Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

Abstract

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons.

This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva.

Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

The Caring Wife: The Experience of Caring for a Severely Disabled Husband in the Community

Modern medicine has dramatically increased the chances of survival following major trauma such as a severe head injury or high level injury to the spinal cord. Greater numbers of seriously disabled people are thus returning to live in the community. This article examines the situation of the wife who assumes a caring role following the onset of severe disability in her husband. The study examines community care for people with traumatic disabilities and the social expectations of women's role in the provision of that care. Reference is made to the British situation although similar experiences are shared by women in other developed countries. As health care and social service professionals seek to serve the needs of their physically disabled client it is recommended that they view also the needs of their other client-the carer.     

Systemic Therapy and Aged Respite Care A Neglected Area

This paper discusses how placing an elderly individual in nursing home respite care can lead to the emergence of major marital issues for an elderly couple. It illustrates how one can intervene systemically to change the context of this event, so that it is freeing for the individuals concerned rather than punishing. The discussion focusses on the main developmental issues for the aged and how these need to be considered for therapy and there is a review of research on the effects of out of home placement on individuals and their carers. The main techniques discussed are the use of letter writing and reflexive questioning to provide avenues for alternate explorations for the individuals concerned. These techniques were used to help a husband and wife escape repeated serious escalations that became depleting and damaging to them personally and to their relationship. There is brief comment also on the lack of attention given to psychotherapy for the elderly, with some suggestions for change.     

湖南省解决农村贫困重度残疾人托养照护问题的实践与启示

解决农村贫困重度残疾人照护问题,既是党和政府的明确要求,也是残疾人和家属的热切期盼.湖南省农村贫困重度残疾人托养照护专项实践的主要启示:一是照护服务能有效改善农村重度残疾人生活质量和巩固脱贫攻坚成果;二是规划部署和经费配置是解决照顾问题的关键所在;三是"家庭自付+村社支持+政府补贴"的付费方式在实践中具有可行性和可持续性;四是农村地区需要优先发展保障急需的基本生活照护和寄宿照护服务,需要根据残疾人生活自理能力和家庭照护能力精准提供适合的照护服务.建议将"优先重点解决城乡低收入重度残疾人照护问题"纳入"十四五"规划及政府实事工程任务,加快建立以家庭照护为基础、社会化照护为支持、集中照护为补充的重度残疾人照护服务体系,完善以生活自理能力和家庭照护能力为核心指标的优先保障对象精准识别机制,通过"两补提标"、建立家庭照护和集中照护机构统一认定制度、评价制度和支持机制,完善残疾人帮扶机制.     

THE EFFECT OF THE MEDICAID HOME CARE BENEFIT ONLONG-TERM CARE CHOICES OF THE ELDERLY

This paper analyses the impact of Medicaid home care benefits on the probability of nursing home entry and the use of formal and informal home care by disabled elderly remaining in the community. Using data from the National Long-Term Care Survey, I find evidence that Medicaid home care subsidies reduced the probability of nursing home entry among at-risk elderly using formal home care. Among non-in-stitutionalized persons, the subsidy increased the use of formal home care but led to substitution of informal with formal care for services that were non-medical in nature.     

Resource allocations to the aged according to greatest social need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their every-day lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (magnitude of beta i/sigma magnitude of beta i) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

Resource Allocations to the Aged According to Greatest Social Need

The purposes of the study reported on in this article were: (a) to explore the measurement of social need among the elderly, and (b) to develop an appropriate method for including social need in funding allocation procedures. Interview responses from over 4,000 randomly selected elderly persons were used to identify the demographic correlates of those having the most restrictions in their everyday lives. Procedures for intrastate allocations were developed using variables suggested by the Older Americans Act and by research to explain variance in activities of daily living. Variables tested for the model were: age, income, living arrangement, gender, ethnicity, area of residence, occupation, hospitalization, years in the neighborhood, language at home, and utilization of senior services. Prediction formula weights were adjusted (|ß_i|/Σ|ß_i|) to allocate resources to the proportions of 10 "high-need" groups residing in each planning area: the population aged 75 and older, the proportion of hospital discharges of elderly patients, elderly females, elderly non-Caucasians, the elderly not completing high school, elderly farm workers, elderly urban residents, a proportion for participation in senior services, for low-income elderly persons, and for the elderly not living with their spouses. Compared to current systems, the proposed procedure provides a closer fit to the actual needs of the elderly.     

Service Credit Banking:

Informal care provided by family and friends is widely recognized as one of the key factors in keeping long-term care financially manageable for individuals as well as for public programs. Sociodemographic trends predict that the demand for formal and informal home care services among the elderly will increase faster than the supply. Programs that allow volunteers to earn credits later redeemable for comparable services when they may be required are beginning to be examined as a way to help fill the need for respite services and other basic home care services. This paper examines key considerations of the service credit concept in the context of existing programs and initiatives designed to encourage its development.     

