Long-Term Care Planning as a Cultural System

Abstract

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

Broadening Our View

Summary

The growth in child welfare caseloads and the increasing use of kinship foster care has raised new questions about effective permanency planning. The majority of children in kinship foster care are children of color and have been less likely to exit the custody of the child welfare system than children placed in traditional foster care. Permanency planning which ensures the long-term protection and well-being of children from diverse cultural backgrounds requires a broad view of family, ongoing striving for cultural competence, collaboration between the formal child welfare system and the kinship systems of children in state custody, and a long-term view of permanency planning and child-rearing that builds on the case-management capacities of kinship networks to support permanent plans, looks beyond the child's exit from state custody, and helps families and larger kinship systems make long-term plans for the protection, permanence, and well-being of children.     

Reviewing Respite Services: some lessons from the literature

Although the community care reforms raised the profile of respite services for adults with learning disabilities, little is known about the character of respite provision in Britain. This lack of information is compounded by the way the literature about respite is dispersed across user groups and is often restricted to particular types of services or to specific localities. In order to highlight some of the key issues associated with respite, this paper draws on a wide range of literature. Regardless of differences in terms of the service user groups, common themes are identified which are relevant to service planning and provision for adults with learning disabilities. The paper discusses these themes and argues that a break with the traditional notion of respite as primarily a way to relieve carer burden is long overdue. Adopting the perspective of the primary service users affords the opportunity to re-think respite services.     

The role of life experience in long-term care insurance decisions

This study uses data from a unique survey of the retirement planning behaviors of late middle-aged individuals living in New York State, to test hypotheses regarding the role of earlier life experiences on the demand for long-term care insurance. Our primary focus is on previous provision of informal long-term care, which some studies have found to be correlated with demand for long-term care insurance. We add to the literature by providing a test for causal relationships between previous care-giving and insurance demand, and by exploring the more generally the mechanisms through which previous life experiences are linked to insurance demand. Results are robust to a variety of empirical specifications and estimation methods, including consideration of current care-giving roles and endogenous selection into previous care-giving, and strongly support a causal relationship between previous long-term care-giving and demand for insurance. Our estimates also provide evidence that lifetime health trajectories and family relationships are associated with long-term care insurance demand, and suggest that both emotional and informational forces influence demand.     

Financing Long-Term Care: Examining Decision Outcomes and Systemic Influences from the Perspective of Family Members

This study examined financing long-term care from a micro-level family perspective. Qualitative analysis of interviews conducted with 45 families coping with paying for an elder's long-term care provided insight into what decisions were made as well as what factors influenced those decisions. Family members articulate systemic factors within and outside of the family system influencing three decision making outcomes: (a) using and preserving private resources, (b) Medicaid estate planning and (c) deciding not to decide. Case examples and a discussion of the emerging framework provide insight for researchers working to inform long-term care issues and for educational focused practitioners.     

Children with Special Health Care Needs

Abstract

The health care model presented in this paper is a non-linear, systems approach to service delivery. The model was a by-product of three ethnic-specific conferences that were convened to discuss strategies for improving access to care and the quality of services provided to children with special health care needs (CSHCN) from diverse cultural backgrounds. The model evolved as insights regarding the common values and norms held by parents, health care providers, and cultural representatives were shared. Content analysis was used to identify core themes identified by participants. These themes were incorporated into a model that included the following elements: community-based, culturally competent, health-oriented, resiliency-focused, and family-centered care. At the fourth Consensus Conference, selected participants from the previous ethnic specific conferences reviewed the proposed model and deemed it a vehicle for facilitating health care service utilization by culturally and linguistically diverse CSHCN and their families.     

Life-Stage and Mobility: An Exploratory GPS Study of Mobility in Multigenerational Families,Ahmedabad, India

As the population of older adults in India grows, research is needed to plan a sustainable future for India’s older adults. This article reports results from a Global Positioning System (GPS)–based pilot study that examined the mobility of middle-class, older adults living in Ahmedabad, Gujarat, India. Using mobility as a lens through which to examine the lives of older adults, we map potential research and identify policy areas of interest considering older adults in urban India. The study explores the role of life stage in mobility as well as the effects of gender and urban environment on mobility. Using this distinctive perspective on day-to-day life, we propose themes through which, using policy and planning tools, the living environments of older adults in Indian cities can be improved. These policy measures include focusing on walkability and pedestrian safety in residential areas and building on existing mixed land use to create high accessibility to goods and services in urban environments.     

