Eldercare and employed caregivers: a public/private responsibility?

The National Alliance for Caregiving (NAC) and the American Association of Retired Persons (AARP, 2004) have reported that 21% of the U.S. population provides family caregiving services to someone over 18 years old. Seventy-nine percent (79%) of these caregivers provide care for someone aged 50 or older. The majority of caregivers work full or part-time, and nearly two-thirds of employed caregivers make work-related adjustments in order to provide care (NAC & AARP, 2004). This article examines eldercare issues of employed caregivers, identifies current public and private policies addressing caregiver needs, presents a process model to assist organizations in creating family-friendly workplaces, and suggests social work roles that support family caregiving.     

Family Support of the Aged: Some Evidence and Interpretation

This paper brings together a range of Australian material concerning family support for the aged. From a review of studies dealing with the family structure of the aged and accounts of inter generational contact and supportive exchanges within families, including migrant families, considerable evidence of family support is found. The implications of the absence of such support are seen from data on the use of services and admissions to institutional care; the preventive effect of marriage and family is apparent, those aged without family being identified as most at risk. Reasons for the commonly held view of family breakdown are then examined and some suggestions for service development outlined.     

Temporary Foster Care

Summary In order to improve outcomes in temporary foster care the authorbelieves there is a need to develop alternative models for practicethat would (a) define the social work task (b) specify in operational terms how that task would be accomplishedand thus would be amenable to empirical testing. (Temporaryfoster care is defined as the provision of substitute familylife for a child received into care, where there is a clearintention to re-unite the natural family at a future date). This article deals with the essential preliminaries to the developmentof a practice model. The first part surveys the relevant literature;part two develops a theoretical framework for practice aroundthree themes which are considered central to a considerationof foster care. These are the separation experience, the placeof the natural family, and role clarification. Other crucialvariables such as the age of the child, the nature of the problem,or the parents' potentiality for change are not dealt with withinthese papers, but are nevertheless seen as important issuesto be considered at the stage of designing a model for practice.     

Family Caregivers of the Elderly

Two groups of primary family caregivers were interviewed; one whose older relatives received assistance from an inhome chore services program, the other whose relatives had been terminated from service due to budget reductions. Both groups of caregivers were found to be actively involved in providing care to their older relatives. The assistance that caregivers provided was similar whether or not their relative received chore services. No significant differences were found in the type of tasks they provided nor in the amount or length of time they have provided care. The data suggest that there may be limits to the assistance that these caregivers can provide and that care of the elderly beyond such limitations needs to be supplied by other sources. Caregiving may be influenced both by the particular circumstances of the caregiver and the individual needs of the older relative. These findings support the notion that there is a need for shared responsibility between the family and government, based on an understanding of the tasks that family caregivers are best able to provide.     

Family Disruption and Support in Later Life: A Comparative Study Between the United Kingdom and Italy

Global population aging has led to considerable disquiet about future support for frail older people; however, the determinants are poorly understood. Moreover, most industrialized societies have witnessed considerable changes in family behavior (e.g., rises in divorce and declining fertility). Such trends may have adversely affected the support systems of older people; nonetheless, only recently has research begun to address this issue. Employing data from the longitudinal British Household Panel Survey (1991–2003) and the 1998 Indagine Multiscopo sulle Famiglie "Famiglia, soggetti sociali e condizione dell'infanzia," we investigated the association between family disruptions due to divorce, separation, or death and three key dimensions of informal support: (i) frequency of contact with unrelated friends (among all respondents aged 65 years and over); (ii) co-residence with children (among unmarried mothers aged 65 years and over); and (iii) regular or frequent help received from children (e.g., household assistance including care) among parents aged 65 years and over. In addition, we conducted a comparative investigation of the relationship between family disruptions and the use of home care services (i.e., health visitor or district nurse; home help; meals-on-wheels) among parents aged 65 years and over. Our findings suggest that in a culture like the U.K.'s, where relations between kin are primarily influenced by individualistic values, support in later life appears to be primarily related to need, whereas in societies with a strong familistic culture (like Italy's), support is received irrespective of the older person's individual characteristics.     

