Who will care for older people? A case study of working with destructiveness and despair in long-stay care

Abstract

The reduction of services for older people is illustrated in a case study of a long-stay NHS service which has been transferred to a private, profit-making company. The effects of cuts in this service are most keenly felt in the very poor conditions of employment now offered by the company to new carers. Other illustrations of cuts are described in attempts to make savings on food or incontinence pads. The difficulties for staff, patients, their relatives, or indeed society at large, in challenging such destructiveness, may be understood in terms of the particular vulnerability of older people to projections of a dreaded infantile dependency and helplessness, in a society in the grip of a destructive narcissism which views ordinary human needs as a weakness.     

Personality and wealth accumulation among older couples: Do dispositional characteristics pay dividends?

This paper explores whether the ‘Big 5’ personality characteristics: Emotional Stability, Extraversion, Conscientiousness, Agreeableness, and Openness to Experience, contribute to net household wealth accumulation among 1172 couple pairs (n = 2344) participating in The Irish Longitudinal Study on Ageing, independent of other socio-demographic and human capital variables. We employ quantile regression to determine whether the effects of personality vary at different levels of the conditional distribution of wealth. Results reveal that the personality characteristics of the financial respondent to the survey are more strongly associated with wealth than those of the non-financial respondent. Specifically, we find that emotional stability and extraversion are positively associated with wealth at the household level among spousal pairs. We also find that conscientiousness is positively associated with wealth, but the relationship is only significant at the lower end of the wealth continuum. In general, agreeableness and openness are negatively associated with wealth although the relationships are non-significant. These findings indicate that personality is an important factor shaping individuals’ consumption preferences and financial decision-making behaviour over the life-course.     

Who is dropped and why? Methodological and substantive accounts for network loss

High rates of egocentric network turnover are frequently observed but not well explained. About 1000 respondents to the UCNets survey named an average of 10 names in each of two waves a year apart. Consistent with prior studies, respondents in wave 2 failed to relist about half of the names they provided in wave 1. Asked why, respondents explained that they had forgotten the alter for about 40 percent of the missing names. Other common answers, such as no “occasion… to be in touch,” also suggest that the true rate of alters being dropped is probably under 20 percent. Multilevel logit models identified the predictors of alters being dropped (neither relisted nor forgotten) versus retained. Immediate kin were likeliest to be retained and roommates, coworkers, and acquaintances to be dropped. Alters who provided companionship, confiding, advice, and emergency help were especially likely to be retained, as were those to whom respondents felt close. Little about the respondents themselves affected drop rates: having moved recently, having a close friend die, or having had an important relationship break up. Results are consistent with the argument that a tie’s degree of constraint (notably being close family) and its balance of rewards determine the likelihood of it being dropped or demoted.     

Long-term care preferences among older adults: a moving target?

This study investigates long-term care preferences across three hypothetical scenarios and over one year of time among a sample of disabled older women receiving informal care (n = 420). Unpaid or paid help in one's home was preferred, given scenarios of instrumental activities of daily living (IADL) and activities of daily living (ADL) needs; nursing home care was most preferred for dementia care. While aggregate preferences for long-term care were relatively stable, there was considerable fluctuation in individuals' preferences over time, with just 52.5%, 44.4%, and 44.6% of participants retaining their initial first choice across IADL, ADL, and dementia scenarios, respectively. Implications of study findings are discussed.     

Risky discounts: Do people prefer them on a per-item or per-purchase basis and why?

Risky discounts differ from other discount formats in that the actual discount level is determined by chance (e.g., “scratch & save” cards). Four studies investigated whether consumers prefer to receive risky discounts on a per-purchase or per-item basis. Although these options do not differ with regard to expected value, they entail multiple differences (e.g., savings distribution, amount of individual gains, excitement, and effort involved) that may lead to differential consumer perceptions and experiences. Controlling for expected value of savings, participants preferred per-item over per-purchase discounts. As hypothesized, the main reasons for this preference were a partly incorrect perception of the properties of the savings distribution, the adoption of a narrow mindset focusing on the best outcome in a series of discount gambles, and the greater excitement provided by multiple discount gambles.     

