Issues of elder care and elder abuse in the Indian context

With 7% of the population of India being elderly, two-thirds of whom live in villages and nearly a half of them in poor conditions, the care of the elderly is a difficult problem to be tackled. The dwindling of the joint family, the rise of dual-career families, a possible shift in filial piety values, the increasing life expectancy with greater chances of a prolonged old age characterized by poverty, degeneration, more empty-nest years, and dependency, have all added to the seriousness of the problem and made the elderly more susceptible than ever to abusive treatment. This paper examines these issues as well as the issue of elder abuse in light of available data and suggests some strategies to meet the problem. Also discussed are the problems, stresses, and strains of caregivers of the elderly. A greater role is envisaged for Non-Governmental Organizations (NGOs) than the state in the care of the elderly, particularly in providing support services to family caregivers.     

Reciprocities in caregiving relationships in Danish elder care

This article examines the nature of the reciprocal relationships between elderly people and both their informal caregivers and home helpers in Denmark. One of the key results concerns the importance that elderly care recipients attached to various forms of reciprocity. The two major ones were hospitality and gift giving. While informal caregivers see their caregiving as normative or as generalized reciprocity, many stressed that the elderly person's personality and their expressions of gratitude and appreciation (symbolic reciprocity) were important factors facilitating caregiving. Home helpers spoke of satisfaction in helping others, but also underlined the fact that they could see some good role models for their own old age. The results are analyzed on the backdrop of the nature of the Danish welfare system, which provided liberal pensions and benefits. This indirect reciprocity enabled elderly people to retain their ability to participate in reciprocal social relations and preserve their integrity and independence.     

The integration of child care services in Scotland

This paper describes the development of integrated child care services in Scotland with a particular focus on the role of residential child care provision. It discusses changes in Social Work Department policies and the impact this has had on their relationship with the Children's Hearings system. Recent research shows the pattern of use of residential and foster care in three Social Work Departments and issues in the development of residential services are identified. Three particular examples of service integration are described: residential outreach work; a centre for young people under an integrated management; and multi-agency youth strategies. Social work and education services in Scotland are in the process of radical change. In the context of the integration of child care services, the paper discusses the impact of local government reorganisation and changes in child care legislation.     

Contestability and social justice: The limits of competitive tendering of welfare services

Abstract

This paper critically analyses competitive tendering as a model for the provision of welfare services. Competitive tendering, driven by National Competition Policy and other imperatives for greater efficiency and a smaller public sector, is now used extensively by governments to fund welfare services. However, the suitability of this funding model to welfare services generally, and specifically welfare services in non-metropolitan areas, can be criticised on both theoretical and empirical grounds. Competitive tendering is grounded in economic rationalist, urbo-centric assumptions that are largely inappropriate for welfare provision, and have limited validity in rural areas. There is little rigorous empirical evidence of improved efficiency and effectiveness of service delivery under this model. Conversely, there is mounting evidence about the negative impacts. In rural areas this includes the erosion of community service obligations, less collaboration and greater secrecy between agencies, the reduction of choice, limited opportunities for local planning, cost shifting, and threats to continuity of care. This paper concludes with a call for greater application of the ‘public benefit’ test under the provisions of the National Competition Policy, and the development of more sophisticated frameworks for assessing the contestability of welfare services. Social workers have a leading role to play in challenging the dominant ideology of competition-orientated welfare reforms.     

Trauma-informed care and elder abuse: a synergistic alliance

ABSTRACT

Elder abuse is a global systemic problem in which one or more traumatic or stressful life experiences directly affect older adults, their families, and communities. Despite its devastating impact, the understanding of—and response to—elder abuse has rarely been explored through a trauma-informed lens. Despite the prevalence of traumatic and stressful life experiences, research and practice are just beginning to target the intersection of elder abuse and life course trauma. This article demonstrates how knowledge about the causes, consequences, and responses to elder abuse can be integrated with the principles of trauma-informed care to improve agency and community responses to preventing or intervening with elder abuse and neglect. In order to address the ongoing problems with detection and treatment of elder abuse, we assert that instilling trauma and elder abuse informed care in organizational services and policies forms a synergistic alliance and would address many of these concerns.     

Failed individualism in community care: An example from elder abuse

Summary

Community care has been associated with a particular vision of interpersonal relations reflecting the demands of a market economy of welfare. It is argued that individualised notions of citizenship significantly effect how social actors respond to issues such as dependence, independence and interdependence, with consequences that locate unacceptable attributes within failed individuals'. This gives rise to a number of possibilities for collusion between workers, carers and older people who require services, and forms the basic triangle for interpersonal relations within community care policy. The parallel rise of elder abuse as a recognised social problem is considered in this light and three forms of collusive alliance, based on life-task, family solidarity and heroic defence are explored in greater detail. The paper concludes by examining the possibility of interdependence as a guiding principle which can be used to contain each actor's perspective, whilst contributing to the development of non-abusive relationships.     

Assimilation versus multiculturalism: The views of urban Americans

Parents of children in public schools in a large American urban center, representing a number of different ethnic groups, were interviewed about their personal views and feelings toward cultural and racial diversity in America today. Three main issues were addressed: respondents' attitudes toward the maintenance of heritage cultures versus assimilation; their attitudes toward bilingualism; and their attitudes toward other groups in the community. The analyses revealed important differences in attitudes between ethnic minority groups and established white and black groups. Nonetheless, strong support was shown for the retention of heritage cultures, even among middle-class white and working-class black Americans. The working-class white American sample was distinctive in its rejection of multiculturalism and in its negative attitudes toward other ethnic and racial groups. All groups supported the idea of bilingualism for their children, and certain groups thought that public schools had an important role to play in its promotion. Overall, the results delineate a series of factors that affect intragroup and intergroup harmony and the processes of adjustment that transpire within a social system when it has to cope with ethnic and racial diversity.     