Services Planned in Abusive Elder Care Situations

This study contrasted 96 physically abusive caregivers of elderly persons with 266 non-caregiver abusers and examined service plans for the two groups of victims and abusers. While elderly persons victimized by caregivers were offered home health care, case management, and adult day care at higher rates than victims of non-caregivers, less than 20% of the victims of caregivers were offered any of these services and 5% or less were offered outreach, counseling, and crisis intervention. Persons abused by caregivers were at particular risk of nursing home placement. Although 25% of the caregiving abusers and 34% of the non-caregiver abusers were reportedly alcoholic, only 3% in each group were referred for alcohol or drug treatment.     

Elderly Living in the Community:

Helping an older individual remain in the community requires the creation of living environments that maximize the individual's strengths while providing supportive services in the areas of decreasing competency. Historically, the community care system has not been viewed by reimbursers as terribly important. The aging of the population, plus the high cost of institutional care has resulted in renewed interest in services provided in one's own home. However, there are both challenges and opportunities in providing such service. Adapting supportive housing and neighborhood environments which help unstable persons remain in their homes is crucial to this effort.     

Attitudes toward wife rape: effects of social background and victim status

The current literature on wife rape is minimal compared to the published research in areas such as wife battering or date rape, and most of the existent work on attitudes toward wife rape is dated and/or focuses on limited samples (i.e., college populations). Using data from a nationally representative telephone survey, this study examined national attitudes toward wife rape using the following measures: perceptions of the occurrence of wife rape, perceptions of the frequency of wife rape, and perceptions of three rape scenarios. Respondent sex, education, age, race, and female victim status were predictors. Findings reveal that older, non-white respondents were less likely to believe wife rape occurs. Males and the more educated were less likely to believe it occurs frequently. Older and less educated respondents were less likely to believe forced sex scenarios between a husband and wife constitute wife rape. Among women, non-victims of forced sex were significantly less likely than current victims to believe that wife rape occurs.     

Mate Availability,Family Formation,and Family Structure Among Black Americans in Nonmetropolitan Louisiana 1970–19801

Abstract This paper assesses the effects of the community sex ratio on black family formation and family structure in nonmetropolitan parishes in Louisiana. As predicted, the sex ratio is found to have strong positive effects on marriage prevalence for black women, the prevalence of husband and wife families for black families, and the percentage of black children residing in husband and wife families and strong negative effects on the nonmarital fertility ratio for black women. Thus, we conclude that the sex ratio hypothesis should be given greater prominence in discussions of changes in black family structure and that sex ratio effects should be taken into account when framing policies aimed at ameliorating social problems attendant to high relative incidence of nonmarital births and single-parent, female-headed families with young children (e.g., poverty). We also note that, while the literature overwhelmingly concentrates on black family structure in urban areas, changes in the black family are equally pronounced in nonmetropolitan areas suggesting that explanations emphasizing the dynamics of urban ghettos may be too narrow.     

Status and Sex Variations in Modes of Parental Influence on Students' Decisions to go to College

Abstract

Although research has shown that conflicting expectations exist in the marital role for women, little is known about the impact of this conflict on female psychological well-being. This study empirically investigates the relationship between conflicting husband and wife sex role expectations for the female role and depressive symptoms in married women. Based on a community sample of 273 married women, it was found that women who indicate that a conflict in sex role expectations exists in their marriage report more symptoms of depression than married women who do not indicate such a discrepancy in sex role expectations. The effects of this relationship were found to be stronger for housewives than for women who are employed outside the home.     

Financing Reform for Long-Term Care

The way the nation provides for the financing and delivery of long-term care is badly in need of reform. The principal options for change are private insurance, altering Medicaid, and 110 FROM NURSJNG HOMES TO HOME CARE public long-term care insurance. This article uses the Brookings-ICE Long-Term Care Financing Model to evaluate each of these options in terms of affordability, distribution of benefits, and ability to reduce catastrophic out-of-pocket costs. So long as private insurance is aimed at the elderly, its market penetration and ability to finance long-term care will remain scverely limited. Affordability is a major problem. Selling to younger persons could solve the affordability problem, but marketing is extremely difficult. Liberalizing Medicaid could help solve the problems of long-term care, but there is little public support for means-tested programs. Finally, universalistic public insurance programs do well in meeting the goals of longterm care reform, but all social insurance programs are expensive and seem politically infeasible in the current political environment. The way the nation provides for the financing and delivery of long-term care is badly in need of reform. No other part of the health care system generates as much passionate discontent as does long-term care. At the heart of the problem is the absence of any satisfactory way to help people anticipate and pay for long-term care. The disabled elderly find, often to their surprise, that the costs of nursing home and home care are not covered to any significant extent by Medicare or private insurance. Instead, they must rely on their own savings or, failing that, turn to welfare in the form of Medicaid. At a national average cost of $40,000 a year for nursing home care, long-term care is a leading cause of catastrophic out-of-pocket health care costs for the elderly. In addition, despite the strong preferences of the disabled for home and community-based services, current financing is highly skewed toward care in nursing homes. While the debate over long-term care reform has many facets, it is primarily an argument over the relative merits of private- versus publicsector approaches. Differences over how much emphasis to put on each sector partly depend on values that cannot be directly proved or disproved. Some believe that the primary responsibility for care of the elderly belongs with individuals and their families, and that government should act only as a payer of last resort for those unable to provide for themselves. The opposite view is that the government should take the lead in ensuring comprehensive care for all disabled older people, regardless of financial need, by providing comprehensive, compulsory social insurance. In this view, there is little or no role for the private sector. Between these polar positions, many combinations of public and private responsibility are possible.     