Choice: what,when and why? Exploring the importance of choice to disabled people

Extending choice and control over public services is central to current policies in England. Such policies have immense potential for independence and well‐being. However, it is still not clear how disabled people conceptualise choices, what choices are important, for which groups of people, in what areas of life and why. This paper presents findings from the first phase of a longitudinal qualitative study of choice and control over the life‐course. Semi‐structured interviews were carried out with 111 participants including disabled young people with progressive conditions; their parents; adults and older people with fluctuating support needs and those experiencing sudden deterioration in health. The findings suggest that while most people across all study groups wanted to be able to make choices in all areas of their lives, there are significant differences in the importance they attach to specific choices. The findings have implications for service reforms and identify some policy and practice issues that need to be addressed.     

Intergenerational support and functional limitations among older Chinese immigrants: Does acculturation moderate their relationship?

ABSTRACT

Using a purposive sample of 236 older Chinese immigrants in Los Angeles, California, this study investigated the association between intergenerational support and functional limitations and the potential moderating effect of acculturation in such a relationship. The results of multiple regression analyses showed that receiving financial support from children and coresiding with offspring were significantly correlated with more limitations in instrumental activities of daily living. Perceived emotional cohesion with children was significantly correlated with fewer such limitations. The relationship between different dimensions of intergenerational support and functional limitations varied by acculturation. To prevent or reduce functional limitations, interventions need to consider acculturation.     

50 + among the 50+: who works long workweeks among older workers in Canada?

The focus of this short report is on workers who are 50+ years of age and who have a work schedule averaging 50+ hours per week (i.e. a ‘long workweek’), using Statistics Canada's linked Workplace and Employee Survey (WES) 2005 microdata, as well as selected qualitative study findings. The results show that the proportion having a long workweek is actually higher among older workers relative to others. Also, mean job satisfaction among older workers with a long workweek is at least as high as older workers without one, whether or not controlling for other factors. In terms of the characteristics of older workers with a long workweek, this is overwhelmingly a male-dominated group, and the majority are in a managerial/professional occupation. Thus, they do not exhibit the characteristics typically associated with those having poor quality schedules or employment. Since older workers represent a growing proportion of labour markets in industrialised nations, it is important that these workers access sufficiently attractive employment opportunities to keep them in the labour force. However, the findings provide yet another reminder that workers' scheduling realities and preferences are not homogeneous.     

Who Pays for Seniors Housing and Care Communities? Evidence from the Residents Financial Survey

To examine the financial characteristics of residents in assisted living and independent living communities and to see how they currently pay for their care arrangements, we surveyed 2,617 residents in assisted living and independent living communities. We asked them how they pay for their current costs and verified their answers by examining self-reported information on their cost and income. Residents stated that they are largely paying for their community costs independently. Approximately one third of respondents reported using their assets and income to cover their current costs. The data supported the notion that individuals living in assisted living and independent living communities are largely mid- to high-income elderly. However, the cross-sectional analysis showed that length of time in the community was positively associated with paying for their expenses independently out of income, after controlling for many confounders including age, education, and lifetime earnings to try to rule out differential longevity and differential selection over time. Further longitudinal analysis is needed to understand the cause and the implications of the positive correlation between ability to pay one's bills out of income and the length of time in the community before conclusions about spend-down can be made.     

Reciprocity and uncertainty: When do people forgive?

A sizable proportion of individuals act reciprocally. They punish and reward depending on the (un)kindness of those with whom they interact. In this paper, I explore whether individuals still reciprocate intentions when others lack full control over the consequences of their actions. By means of a dictator game with punishment opportunities, I show that unkind intentions are enough to trigger punishments, irrespectively of the outcome. By contrast, accidents are forgiven. To isolate how uncertainty over the result of an action affects the assessment of intentions, I control for other possible departures from self-profit maximization, such as distributional concerns or efficiency maximization. I find that the former also plays a role in respondents’ behavior.     