Counting family support

Preventative family support approaches are positioned as central to child welfare policy reforms aiming to address the problems of relying upon investigation and out‐of‐home care as the main modes of intervention. Extensive claims are made for family support but relatively little is known about its scope, processes and impact. This study examines the provision of family support in one jurisdiction. A census‐type survey of family support services in one Australian state was conducted using a performance measurement framework in which inputs, outputs, processes and outcomes were measured. Family support services constituted a minor part of child welfare expenditure. They provided a narrow range of service types, and most families received short duration, low intensity services. Workers had difficulty identifying the specific child and family needs that were met by services. For family support to be a genuinely alternative response to concerns about the care of children, it must be capable of making an observable difference in the lives of families experiencing serious difficulties. The collection of aggregate performance data on family support would assist in understanding the nature and outcomes of service provision, as well as ensure family support is ‘counted’ in measurement‐orientated policy and budget processes.     

From Assistance to Prevention: Categorizing Young Carer Support Services in Australia,and International Implications

Young people who provide unpaid care for a relative with chronic illness or disability are a growing focus of public policy and research in Australia and internationally. Support services for these young carers have emerged, but not enough is known about their effectiveness. This article develops an analytical framework that categorizes young carer support services according to their goals and the types of intervention provided. The analytical framework is based on Australian data. It is applied to young carer support services available in Australia but may be applicable to other countries. The aim of the framework is to provide a structure for assessing the effectiveness of current services in supporting young carers by clarifying service goals and identifying gaps in existing service provision. The framework contributes to conceptual discussions about young carer supports, and it can be used to guide future policy development. The article draws on Australian and international literature as well as findings from a recent Australian study on young carers. The proposed framework groups young carer support services according to three overarching goals: assisting young people who provide care; mitigating the care‐giving responsibility; and preventing the entrenchment of a young person's caring role. The framework is applied to an audit of Australian support services for young carers, illustrating how it can be used to assess existing supports for young carers and inform future policy development. The findings suggest that most services in Australia fall into the categories of assistance and mitigation, while few contain preventative elements.     

A comparison of state support for young people leaving care in Norway and Sweden: Differences within comparable welfare systems

The aim of this article is to account for and discuss support to young care leavers within the comparable welfare regimes of Norway and Sweden and to explore key differences between these 2 countries. This model implies that children and young people are included and entitled to support through being family members, not as independent actors in their own right. This makes young care leaver's transition from care to adulthood problematic—as they often do not have access to family support, they may be positioned in a vacuum where they are clients neither entitled to support from the child welfare system nor supported by their families of origin. In Norway, legislators and policymakers have agreed that care leavers need particular attention and targeted support, whereas in Sweden, there has been no such agreement. However, the Norwegian system of giving leaving care services is not strong enough to provide transition support to all care leavers, even if the legislation gives stronger protection than in Sweden. The article discusses the need for targeted measures of support for a successful care‐leaving process.     

Carer Break or Carer‐blind? Policies for Informal Carers in the UK

This article examines three policy statements on informal carers published in the UK in 1999—the National Strategy for Carers, the report of the Royal Commission on Long Term Care and the note of dissent by two members of the Royal Commission. These three documents contain two rather different approaches to policy for carers. On the one hand, the National Strategy and note of dissent emphasize respite care or short-term breaks for carers, and are concerned with sustaining the well-being of carers as well as ensuring the continuation of caring itself. The Royal Commission, on the other hand, emphasizes support for the older or disabled person who is being cared for, as a means of supporting the carer, and advocates "carer-blind" services. It is argued that this policy contains within it the potential to substitute for or replace the carer and that this represents a radical new departure for social policy for carers in the UK. The advantages and disadvantages of the two policy approaches are explored. It is argued that policies for carers should include both services specifically for carers, like breaks from caring, and services provided for the cared-for person, like domestic and personal care services. Wider issues about the proper boundary between family and state care are explored.     