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

Voluntary work in the Norwegian long-term care sector: complementing or substituting formal services?

ABSTRACT

Across Europe, governments call for increased involvement of volunteers to shoulder some of the welfare burden. Nevertheless, there is little research into what kind of work and how much volunteers currently contribute in the long-term care services and whether this has the potential to substitute formal services. Drawing on findings from a survey of employees in Norwegian nursing homes and home care districts, we examine the nature and volume of voluntary, unpaid work in the long-term care services in Norway. Our data suggest that volunteers to a very limited degree carry out work that has traditionally been considered the formal system’s domain: personal care and practical help. Nearly all the voluntary, unpaid contributions in our data takes place within cultural, social and other activities aimed at promoting mental stimulation and well-being, indicating a classic specialisation of tasks between volunteers and professionals. However, there has been an expansion of the formal care system to include activities aimed at promoting well-being in recent decades. This may indicate that there is a certain level of task sharing between voluntary and formal care. Thus, social workers need to consider voluntary service provision when assessing the needs of clients.     

Multiple Perspectives of Teams’ Experiences of a New Zealand Wraparound Process

Since it was first introduced in the 1980s, Wraparound has been defined as ‘a philosophy,’ ‘an approach,’ and ‘a service’ which is designed to work with youth and families with high and complex needs. Wraparound is most commonly understood as an intensive, individualised care planning process. It aims to achieve positive outcomes through a structured, creative, and individualised team planning process, which results in effective and more relevant plans for the youth and family. The purpose of this qualitative study was to explore the experiences of Wraparound facilitators, caregivers, youths, and team members to gain a multi‐perspective insight into the process. Sixteen families and Wraparound teams participated in the study which resulted in 56 semi‐structured interviews being conducted involving 16 Wraparound facilitators (some facilitators were interviewed more than once because they served multiple families who participated in the study), 16 caregivers, eight youth, and 16 team members (one person from the team, i.e., teacher, social worker, or mentor). Thematic analysis gave seven themes organised into three broad domains: (1) key elements of the Wraparound process including the Wraparound facilitator, Wraparound's philosophies and principles, and the supportive nature of the process; (2) the outcomes achieved throughout the process including family empowerment and hope, improved family dynamics and relationships as well as individual parent and youth change; and (3) the challenges and feedback respondents identified through the process, which included personal and systemic challenges, improved transition, and continuity of care, role clarity, and accessibility of the service. Overall, the findings from this study support Wraparound as an effective process for youth and their families, identify the importance of key aspects of the process, and suggest some improvements to increase the efficacy of and accessibility to the process.     

Exploring Definitions of Financial Abuse in Elderly Korean Immigrants: The Contribution of Traditional Cultural Values

The purpose of this study is to explore the cultural definitions of financial abuse from the perspective of 124 elderly Korean immigrants and to examine the role of traditional cultural values in their definitions by using a mixed methods approach. The qualitative analysis generated four themes relevant to definition of financial abuse. A binary logistic regression indicated that those with stronger cultural adherence to traditional values had higher odds of providing culture-based definitions of financial abuse. Education is needed for health professionals, social service providers, and adult protective workers to increase their understanding of culture-specific experiences of financial abuse among ethnic minority elders.     

Reclaiming and Reimagining Macro Social Work Education: A Collective Biography

The authors focus on a collective biography of 12 women social work educators, all either tenured or in tenure lines, from five different universities at the time of the study. The participants represent several aspects of macro practice including administration, planning, community practice, and policy. Beginning with reflections about coming into macro practice, we highlight memories about first teaching experiences and examine cultural shifts discovered in our academic journeys. We feature students who inspired us and perceptions of challenges in curricular development affecting the preparation of students. This article includes comments that emphasize the themes and focus of our collective reflections. Finally, we place what we learned in the context of a report from the Association for Community Organization and Social Administration calling for the visibility of and advocacy for macro social work education.     

