Residential Respite Care: The Caregiver's Last Resort

Understanding the beliefs that caregivers of people with dementia have in regard to the use of residential respite may inform strategies to address low service utilisation. In this article, the application of theory in qualitative research with 36 caregivers provides insight into why most delay service use. Although some believe that service use may increase caregiving longevity, others position service use in conflict with normative values, and may hold beliefs that negative outcomes will result from utilisation. To address caregivers' beliefs to support service use, improvements are required to service promotion, as well as to models of care.     

Caring for mentally disabled people in Scotland

Scotland's mental health agencies face a major challenge with the appearance of Caring for People. The arrival of the community care White Paper has coincided with the appearance of renewed concern over hospital inpatient provision and over the perceived lack of progress in the development of community care. This article examines some of the differences which arise from the construction of community care policy in Scotland and some of the evidence available for assessing the present state of care in the community for the younger mentally disabled. It is found that some 630,000 adults under the age of 65 (or 19% of all adults in this age group) are suffering from some form of mental disability, some 22% of whom are in severe need of care. 93% of this group are located in the community. Problems for carers are created by the presence of significant shortfalls in resources and by the balance of care which exists in Scotland.     

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.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

The school to work transition for young people in state care: perspectives from young people,carers and professionals

Workforce participation has many positive effects on quality of life. However, as young people in care have generally below‐average levels of educational participation and attainment, they may be ill‐equipped for the transition to further education and work. A mixed‐method study conducted in Australia about career development for young people in care investigated how this population develops ideas about future work: the social and cognitive variables that influence career decision‐making; practices for preparing young people in care for the transition to work or further education; and factors that support or impede the transition. Findings from the qualitative study are reported in this paper. Interview data were obtained from the multiple perspectives of young people in care, foster carers, caseworkers and school personnel. The overall picture was one of young people in care lacking the encouragement, resources and capacity to realistically plan for the job they want. Specific interventions are required to enhance career development and employment outcomes for this population.     

The impact of ethnicity on attitudes toward health care reform in New Mexico

Latinos tend to have significantly lower levels of access to general and top quality medical care than do non-Latino whites, and although disparities in access to health care have diminished for all other minority groups over time, they have widened for Latinos. Given these trends, current attempts to provide universal health care at both the national and state levels across the United States have large implications for the health status of Latinos. The objective of this analysis is to determine whether Latinos have different attitudes regarding health reform than non-Latino whites. Our data are from a statewide random digit dialing telephone survey of New Mexico residents, age 18 and older, conducted in the Fall of 2007. With a Latino population of 44% and ongoing health care reform efforts by the state legislature, New Mexico is an ideal location for this analysis. After controlling for a host of individual level factors, our findings suggest that while Latinos are less likely to identify health care as a salient state issue relative to the economy and crime, they are more likely than non-Latino whites to believe affordable health care programs are important. Finally, Latinos view employers, more than government or individuals, to be responsible for expanding health care coverage.     

老年人日常照料的角色介入模型

本文在总结国内外老年人照料研究的基础上,提出老年人日常照料的角色介入模型,其核心是三个规律：即（1）成本命题：一个角色介入老年人日常照料的成本越大,其介入照料的概率就越低;（2）邻近命题：与被照料者的地理和社会邻近度越高,照料角色介入的可能性就越高;（3）责任命题：对被照料者的责任感越高,照料者介入的可能性就越大。由此三个命题所延伸出的六个假设,通过多元正态概率模型对2000年“中国城乡老年人口状况一次性抽样调查”的原始数据进行分析,结果显示,多数假设得到数据的支持。这一研究结果对厘清老年人照料的社会化和家庭照料之间的关系及其理性的公共政策选择,提供了新的视角和理论依据。     

Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice

The importance of interprofessional collaboration in achieving high quality outcomes, improving patient quality of life, and decreasing costs has been growing significantly in health care. Palliative care has been viewed as an exemplary model of interprofessional care delivery, yet best practices in both interprofessional education (IPE) and interprofessional practice (IPP) in the field are still developing. So, too, is the leadership of hospice and palliative care social workers within IPE and IPP. Generating evidence regarding best practices that can prepare social work professionals for collaborative practice is essential. Lessons learned from practice experiences of social workers working in hospice and palliative care can inform educational efforts of all professionals. The emergence of interprofessional education and competencies is a development that is relevant to social work practice in this field. Opportunities for hospice and palliative social workers to demonstrate leadership in IPE and IPP are presented in this article.     

Ethics of care and social policy

Care work is to a high degree equivalent with female work and has not, to any great extent, been of interest to traditional social sciences. Women's studies has however changed this, and today there is a broad academic discussion about care work as well as about the concept of care itself. This article reviews this discussion; the concepts of care and ethics are linked and given feminine content. With reference to studies within the authors' research programme: "Care for the elderly: conditions and everyday realities", results are then reviewed that show how organizational, political and ideological relationships affect the content and quality of care. Finally, European social policy trends and the consequences of new systems of paying for care are discussed from a gender perspective. The authors warn against a context-free coupling between women and an ethic of care, and show how neoliberal politics can use feminist "struggle concepts" to put women "back in their place".     

Needs and availability of support among care‐leavers: A mixed‐methods study

Data are scarce on the long‐term needs of care‐leavers and on the support resources that are available for them in the years after leaving care. This mixed‐methods study presents data on the needs and availability of support of 222 Israeli care‐leavers, suggesting that the most urgent needs of care‐leavers are a lasting need for a stable and available support figure and assistance with educational issues. For some care‐leavers, these needs are fulfilled by their mentors. Parents and other familial figures were found to be the most common support resource for care‐leavers, which highlights the need for the intervention of social workers to improve relationships within families while the children are still in care. Due to high rate of young people who have no support resources and a low rate of services utilization, social services should provide a platform to support this group, using mentors and other supporters. The longitudinal data of up to 4 years after leaving care indicated that the availability of various types of informal support improved over the years, and the reports on difficulties in relationships of the care‐leavers with their parents were significantly fewer 4 years after leaving care than on the verge of leaving care.     

The Milieu Standard for Care of Dementia in a Nursing Home

Recent attention has been directed toward providing specialized skilled nursing facility care for patients suffering from dementia. This paper explores and details how The Hebrew Home for the Aged at Riverdale developed such a unit and its applicability for the provision of appropriate care to demented elderly in other settings. The leadership roles of professional care staff, particularly the social worker in the development of this project are highlighted.     

Comfort and confidence levels of health care professionals providing pediatric palliative care in the intensive care unit

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.     

Family-centered care: a resource for social work in end-of-life and palliative care

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider- focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family- centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

Family-Centered Care

Abstract

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider-focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family-centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

Interpretative phenomenological analysis of young people's lived experiences of therapeutic residential care

Concerns of maltreatment and poor outcomes persist in residential care despite numerous government inquiries and recommendations. Young people in residential care continue to be the most vulnerable and marginalized group in the out‐of‐home care population. Young people's voices are also underrepresented in research. Existing studies predominantly focus on service evaluations in which individual voices of young people are overshadowed by adults' perspectives. Other studies examine the perspectives of young people in out‐of‐home care as a homogenous population, limiting understandings of the subjective experiences of young people in residential care. This study focused exclusively on young people's lived experiences in Australian therapeutic residential care, utilizing interpretative phenomenological analysis. The young people in this study revealed experiences of peer victimization, ambiguous loss and uncertainty during transitions. These findings suggest that more work is required in order to provide safe and healing environments and experiences for young people in therapeutic residential care. Each individual voice captured in this study offers valuable insights into how residential care practitioners can strengthen practice to enhance protection, engagement, connection with families and leaving care support.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.