Culture Change in Long-Term Care

Abstract

Long-term care facilities for frail elders are usually based upon the medical model, which is focused primarily on the biological functioning of these elders. The medical model allows for little choice on the part of the residents of these facilities. By way of contrast, culture change is a new approach to long-term care. This model of care seeks to meet a wide variety of needs for the elders and aims to expand their choices. This article presents the observations of college students responding to interactions with frail elders and looks at the implications of culture change for young adult college Students.     

Older Women Doing Home Care: Exploitation or Ideal Job?

The increased need for both personal assistance workers and meaningful employment opportunities for older workers results in growing numbers of older home care aides. This study examined lifetime financial security and perceived advantages of older age in this field through interviews with 31 older home care aides. Study participants experienced high levels of financial insecurity and perceived older workers as particularly well suited to the home care job. The consequences of this low-wage, low-status work are explored along with implications for social workers to advocate for improved conditions for these workers providing essential care to frail elders.     

Geriatric care management: spiritual challenges

Geriatric care managers face a complex task of helping families negotiate challenges of caring for frail elders and meeting everyday practical needs. At the same time care managers can respond to clients and families with acknowledgment of the spiritual dimension of caregiving. By being fully present to the suffering of families and elders, care managers can experience their own spiritual growth and can offer help to others at the same time.     

Balancing Long-term Care in Japan

This article discusses Japan's long-term care (LTC) from the perspective of balancing the provision and financing of care. Specifically, this article provides an overview of the long-term care insurance (LTCI) system in Japan and analyzes the current state of Japan's LTC with current statistical data as to whether the supply meets the demand for care by frail elders and their families.     

Mental Health Service Utilization Among Frail,Low-Income Elders

Abstract

This study was conducted to determine the extent to which service providers in a community-based care program accurately identified and referred elders with symptoms of depression. Interviews were conducted with 79 frail, low-income elders, with the CES-D used to gauge depressive symptomatology. Reviews of their case files were then conducted to determine first, the extent to which case managers recognized depressive symptoms and second, the extent to which respondents who screened with significant symptoms were referred for mental health services. Results suggest an imperfect association between CES-D scores and case managers' perceptions and referrals. Less than 1/3 (31%) of those who screened for depression received counseling.     

Vital Involvement Practice: strengths as more than tools for solving problems

This article describes Vital Involvement Practice, a strength-based approach to clinical practice with elders, including those who are extremely frail. Using this approach, practitioners have been able to help elders increase later-life vitality and associated positive quality of life through: (1) systematic identification of individual strengths and assets (found both in the person and in the surrounding environment), and (2) consideration of these strengths alongside the individual and environmental deficits that are the subject of most geriatric practice. The approach utilizes original data-gathering tools (Occupational Profile; Life Strengths Interview Guide) and a stepwise, worksheet- structured consideration of these data in order to formulate action strategies for achieving client goals (Domain Scan; Domain Goals; Life Plan/Strategy). All elements of VIP emerged in pilot work with gerontological practitioners and their elder clients in such settings as: primary health care; government social service; subsidized senior housing; private clinical practice; community recreation. Limitations, implications, and promise are noted, with respect to practice and research.     

The Transformed Political World of Older Boomers

Abstract

This article describes Vital Involvement Practice, a strength-based approach to clinical practice with elders, including those who are extremely frail. Using this approach, practitioners have been able to help elders increase later-life vitality and associated positive quality of life through: (1) systematic identification of individual strengths and assets (found both in the person and in the surrounding environment), and (2) consideration of these strengths alongside the individual and environmental deficits that are the subject of most geriatric practice. The approach utilizes original data-gathering tools (Occupational Profile; Life Strengths Interview Guide) and a stepwise, work-sheet-structured consideration of these data in order to formulate action strategies for achieving client goals (Domain Scan; Domain Goals; Life Plan/Strategy). All elements of VIP emerged in pilot work with gerontological practitioners and their elder clients in such settings as: primary health care; government social service; subsidized senior housing; private clinical practice; community recreation. Limitations, implications, and promise are noted, with respect to practice and research.     

From person-centered to relational care: expanding the focus in residential care facilities

Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization. A qualitative study conducted with 4 social workers and 1 physician employed in residential care facilities demonstrates not only the structural barriers to PCC, but also the importance of meaningful relationships to residents' socio-emotional well-being. The final section explores how organizational barriers might be mitigated through the complementary use of relational care.     

From Person-Centered to Relational Care: Expanding the Focus in Residential Care Facilities

Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization. A qualitative study conducted with 4 social workers and 1 physician employed in residential care facilities demonstrates not only the structural barriers to PCC, but also the importance of meaningful relationships to residents' socio-emotional well-being. The final section explores how organizational barriers might be mitigated through the complementary use of relational care.     