Who runs away from home and why? How families,schools, and bullying influence youth runaways

While prior research establishes that youth who experience family problems are more likely to leave home before reaching adulthood, we know less regarding how peer victimization in the form of bullying may influence youths' likelihood of becoming runaways. Youth often run away from home to escape family conflict or abusive home environments. Mental illness, behavioral problems, and delinquent peers are also powerful forces predicting the likelihood of running away from home. Additionally, recent literature suggests that negative experiences at school may increase youths' decisions to leave home prematurely. In this article, I review literature that addresses who runs away from home, including variations by age, race/ethnicity, sexual orientation, gender, family structure, mental health, problem behaviors, and peer networks. I also suggest directions for future research, including an approach that considers how families and schools individually and collectively affect youths' likelihood of running away from home. Finally, I recommend a focus on bully victimization to better understand how victimization outside of the family affects the likelihood that youth will become runaways.     

The exclusion of older people in disability activism and policies — A case of inadvertent ageism?

Using Sweden as a case, the article discusses the tendency within disability activism and policies to overlook elderly people. From an analysis of a major Swedish government investigation on disability it is clear that disability policies in Sweden have come to rest upon stereotyped age norms that divide the life course into set stages, and there has been a tendency to define elderly disabled people as elderly rather than disabled. It is argued that this exclusion is partly the result of a successful endeavor to provide disabled people of younger ages with rights that are typical of non-disabled citizens. Justice and equality have been defined in comparison to citizens of similar ages: children, youth and adults of “active age”. Based on the analysis of the paper it is argued that activities of movements struggling to liberate oppressed populations may contribute to ageism, and that anti-ageist research must go beyond the idea that ageism is a simple matter of attitudes towards older people.     

A configurational approach to transnational families: Who and where is one's family in the case of mobile older adults?

This article introduces a novel transnational family configuration (TNFC) approach to study the diversity of family forms across kinship and geographical boundaries. Integrating theoretical insights from family sociology and transnational family research, it examines contemporary families as personal networks that encompass both subjectively identified and potentially transnationally dispersed kin and non-kin members. Drawing on original survey data and in-depth interviews with adults aged 55+ living in Switzerland, it compares migrants’ and non-migrants’ personal family networks. The results indicate that these networks are both diverse and transnational. Although there is a strong correlation between transnationality and migration background, other life-course factors also contribute to the development of transnational family networks beyond the scope of migrant ‘exceptionalism’. By advocating the adoption of a TNFC approach to the study of contemporary families, in diverse population groups and various cultural contexts, this study paves the way for future research in this area.     

Financial Risk Attitude and Behavior: Do Planners Help Increase Consistency?

This study is the first to evaluate the effect of sources of information on households’ consistency between their risk attitude when making savings and investment decisions and risk behavior displayed when they do save and invest. As the responsibility is being shifted to individuals to save for their own financial future, it is important that individuals and households save and invest in a manner that is consistent with their financial risk tolerance. Financial planners were found to provide significant value to households on the consistency of their financial risk attitude and behavior. The implications of this work are far-reaching in the financial planning arena.     

Young people and prostitution: an end to the beginning?

Since the mid‐1970s, we have developed in England and Wales a complex and sophisticated inter‐agency system dedicated to protecting children from abuse. However, we have failed to apply it effectively to the protection of young people sexually abused through involvement in prostitution. This paper examines some of the reasons for this failure and identifies a number of characteristics of the child protection system which seem to fit it poorly for work with these young people. It is argued that lasting improvement in their well‐being depends on the creation of truly ‘joined‐up’, integrated, interdisciplinary services addressing the whole range of their needs. Copyright © 2000 John Wiley & Sons, Ltd.