The feasibility of goal attainment scaling to measure case resolution in elder abuse and neglect adult protective services intervention

Objectives: This pilot study describes implementation procedures of goal attainment scaling (GAS) and examines the feasibility of using GAS to measure the multifarious intervention outcome of case resolution in elder mistreatment (EM) adult protective services (APS).

Methods: Substantiated EM victims (n = 27) were recruited prospectively from the State of Maine APS. An adapted GAS approach was implemented involving development of a pre-populated goal scale menu and web-based GAS application.

Results: The GAS menu comprised 18 goals and corresponding scales spanning several domains of case resolution: social support, service access, health/functioning, enhancing independence, and protective measures. The overall GAS process had mean length 33.8 min per case. The mean GAS summary t-score (54.3) aligned with theoretical expectations.

Discussion: Without a measure of case resolution, research cannot compare the effectiveness of different EM intervention models. Findings suggest that GAS is a feasible, client-centered strategy to measure the multifarious EM intervention case resolution outcome.     

Health care professionals' perspectives on barriers to elder abuse detection and reporting in primary care settings

The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.     

The retreat of multiculturalism in the liberal state: theory and policy

This article discusses a recent retreat of multiculturalism in the liberal state. This retreat has occurred both at the level of theory and policy. With the help of some recent liberal critiques of multiculturalism, the first part maps out some shortcomings of the notion of minority integration through cultural recognition, particularly with respect to immigrants. The second part discusses a retreat from multiculturalism policies in three states that had been prominently committed to them: Australia, the Netherlands, and Britain. This practical retreat of multiculturalism is due to a variety of factors, their importance differing across cases: the chronic lack of public support for multiculturalism policies; inherent deficits and failures of multiculturalism policies, especially in socio-economic respect; and a new assertiveness of the liberal state to impose liberal principles.     

Recent developments in institutional elder care in China: changing concepts and attitudes

This study examines recent developments in institutional care for Chinese elders and attitudinal changes toward institutional care in Tianjin, China. Based on studies in 12 elder home sites and survey interviews with 265 older residents, this study compares institutional differences between government and non-government-owned elder homes, and examines elders' evaluations of elder homes' quality and their level of willingness to stay in elder homes. Findings suggest that government-owned elder homes still enjoy institutional and bureaucratic privileges in funding, staffing, and insurance. Elders' overall evaluation of elder home quality was high. Elders' former living arrangement and financial ability were related to their willingness to stay in the elder home. The unfair competition between governmental and non-governmental elder homes is likely to hinder the development of elder home industry in the free-market system and foster a growing gap between the rich and poor elders in their capability and decisions in elder home care. As adult children become increasingly unavailable due to the one-child policy and geographic mobility, institutional care for aging parents is likely to become one of the major options for parent care.     

The periphery of care: Emergency services for homeless people in rural areas

Until recently, homelessness in rural areas has received little recognition because of overwhelming assumptions about the urban-centredness of homeless people and their needs. This paper seeks to build on recent research that has begun to uncover some of the problems and characteristics of rural homelessness, by suggesting two significant dynamics which together can shape the experience of different groups of homeless people in rural environments. First, rural places reflect particular local qualities which contextualise both the circumstances of homelessness and the provision of services in response to those circumstances. Secondly, the contemporary governance of homelessness unfolds rather unevenly in different rural areas, producing distinct local service environments with varying degrees of ‘insider’ and ‘outsider’ status in relation to joined-up responses to the needs of homeless people. These dynamics are articulated through three case studies: a remote friary in a deep rural area of southern England; a small hostel run by a vibrant non-statutory organisation in a small town in the west of England, and two advice centres in a coastal resort in the north-east of England. Through these case studies we highlight the importance of both local reactions to the homeless other, and local relations between central government funding, local authority initiatives and charitable organisations, in the production and consumption of spaces of care in settings set in, or serving, rural environments.     

Swedish multiculturalism in a comparative European perspective

This article discusses the use of the term multiculturalism and the background of multiculturalist policies in Europe. Postwar migration within and to Europe has changed the ethnic composition of population in most European countries. The main focus is on Sweden, which more strikingly than most European countries has gone through a transformation from a relatively homogeneous society to one with a variety of ethnic and language groups. The author stresses the role of historical factors behind different countries' reception of immigrants and their attitude to programs of integration or assimilation. Parallel to xenophobix phenomena there are very decided activities from governments and organizations to counteract in Western Europe. The increasing cooperation in the economic and political field also makes the issues of immigrant, border minorities, and historic minorities relevant.     

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

ABSTRACT

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.     

The limits of collaboration

The premise of the essay is that collaborative public relations is unfeasible in some situations. Certain types of conflicts virtually require asymmetric or win-lose public relations efforts. The involvement of multiple parties in a dispute or the timing of a dispute, may necessitate reactive and confrontational responses on the part of public relations personnel. Practitioners sometimes perceive few degrees of freedom in how they may respond to a situation. There are also cases in which activist publics are motivated to pursue confrontation and to avoid open communication and collaboration.     

Informal care vs. formal services: changes in patterns of care over time

Longitudinal data from a representative sample of community-residing older persons were used to document changes in patterns and costs of care, both informal and formal. It was found that use of formal services was usually in conjunction with, and secondary to, informal care. Limited availability of informal care as well as increased disability raised the odds of using services. Substitution of formal services for informal care was limited and usually temporary. Total costs of community care, including living expenses, were generally less than the cost of nursing home care.