The Affordable Care Act: Implications for African Americans Living with HIV

This article reviews the Patient Protection and Affordable Care Act (ACA), 2010. It highlights the implications of the ACA for African Americans living with HIV/AIDS. This law is a practical step toward decreasing disproportionate chronic disease in vulnerable communities. Proper implementation of provisions will help the United States catch up to other industrialized nations with well-established public health care programs. Included is a concise table referencing notable provisions that support increased access to treatment, health education, and quality of care for clients. Social workers can use this information to ensure that clients benefit from this legislation.     

The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.     

Understanding the role of Australian Aboriginal maternal infant care workers: bringing a cultural dimension to a critique of the ideal worker concept

Models of care that include a prominent role for Aboriginal workers are fundamental to improving the health of Aboriginal Australians. However, tension arises when these models co-exist with mainstream models, contributing to difficulties sustaining an Aboriginal workforce. The ‘ideal worker’ theory is drawn on to explore whether historical workplace norms undermine the roles of Aboriginal workers in an Australian hospital setting. In-depth interviews were conducted with 30 staff and clients of an innovative maternity service, featuring Aboriginal Maternal Infant Care (AMIC) workers caring for Aboriginal women in partnership with midwives. A phenomenological methodology highlighted that unrealistic and inappropriate assumptions embedded in the ideal worker notion underpin many challenges facing AMIC workers. These workers have deep ties to their communities, with extensive responsibilities beyond the workplace. Although the hospital system relies on these ties to engage clients, this time commitment and the unbounded ways in which AMIC workers provide care are not acknowledged. Findings illustrate how the ideal worker concept has a cultural and gender dimension, which undermines AMIC workers and does not value culturally relevant care. This work has implications for ingraining cultural competence into health care, suggesting the wide-ranging contributions of Aboriginal workers must be recognised to achieve sustainable reform.     

Care coordination for dually eligible medicare-medicaid beneficiaries under the affordable care act

The coordination of Medicare and Medicaid benefits and services for dually eligible enrollees has been a longstanding policy challenge. Several provisions of the Affordable Care Act (ACA) attempt to address this lack of coordination, including the establishment of the Federal Coordinated Health Care Office. This paper reviews the major changes under the ACA directed at care coordination for the dually eligible population and then concludes with a discussion of the continuing legislative and legal challenges in integrating care for the dually eligible.     

Medicaid home- and community-based services: impact of the affordable care act

The Affordable care Act (ACA) legislation of 2010 has three important voluntary provisions for the expansion of home- and community-based services (HCBS) under Medicaid: A state can choose to (1) offer a community first choice option to provide attendant care services and supports; (2) amend its state plan to provide an optional HCBS benefit; and (3) rebalance its spending on long term services and supports to increase the proportion that is community-based. The first and third provisions offer states enhanced federal matching rates as an incentive. Although the new provisions are valuable, the law does not set minimum standards for access to HCBS, and the new financial incentives are limited especially for the many states facing serious budget problems. Wide variations in access to HCBS can be expected to continue, while HCBS will continue to compete for funding with mandated institutional services.     

<Emphasis Type="Italic">What do unions do?</Emphasis>—A management perspective

conclusion Over the past 30 years, progressive human resource policies and government regulation of the workplace have improved working conditions. Today unions are no longer exercising union power to“protect the underdog” or “level the playing field” (Kaufman, 2005). Unions are using their power to pass legislation to benefit their narrow special interests. There are two groups in the workforce that may provide unions with organizing opportunities. One segment of the workforce is the growing number of nonpermanent employees or contingent workers. Another is the growing low-wage part of the service sector. The Service Employees International Union has been one of the few unions to expand membership among these employees. The aging of the baby boomers will raise the demand for service workers in health care facilities and in hotel and office maintenance which will increase organizing opportunities for unions in this industry (Kosters, 2004).     

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.     

Long-Term Care Insurance in Japan

Abstract

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan? This article presents answers to these questions.     

Times of transition: elder abuse and neglect in Israel

The present paper addresses the advancement of research, policies, legislation, and practice experiences designed to deal with the phenomenon of elder abuse and neglect in Israel in times of transition. The paper presents a short overview of the demographic scene, reflecting population characteristics and needs that impact care giving as well as elder abuse and neglect. The developments of scientific knowledge and its accumulation, especially the empirical data from the first national survey on elder abuse and neglect are discussed. Further, legislative developments relating to four generational laws and the advancement of policies and innovative practice experiences are described and analyzed. Finally, future challenges in the field are identified.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