Providing mental health services to older people living in rural communities

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional wellbeing and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.     

在“项目为基础”的研究学习中成长

研究性学习是以问题为导向,通过学生自主解决问题的过程来学习的教学模式。本文以老年社工实务为平台,以“老年照顾与管理”为主题,组成了“研究性学习”团队,在教师的引导下相继完成四个优秀本科训练计划（SRTP）,并获得“云南省大学生创新实验计划”立项。在循环迁升和环环相扣的项目链上,不仅调动了学生学习的主动性和积极性,还激发同学们的创新思维和创新意识,对学生掌握思考和解决问题的能力具有积极的作用。     

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.     

Barriers to Implementation of a Cooperative Model of Respite Care

This paper describes the conceptualization and field experience with a cooperative model of respite care for the frail elderly. Planning and program development were successfully completed yet implementation did not come to fruition. A survey of family caregivers, conducted to analyze obstacles to implementation, is instructive in identifying attitudinal barriers to use of a cooperative model for providing respite care for the frail elderly. The reasons for the program's failure and the lessons learned from it are examined and discussed. Implications are drawn for the planning and development of new intervention programs.     

Providing Mental Health Services to Older People Living in Rural Communities

Summary

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.     

Nowhere to go: Housing pathways of college students with foster care and homelessness experience

This study builds on previous research to understand longer term housing experiences in late adolescence and early adulthood for vulnerable college students. Using a biographical, qualitative method, we study high school and college housing and family circumstances for 27 students with homelessness or foster care experience enrolled in 4-year colleges in Georgia. We identified three different housing pathway types in high school—family homelessness, unaccompanied youth and foster care. Housing instability and frequent moves were common in high school among all housing pathway types. In college, students who were able to find low or no-cost housing and those who identified a foster care pathway in high school achieved greater housing stability. Others students experienced a continuation of housing instability that began in high school. Additional funding to cover the cost of on-campus housing would likely contribute to increased stability. Additional strategies, such as rental assistance programmes tailored for college students, may be needed to address housing instability for vulnerable college students. More research on the unmet housing needs and the consequences of housing instability during college for homeless and foster youth is needed to further a housing policy agenda that focuses on practical solutions.     

Coordinating County Based Services for the Frail Elderly

The aging network is fraught with fragmentation. Services to the elderly are administered out of multiple agencies and departments at all levels of government. This article discusses the approach taken by one county to diminish the level of fragmentation to frail elders by a cooperative agreement between key county departments providing services to the aged.     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

Educating Our Future Colleagues: Creating an MSW Palliative Care Practicum

As the number of older adults and those with chronic medical conditions continues to rise, the need to train social work students in palliative and end-of-life competencies becomes critical. To address this growing need, the social work team at a large urban academic medical center in the Midwest developed an MSW concentration practicum in palliative and end-of-life care. During the practicum, students receive immersive training in palliative care social work values and the skills required for these specialized assessments, interventions, and evaluations. Their training culminates in their participation on an interdisciplinary team to provide psychosocial support to patients and families receiving palliative and end-of-life care throughout the medical center. This article describes the curriculum, practice immersion, training manual, teaching modules, and structure of student supervision which is applicable to and adaptable for other palliative care social work field instructors.     

Ethnic and University Identities across the College Years: A Common In-Group Identity Perspective

The common in-group identity model advocates the creation of a superordinate group identity in order to reduce conflict between members of different ethnic subgroups. This study demonstrates that a university identity can serve as an effective common in-group identity for students from different ethnic groups. Longitudinal data were collected from an ethnically diverse sample of university students at the end of each year of college. Although ethnic identification tended to be correlated with status-legitimizing orientations and ideologies in a way that reinforces ethnic-status differences (i.e., these variables tended to be positively related for Whites but less so for ethnic minorities), the status-legitimizing variables were largely unrelated to university identification during each year in college. The longitudinal data also allowed us to examine these relationships over time. The relationships between ethnic and university identification and status-legitimizing orientations and ideologies did not change. Ethnic and university identities are discussed in terms of the common in-group identity model.     

Satisfaction,Communication and Affection in Caregiving

Multigenerational caregiving is becoming a prevalent means of caring for moderately to severely impaired elders. Handling the stress created in these arrangements may depend on the relationship between the elder and the caregiver. This study examines components of such relationships and highlights caregiving as experienced by the elder receiving care. Findings 'indicate that improved quality of relationship between elder and caregiver is related to a high degree of elder's satisfaction with the arrangement, whereas level of functioning of the elder is not related to degree of satisfaction. However, findings also suggest that elders fear being a burden, hide their troubles and feelings and generally feel no sense of contribution to the household.