The potential of domiciliary care service in the Czech Republic to promote ageing in place

Due to population ageing, the need for long-term care is increasing. In many European countries, there is now a firm policy preference for care in the home as opposed to institutional care and policies at the local level support this preference. The purpose of this study is to report on the position of domiciliary care service within the Czech social services for the elderly and to explore its potential to promote ‘ageing in place’. The aim of the research was to perceive this issue from the viewpoint of the different parties: service users, service workers, service managers as well as policy-makers. Therefore, the qualitative methodology (case study method) was used. The results revealed that users considered domiciliary care as the only service in the Czech Republic that allowed them to remain at home despite their worsening capacity to manage the activities of daily living. On the part of the domiciliary care service, however, we found that this was strong in the provision of practical help, as well as assistance with users' self-maintenance, whereas their supervision and care management were not explicitly included either in the concept or the practice of this type of service.     

Respite and family support services: Responding to the need

Increased focus on the needs of parents and guardians for structured opportunities for temporary relief from care of disabled persons has stimulated policy and implementation initiatives at the state government level on behalf of these families. This article presents qualitative and quantitative data on the need for respite services not only in terms of relief, but as a positive, supportive force in the prevention of permanent placement outside the home. Current services are outlined and issues important to clinicians and managers working with such families are discussed.Planning and Development     

One Family, Two Households: Rural to Urban Migration in Kenya

Many households in sub-Saharan Africa allocate their labor resources between rural and urban areas to diversify risks and maximize income. One such strategy would be for a husband in a rural area to migrate to an urban area while his wife and family remain in the rural area without any chance of joining the migrant husband in the urban area. The family maintains a rural home and an urban home. This article explores possible determinants of this type of migration using data from Kenya. Nontrivial findings suggest that such migratory behavior may be motivated by agglomeration effects of household size in the rural area, an increase in remittance by the migrant husband to his rural family, a relatively low education for the husband, and a high urban cost of living.     

The relationship of modernity of sex roles to pregnancy planning

This study investigates the relationship of women's role modernity to pregnancy planning. The subjects were 59 married primiparous women aged 18 to 33 who had given birth in a metropolitan midwestern hospital. Over 1/2 the sample had some college eduction. The pregnancy planning variable is operationalized as the implementation of family planning goals. Subjects who desired pregnancy and actively attempted to conceive are considered to be planners. In contrast, nonplanners are defined as women who preferred to avoid pregnancy but were not successful and women who did not actively seek or avoid pregancy. The modernity of sex roles variable is operationalized through use of the Scanzoni instrument. This instrument is constructed from a series of items that measure 3 social positions related to sex roles in the family context: those of wife, husband and mother. The instrument is modified in this investigation, leaving 21 5-point scale items to be included in the data analysis. Smallest space analysis of the inter-item correlation matrix demonstrate that the social positions of wife and husband do not clearly reflect different aspects of sex role modernity. A comparison of the average inter-item correlation for the variables within each social position with the average inter-item for the variables across the positions reveals that the dimensions proposed by Scanzoni are not empirically different. In light of these findings, further exploratory data analysis of all items was conducted to discern which items do empirically cluster together. Scanzoni's 21 sex role items were submitted to principal component factor analysis; 3 factors emerged. 1) wife-husband equlity; 2) flexibility in role integration; and 3) values regarding primary role. 3 new sex role modernity values were created to correspond to the 3 factors and were then used to explore the relationship between sex role modernity and pregnancy planning. Chi square analyses were not statistically significant. Therefore, the hypothesis that women at the extremes of the modernity continuum would be more likely to plan than women who fall in the middle, was rejected. Although no relationship between the sex role factors and pregnancy planning was found, 6 of the Scanzoni items, when linearly combined, manifested a strong relationship to planning: 1) wife's emotional nature; 2) wife's most important task is caring for husbands and kids; 3) wife takes job if not satisfied with wife/mom role; 4) wife gives up job if inconveniences husband/kids; 5) wife's job as important as husband's job; 6) women's pay equal to man's. Although 4 of these items load on the sex role factors, it is unclear whether they are truly reflective of these factors.     

The Health Status of Elderly People and the New Direction of Health Services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.