Paternal Multiple Partner Fertility and Environmental Chaos Among Unmarried Nonresident Fathers

This study examined the association between paternal multiple partner fertility (MPF; having children with two or more partners) and indicators of environmental chaos (partnership instability, residential instability, work stability, material hardship, and perceived social support) among unmarried, nonresident fathers. Survey data from the Fragile Families and Child Wellbeing Study (N = 873) were used to compare unmarried nonresident fathers who experienced MPF to those who had children with one partner. Results show that paternal MPF is associated with most indicators of environmental chaos (greater partnership instability, residential instability, work instability, material hardship) but not social support. Results suggest that fathers who experience MPF face challenges beyond those of other nonresident fathers. Policies and interventions should address aspects of instability and hardship that are unique to paternal MPF in order to encourage fathers’ positive contributions to children and families. Directions for future research are discussed.     

Early access and use of housing: care leavers and other young people in difficulty

This paper presents findings from a study of how care leavers access and use housing services, and what they said had helped them to do so. The sample comprised 80 care leavers, and, for comparison, a group of 59 young people (termed ‘in difficulty’) who met certain criteria of disadvantage. Care leavers were found to have fewer crisis transitions and less experience of homelessness, together with a much higher level of autonomy and support in their first accommodation, relative to other young people in difficulty. Several factors are identified that, from the care leavers' point of view, contributed to their better access and use of housing services, including having family and friends to turn to, and leaving care teams that negotiated on their behalf with housing services. The paper concludes that care leavers had more positive housing experiences than other young people in difficulty, helped by the improved preparation for independence and ongoing support available to them from leaving care teams.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

Facilitating Factors for Nonresident Parents' Financial Provisions for Children in Hong Kong

This study examines the facilitating factors for nonresident parents' financial provisions for children among the Chinese in Hong Kong. It found that financial provisions from nonresident parents are subject to economic and ideological as well as relational factors. The results call for the enhancement of active parenting of nonresident parents in a context of cooperative and supportive parental relationship, as well as for adequate employment support to poor nonresident parents. Findings of the study support the recent law reform on creating a less adversarial divorce system that is more conducive to a culture of settlement and cooperation, and on a shifted emphasis from parental rights to both rights and responsibilities of divorced parents.     

Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

Caring and the generation of social capital: Two models for a positive relationship

Johansson S, Leonard R, Noonan K. Caring and the generation of social capital: two models for a positive relationship When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used for care work. When there is inadequate funding of aged care services by the state, then social capital may be seen as a substitute for economic and human capital. Caring, therefore, is seen as a drain on capital. However, this does not have to be the case. Aged care services, if thoughtfully designed, can not only consume social capital, but also generate it. Two models of elder care, one Swedish and one Australian, have been identified which specifically address the generation of social capital. In each case, the services and facilities have been developed by third‐sector organisations with a strong community development focus, often in the face of resistance from state‐run or medically oriented services.     

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.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Driving outcomes: learning to drive,resilience and young people living in residential care

There are continuing concerns about the experiences offered to older adolescents being looked after (‘in care’) in the UK and, especially, to care leavers. Questions are asked about the limitations of State care compared with normal family life. This paper reports on an initiative to provide driving lessons to a group of six young men living in residential homes in one city. It links with resilience theory – how individuals can have relatively good outcomes despite early adversity. A qualitative study was undertaken to explore the effects of the initiative, including individual interviews with young men, heads of homes in which they lived and children's services managers. The overall results indicated that the initiative was very worthwhile. The lessons were a significant part of young people's lives. Possible effects on young people were divided into personal, instrumental and social. Benefits were reported from all parties concerning young people's self‐esteem and self‐confidence, as well as in forging close relationships with supportive adults. Driving would not be seen as a panacea for complex personal histories and structural problems, yet this small experiment suggests that driving lessons could be of disproportionate benefit and there is a moral obligation to provide them in any case.