. The treatment group received an interdisciplinary home-based palliative care program and the comparison group received usual Kaiser Permanente services. Data collected included patient demographics, se-

Results: Among all diseases, patients enrolled in palliative care were more likely to die at home. Enrollment in palliative care was significant associated with cost reductions for patients with cancer, COPD, and CHF. No significant difference was found between diagnostic groups in terms of magnitude of cost savings.

Implications: Provision of interdisciplinary home-based palliative care at end of life can effectively increase the likelihood of dying at home for patients with CHF, COPD, and cancer while realizing significant COSt savings.     

Family conflict and future concerns: Opportunities for social workers to better support Chinese immigrant caregiver employees

ABSTRACT

This paper explores the experiences of Chinese immigrant caregiver employees (CEs) residing in Southern Ontario, Canada. Qualitative analysis of participant interviews with thirteen Mandarin Chinese immigrant CEs revealed family conflicts due to cultural differences and an intergenerational gap between CEs and their care recipients. CEs also had future concerns in regards to their own health and the lack of long-term care facilities that offer cultural services for immigrant seniors. These findings provide an opportunity for social workers to collaborate with other service providers to provide ethno-specific and culturally sensitive health, community. and employment services to immigrant ethnic minority CEs.     

Gerontological Social Work Student-Delivered Respite: A Community-University Partnership Pilot Program

ABSTRACT

This study describes a community-university partnership to support a gerontological social work student-delivered respite program, the Houseguest Program (Houseguest). Houseguest was designed using a community-engaged scholarship model of integrating research, teaching, and service. Houseguest was piloted with a small group of community-dwelling, coresiding dementia caregivers and care recipients. We examined caregivers’ experiences with student-delivered respite using qualitative data analysis. Thematic analysis produced 8 themes: (a) respite from full time caregiving role, (b) information on caregiving strategies, (c) no-cost supportive services, (d) opportunity for care recipients to socialize, (e) tailored activities for care recipients, (f) rapport-building between students and family dyad, (g) reciprocity between students and family dyad, and (h) program continuation. We conclude with a proposed community-engaged scholarship model for dementia caregiving. Through a community-university partnership, Houseguest reduced the impact of caregiver burden and created an opportunity for students to serve families affected by dementia through respite and tailored activities.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis

ABSTRACT

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although public-private partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources.

Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on state-provided care, use of expensive private care, and waiting lists to secure services.     

Friendship Across the Life Cycle

Abstract

Using a group work model, this article discusses a short term group for older women developed to explore the importance of friendship in late life. In collaboration with group leaders, group members determined weekly topics that explored the significance of friendship through the life cycle. Social work group practice that focuses on the meaning and development of friendship for and with older women is presented as an effective therapeutic intervention for practitioners in settings such as community mental health clinics, senior centers, elderly housing, home care agencies and nursing homes.     

Living with and Caring for Older Family Members

Abstract

Using the strengths-based Caregiver Well-Being Scale, this research provides social workers with strategies for assessing and promoting caregiver well-being. One hundred eighteen family caregivers (64 spouse and 54 adult child caregivers) are used to examine caregiver relationship to the care-recipient and 138 caregivers are included in the analyses for coresidential arrangement with the care-recipient. Predictors of well-being are highlighted for each group. Caregiver competence and depression predict well-being for spouse, adult child and non-co-resident caregivers. Depression is the only predictor for co-resident caregivers. Using the activities of living sub-scale, depression predicts wellbeing for all groups. Additionally, caregiver strain relates to spouse wellbeing. Implications for social work practice with family caregivers are highlighted.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

ABSTRACT

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.     

A Survey of the Unmet Needs of Homebound Elders

Abstract

In conjunction with the 1995 White House Conference on Aging (WHCoA), the authors conducted a study of 917 homebound elders in one state in order to determine whether medications and medical care were always affordable and accessible, and how nursing home care would be paid for if needed. For more than two-fifths of the sample, paying for physicians' services and medications, as welt as locating reliable medical transportation was problematic at times. A similar proportion did not know where they would turn for assistance if family and friends were unavailable. Although Medicare only pays for up to 100 days under certain circumstances, more than half of the sample projected that Medicare would pay for nursing home care if it was needed. The authors conclude by discussing the WHCoA resolutions and resulting social policy implications.     

Instability and caregiving in the lives of street‐involved youth from foster care

A large proportion of youth who become street‐involved have experience in foster care, and our sample of 92 street‐involved youth, aged 14–18 years, all had foster care experience. We report on (i) instability of guardians and home from birth to street involvement; (ii) the connection between perceptions about foster care and measures of well‐being; and (iii) the implications of these findings for understanding street‐involved youth and the role of foster care in their life. The average number of transitions per youth from birth to mid‐teens was nine. Youth with experience in permanent care first lived away from biological parents at age 8.5 years, and for those with temporary care experience, it was age 10 years. Foster care was one of many living situations and one of several sources of caregivers. If participants were satisfied with foster care, they were more likely to be currently hopeful and happy. Participants who experienced positive influences from at least one long‐term caregiver tended to have other positive caregiver experiences, and those with negative influences were more likely to also have a positive relationship with a female caregiver. Foster care was one of several ‘way stations’ in their lives, one whose meaning needs further study.     

Access to Services by the Elderly:

Abstract

This analysis evaluated the hypothesis that comorbidity, as a measure of physical health status, would negatively impact the stress management capability of caregivers. To examine this relationship, data from 3,112 caregivers participating in the Uniform Caregiver Assessment through California's Caregiver Resource Center System in 2000 were used. Results indicated that comorbidity was not a significant predictor of caregiver inability to manage stress; however, high depression scores, disruptive behavior by the care receiver, and reduced social support from family and friends were significantly associated. Implications for social workers in these areas are discussed.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.