Maternal and child health and family planning services in the Sudan

Given the high rates of infant and maternal mortalty, the prevalence of infectious diseases, poor nutritional status among women and children, and numerous endemic diseases such as malaria and bilharzia, maternal-child health serivces have been given a high priority in the Sudan. In reality, however, this area has not received adequate attention within the primary health care system in terms of management, service provision, and training. Major obstacles to effective maternal-child health services include: 1) the lack of involvement of community health workers, the main providers of other primary health care services in the Sudan, in the area; 2) the clinical orientation of physicians, which mitigates against attention to the promotive and preventive components of health care; 3) a lack of standardization of medical records or data collection routines, which hinders program monitoring; and 4) the failure to integrate related national programs such as immunization into a comprehensive maternal-child health program. In addition, there are administrative and organizational obstacles, such as the lack of institutionalization of maternal-child health services within the Ministry of Health, inadequate managerial capabilities, an absence of guidelines for service delivery at the regional and provincial levels, delays in the procurement of equipment and supplies, a widely dispersed population, and transportation difficulties. Family planning, too, is supposed to be the responsibility of all primary health care workers in the Sudan. However, current training programs for physicians, nurses, village midwives, and community health workers do not prepare them to fulfill this role. Development of an official population policy in the Sudan is recommended to ameliorate some of these problems.     

Times of Transition: Elder Abuse and Neglect in Israel

ABSTRACT

The present paper addresses the advancement of research, policies, legislation, and practice experiences designed to deal with the phenomenon of elder abuse and neglect in Israel in times of transition. The paper presents a short overview of the demographic scene, reflecting population characteristics and needs that impact care giving as well as elder abuse and neglect. The developments of scientific knowledge and its accumulation, especially the empirical data from the first national survey on elder abuse and neglect are discussed. Further, legislative developments relating to four generational laws and the advancement of policies and innovative practice experiences are described and analyzed. Finally, future challenges in the field are identified.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

Caring Labor and Class Consciousness: The Class Dynamics of Gendered Work

Previous research on class consciousness has not examined the gendered nature of paid labor. Paid caring laborwork that involves the direct provision of care to clients or customers—now comprises 20% of the labor force. This is work that tends to place workers in conflict with the goals of management. The conflict between caring values and exchange values may lead workers to greater levels of class consciousness. I use national survey data to examine whether workers in caring labor occupations are more class conscious than other workers. Results indicate that caring laborers are more likely to be pro–working-class conscious than other workers after controlling for class position, income, education, government and nonprofit sectors, sex, and race. Workers in high intensity caring jobs are especially likely to be class conscious. This suggests that, at crucial points, the logic of caring and the logic of commodification are at odds.     

Towards an Integrated Approach to a Family Intervention for Co‐occurring Substance Abuse and Schizophrenia

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate.     

The Revitalization of Community Practice: Characteristics,Competencies, and Curricula for Community-Based Services

Abstract

A recent move toward community-based services on the part of direct service agencies presents a major opportunity for the revitalization of community practice. Driven by funding from major philanthropic foundations and also by recent changes in federal entitlement legislation, these efforts at system reform are designed to make services for vulnerable populations more effective, accessible, integrated, and comprehensive in the context of the local community. Although this service reorganization requires the type of methods typically found in community practice, direct service workers employed in these agencies usually have not been trained in community work. To begin to address this concern, this article uses a computerized word search to review the community practice and community organization literature. A working definition of “community-based” practice is developed. The extensive literature review yields six characteristics of community-based service delivery: (1) neighborhood-based and family-focused; (2) strengths- and empowerment-oriented; (3) cultural sensitivity and multi-cultural competency; (4) comprehensive services; (5) access to integrated services and supports; and (6) teamwork and leadership skills. The article reviews what scholars have recommended in each of these areas as a way of understanding the characteristics of community-based service delivery and the skills needed by direct practitioners working in community-based programs. The article summarizes innovative curricula and specific courses which demonstrate ways of teaching community skills to direct practice workers. Future work for community practice scholars and educators is recommended.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

Asian Community Mental Health Services at 35: a pioneering ethnic organization (1973-2008)

Asian Community Mental Health Services is a nonprofit organization that delivers mental health services to primarily Asian and Pacific Islander communities. From its early beginnings and over its 35-year history, the agency has had to overcome numerous challenges, including gaining legitimacy as a culturally specific nonprofit, combating stigma surrounding mental health issues within the Asian Pacific Islander community, building resources to fund service delivery, and developing an educated and culturally sensitive workforce. The history of the organization highlights the multiple challenges and rewards of developing a culturally specific nonprofit in an urban area as well as the important role that internal operations play in relation to nonprofit expansion and growth.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

Training Strategies for Elder Abuse/Inadequate Care

A key component in the efforts to deal with elder abuse/inadequate care is the development of educational programmes for both the public and responsible staff. This article explores the development of training programmes that address the needs of adult learners in the caring professions. Central to the success of the training was the programme design that entailed three methods of teaching in response to the three ways adults learn. Participants acquired a knowledge base that will enable them to work in an environment with few legal directives.