Institutional care for elders in rural China

The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.     

On their own: The experiences of youth after foster care

This study used multiple means to identify 55 young adults who had left foster care in recent years. The young adults who had all emancipated from foster care under the auspices of social services were most often identified by former foster parents, social workers, or other foster youth. This sample of former foster youth are often struggling with ill health, poor educations, severe housing problems, substance abuse, and criminal behavior. Yet the youth in this sample may be surviving more ably than the many former foster youth whom we could not reach.The author thanks Rich Clarke, Pat Lovelock and Sharon Ikami. This study was prepared under Contra Costa County Contract #20-719.     

Caring for day care: a pilot project

Day care in Israel is not always of high quality, and the current forecast for upgrading the standards of the existing centers is bleak, due to economic and social factors that do not place high priority on quality infant care in group settings. The agency attempted, therefore, to develop a low-cost, efficient method of early intervention, wherein skilled social workers were hired, given special training, and worked alongside the caregivers of day care centers to help children and parents defined as at risk. This article describes the observations that were made and the interventions that were chosen.     

Health technology assessment between our health care system and our health

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals. So as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites. We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit.     

Serving our (in)visible elders: The impact of a LGBTQ+ aging presentation on a rural college campus

ABSTRACT

As the number of individuals 65 and older continues to grow, so too does the richness and complexity of their identity. Specifically, the culture of aging within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community has received little attention in the literature. In order to best serve this population, human service professionals must understand the reality of aging within diverse communities. This article explores the impact of an invited campus speaker focused on LGBTQ+ aging on a rural college campus. Results indicate a general increase in overall knowledge and appreciation for issues directly impacting the aging LGBTQ+ community. Recommendations for practice, grounded in a social justice framework, are shared.     

Familiarity effects in nonverbal understanding: Recognizing our own facial expressions and our friends'

In this study we explored how individuals' private expressions are interpreted by the self, same-sex friends, and strangers. Videotapes were made of participants as they watched pleasant, unpleasant, and unusual slides. Approximately a year later, the tapes were shown to the participant, a same-sex friend, another participant, and the other participant's friend. Judges were able to read the facial expressions at levels of accuracy that were significantly greater than chance. They were no better at reading familiar targets (themselves or their friends) than unfamiliar ones (strangers), with only one exception (men were better at recognizing the reactions of familiar targets than unfamiliar targets viewing pleasant slides). In their abilities to understand nonverbal cues, female friends showed resemblances to each other on all accuracy measures (pleasant/unpleasant/unusual X familiar/unfamiliar). Male friends resembled each other only in their understanding of the reactions of unfamiliar men viewing unpleasant slides.This research was supported in part by an NSF grant and an NIMH Research Scientist Development Award to the second author. We thank Charles Frohman and Laura Yamhure for their help with this research.     

Caring children: exploring care in post-divorce families

This article draws on information from in‐depth interviews in addition to a survey from a Norwegian ‘Families after divorce’ study, in which the perspective of children and younger people are emphasized. We describe the complex relations between care‐giving and care‐receiving among children and adults in post‐divorce families and challenge and nuance the traditional western picture that emphasizes children as the receivers of care and adults as care‐givers. Inspired by the notion of ‘caringscapes’, the article seeks to incorporate the spatial and the temporal into the analysis of care and caring, and three ‘caring routes’ are identified: i) the ‘money squeeze route’, ii) the ‘emotional considerations route’ and iii) the ‘time squeeze’ route. The three routes are verified by the interview data as having both direct and indirect effects on the phenomenon of caring. We argue that children's care‐giving should be further investigated both empirically and theoretically and that a caringscapes approach might provide insight and departure for further research.     