Ways of Thinking About the Long-Term Care of the Baby-Boom Cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers-the generational equity/crisis perspective and the generational investment/gradual adjustment perspective-are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

Place-based urban ecology: A century of park planning in Seattle

This research responds to calls from within the field of urban ecology to explicitly incorporate humanities-based research in order to achieve robust interdisciplinarity. Our research provides an example of a place-based urban ecological analysis. We use this framework to analyze over a century of park planning and development within the city of Seattle. We identify four eras of park planning that are linked by a comprehensive 100-year park plan. This case study examines how the political, cultural, and economic aspects of park planning have produced and been influenced by long-term trends and historical contingencies. This research also offers practical insights for effective contemporary urban planning, emphasizing the need for flexible and adaptive long-term plans when confronted with unpredictable events, emerging political arrangements, changing cultural priorities, and shifting fiscal climates.     

Adolescents’ Views on Families as Metaphors in Hong Kong: Implications for Pre‐counselling Assessment

This interpretative study aims to offer metaphors that describe family meanings from the adolescent’s perspective by encouraging them to give a metaphor with their own explanation on a self‐administering essay form. This study has three objectives: to explore the family meanings as a metaphor from the Hong Kong adolescent’s perspective; to reveal any common and unique features of these metaphors; and to search for the possibilities of collecting metaphors from adolescents as a pre‐counselling assessment tool. The 12 participants for this study were referred to me for family counselling because of poor self‐esteem, loss of life goals or ineffective relationships with their parents. Based on the 12 metaphors, the following five themes can be discerned: (i) gender role in a family, (ii) Chinese culture in a family, (iii) heat in a family, (iv) security in a family and (v) the family as honey and a loan company. Based on the above five themes, there are some common metaphors (e.g. a warm place, honey, a shelter, a boat shelter, a chick and a hen, a volcano, a fire, an oven and a loan company), trans‐cultural and unique metaphors (e.g. a wet market and ‘Kung Fu’ experts), and those that are culturally specified. Both strengths and limitations of collecting and analysing metaphors were discussed.     

Kinship Care: A Cultural Resource of African American and Latino Families Coping with Parental Substance Abuse

SUMMARY

This paper examines kinship care as a cultural resource used by African American and Latino families coping with substance abuse by a family member. Although there is a growing body of literature on kinship care, there are no conceptual or empirical studies that have drawn or built on cultural similarities between these two groups of ethnic minority families. A framework that prioritizes cultural assessment and relevance in using familial and cultural resources is proposed to assist practitioners confronted with the demographic realities of working with social, clinical and ethnocultural complexities when serving ethnic minority families. The framework is based on practice implications raised by recent studies on kinship care and from the perspective of pertinent cross-cultural and anthropological literature.     

Cultural Organizations and the State: Art and State Support in Contemporary Britain

Only a small proportion of research in the sociological field of arts and culture is on the state and its effects. Literature which touches on this topic often comes from the policy arena and the wide variety of disciplines interested in public policy. Research tends to focus on two key themes: funding and censorship. But the effects of state actions are much broader. Moreover, state support is often set in opposition to the market, but markets and state systems usually exist together. It is ironic that the effects of the state on cultural organizations are increasingly studied at just this point in time, when states are scaling back their involvement and privatization is coming to the fore. Focusing on cultural organizations usually associated with the fine arts (museums and performing arts organizations), I illustrate some of these themes with a discussion of recent events in the UK.     

The importance of employer sponsorship in the long-term care insurance market

Medicare and Medicaid are major sources of long-term care payments and thus will bear much of the burden from the growth in long-term care service use. The large future demand for long-term care services is of great concern among policymakers due to its expense and the use of public program dollars. It is argued that the individual purchase of long-term care insurance can help alleviate the increasing financial pressure on public programs responsible for the majority of longterm care financing. However, consumers have shown little interest in insuring against the high costs of long-term care. This analysis examines the effect of several factors on the decision to purchase a long-term care insurance policy: knowledge and attitudes of long-term care insurance and the long-term care financing system, the perceived risk for longterm care, financial planning behavior, and the availability of long-term care insurance. The interim results indicate the factor most likely to affect the decision to purchase long-term care insurance is access to employer-sponsored long-term care insurance. This suggests tht the availability of affordable and high quality coverage is more important than demand-side factors such as awareness of long-term care insurance and a perceived greater risk for long-term care.