When caregivers are in need of care: African-American caregivers' preferences for their own later life care

To “care for one's own” is a cultural expectation within a larger ethic of care in the African-American community. Applied to caregiving of aging elders, this ethic of care emphasizes the importance of providing in-home family care rather than opting for out-of-home placement. This study explores why a subset of African-American caregivers prefer or are open to out-of-home placement over in-home family care if they are no longer able to care for themselves. In-depth interviews with 24 family caregivers are analyzed. Three themes emerged including the desire to “spare our children” the burden associated with caregiving, viewing the next generation of potential caregivers as unequipped for the task, and having no one left to provide care for them.     

Covenants of care: The symbols of community support for elders in the all-black towns of Oklahoma

This article explores community covenants of care that benefit older residents in the all-black towns of Oklahoma. Community covenants of care are informal agreements by community residents that favor support of people residing in the community. The covenants are expressions of the social histories of the towns themselves and are intertwined with other social–historical themes, including positive racial identity and racial self-determination, expectations of limited external support, community self-reliance, and special status afforded to elders. There are numerous expressions of community covenants of care within the all-black towns. Although the manifestations of positive community covenants may require considerable time and effort to identify in poor rural minority communities, such as the all-black towns, the experience can lead to a deeper and more comprehensive understanding of the lived experiences of older residents and their community roles.     

Young Adult Carers: The Impact of Caring on Health and Education

Research has shown that young people who care for parents and relatives (young carers and young adult carers) are at greater risk of mental and emotional difficulties and are more likely to do badly at school or college. To explore the difficulties faced by young adult carers (aged 14–25) in the UK, an online survey was conducted. Almost half (45%) of the 295 respondents reported having a mental health problem. The relationship between the extent of caring and perceived mental health problems and the impact of caring responsibilities on work and education were investigated.     

Caring for people with intellectual disabilities in poor rural communities in Cambodia: experience from ADD International

The burden of care for a disabled relative traditionally falls on women: mothers, wives, sisters. In Cambodia, Khmer culture is strongly structured around the family unit within which both the role of women and discrimination towards people with disabilities are sanctioned by social hierarchy, perceptions of weakness, and the concept of karmic merit. This article explores the impact of ADD International's project in Cambodia to support people with ‘intellectual disabilities’ – that is, learning disabilities – and aims to assess how this work affected carers, the majority of whom were women.     

Grief and loss of religion: the experiences of four rural lesbians

The purpose of this four-person study was to discover the grief and loss experiences of rural lesbians using a phenomenological approach. A prominent theme that emerged from the interview data was grief and loss related to religion and a lesbian identity. Participants identified the need to modify their beliefs, the experience of rejection by church members or the church itself, and seeking acceptance.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

Understanding care for the poor in rural Russia

The issues surrounding care and care-provision have been key themes in social scientific research, yet the intersections between care and poverty, particularly in rural contexts, have not been sufficiently explored. This paper addresses this gap by studying care for the poor in rural Russia. It argues that isolated, disengaged and decontextualised caring interventions often ignore situated possibilities and traditions of care and overlook what matters to poor people. To overcome this problem, the paper uses 20 and 22 dwelling approach to prioritise a relational framework that focuses on care as concern, solicitude and possibilities for supportive action in the context of rural Russia. Using examples from fieldwork in two Russian villages, the paper stresses the constitutive role of non-representable practices of care which provide the ontological basis for recognising and understanding the worldviews and coping practices of the poor. It concludes with conceptual observations about alternative approaches to care, relations to others and responsibility for the rural poor.     

In their own words: The life experiences of Mexican-American and white pregnant adolescents and adolescent mothers

The results of an ethnographic study of 32 Mexican-American and 17 White adolescents are presented. Fifty percent or more of the respondents in both groups experienced parental loss during their childhood years. Little information was provided by parents to the adolescents regarding menses and physical maturation. While parent-adolescent conflict arose in both samples, the conflict for the Mexican-American adolescents centered around choice of girlfriends and boyfriends while multiple sources of conflict existed between the White respondents and their parents. White respondents were more sexually active than the Mexican-American respondents, but the latter reported more stable relationships with the father of the baby. The experiences of the adolescents are both summarized and presented in their own words.