Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother’s perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52–90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.     

The Significance of the Early Stage of Illness as a Focus for Social Work Help

Summary This paper considers the experience of illness as a series ofinterrelated phases, in which the beginning phase which is thetransition from health to illness is shown to have special significance.The common responses to this stage of illness are denial, welcomeor inertia, each of which may give some forewarning of problemsthat may be encountered later in the illness. Traditionallysocial work help has focused onto the acute or convalescentstages, but it is suggested here that the beginning phase ofillness offers a rewarding point for intervention, not onlywhen opening new cases, but also among clients who are alreadyknown and where health problems may interact with other problems.The implications of this are explored both for agency policyas well as an added dimension of diagnostic understanding ofindividual clients no matter what the agency     

Social workers' use of spiritual practices in palliative care

Numerous studies have examined client use of spiritual and/or religious practices to cope with illness and adversity. This study explores social workers' use of spiritual practices as reflected in their work with palliative care clients. Survey results (n = 327) indicated significant relationships of spiritual practices such as yoga, prayer and meditation to working with palliative care clients. The total number of these approaches is predicted by factors such as theoretical orientation and the social workers' own struggles with palliative care and other issues. Our study supports the need for additional investigation of spiritual issues in practice.     

Groupwork in a Hospice Setting

Hospice has developed rapidly to become a major health care orovider for those with a life threatening illness and their families. As part of their services, hospices offer several types of groups for their clients, volunteers and staff as well as social support groups for their own team members. This paper examines the functions of groupwork in hospice, focusing particularly on the use of hospice staff support groups. Research on the use of a group perspective and group methods in a hospice setting is presented.     

Perceptions of Difference Between Aging and Disability Service Systems Consumers: Implications for Policy Initiatives to Rebalance Long-Term Care

This study explores service professionals' perceptions of how and why older adults and younger persons with disabilities are different consumers and clients within the long-term care service sector. Data are from 2004, early in the history of federal long-term care rebalancing initiatives, reflecting perceptions at that time. Findings suggest professionals working within aging, developmental disability, and physical disability service networks believe significant distinctions exist related to age of clients and nature of service required and how it is delivered. Overall need for greater professional and organizational capacity to support provision of service to both aging and disability populations is reported.     

Perceptions of difference between aging and disability service systems consumers: implications for policy initiatives to rebalance long-term care

This study explores service professionals' perceptions of how and why older adults and younger persons with disabilities are different consumers and clients within the long-term care service sector. Data are from 2004, early in the history of federal long-term care rebalancing initiatives, reflecting perceptions at that time. Findings suggest professionals working within aging, developmental disability, and physical disability service networks believe significant distinctions exist related to age of clients and nature of service required and how it is delivered. Overall need for greater professional and organizational capacity to support provision of service to both aging and disability populations is reported.     

Social Workers' Use of Spiritual Practices in Palliative Care

Abstract

Numerous studies have examined client use of spiritual and/or religious practices to cope with illness and adversity. This study explores social workers' use of spiritual practices as reflected in their work with palliative care clients. Survey results (n = 327) indicated significant relationships of spiritual practices such as yoga, prayer and meditation to working with palliative care clients. The total number of these approaches is predicted by factors such as theoretical orientation and the social workers' own struggles with palliative care and other issues. Our study supports the need for additional investigation of spiritual issues in practice.     

Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

Part III: A student learns casework

Abstract

When homeless and severely mentally ill individuals leave housing programs designed to help them achieve stability, their very lives become at risk. Despite the prevalence of this problem and its potentially life-threatening consequences, there is a complete dearth of case studies examining why clients in programs for the homeless and mentally ill suddenly depart from those programs, and how paranoid and other seemingly unreachable clients can significantly improve the quality of their lives. This single case study, utilizing a naturalistic methodology, provides a before and after picture of a client who precipitously left a housing program, then returned two years later in a state of severe physical and mental decompensation. The study focuses on understanding why the client left the program the first time and what could be done to prevent another premature discharge. The findings point to a lack of coordination of care and problems with stable human interaction on the part of those caring for Charles, and are critical to understanding how to engage successfully with homeless and severely mentally ill clients.     

Ageism,Death Anxiety and the Caseworker

ABSTRACT

This paper presents the results of an exploratory research study designed to identify some of the attitudes and socio-cultural characteristics of social workers practicing in the field of aging. Data were collected from two groups of caseworkers-one group with a geriatric caseload, the other with a non-geriatric caseload. There were striking and significant differences between the two groups in their preferences for working with particular client populations. The geriatric caseworkers indicated a preference for working with the frail elderly and cancer patients and negative preference for working with younger clients (either disturbed children or adolescent offenders). The non-geriatric caseworkers generally expressed a negative preference for the frail elderly or cancer patients and a preference for young married couples. No single factor seemed to differentiate the two groups as clearly as their levels of death anxiety. Those practicing in the field of aging revealed a significantly greater level of death anxiety as indicated by their higher levels of fear of the dying of others. Results also pointed to a relationship between death anxiety and the number of years of social work practice with the aging. In general, the greater number of years in the field of aging, the greater the level of anxiety tended to be, leveling off at about six or seven years. When the age of the social worker was held constant longevity in the field of aging affected levels of anxiety about the death of others, the dying of self, as well as the dying of others.     

Social service professionals in Finland under the pressures of a depressed economy and European integration

The Nordic welfare states are known as women-friendly. However, during the last years their policies have been to turn the back on women. At least in Finland there seem to exist two powerful forces that have advanced the non-egalitarian development: the economic recession of the 1990s and the integration of Europe. The decline of the Nordic welfare states is going to have considerable consequences for social service professionals, the great majority of whom are women. Therefore, they should create new strategies and find new allies in order to defend their own as well their clients rights.     

Using Photovoice to Identify Service Needs of Older African American Methadone Clients

ABSTRACT

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants’ narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.     

End of Life,Chronic Illness,and Trans-Identities

In this study, the experiences and needs of a sample of 1,963 current, global, English-speaking, transgender-identified adults responding to the Transgender MetLife Survey (TMLS) as related to a number of later-life and end-of-life (EOL) preparations and concerns were examined. EOL concerns are integrated with concerns and challenges around chronic illness and disability. Overall, this population was significantly ill-prepared for the major legalities and events that occur in the later to EOL time periods. The population was found to harbor significant fears around the future. Drawing on the author's decades of survey research in transgender aging and case data along with current scientific and online literature, illustrative quotations and case examples are provided.     

Controlling Access to Sick Leave Programmes: Practices of Physicians in the Netherlands

Policymakers in industrialized countries attempt to contain the costs of sick leave and disability schemes by limiting access to include medically proven cases only. However, a person's incapacity to work cannot be fully deduced by referring to his or her medical condition. It is the question whether using more restrictive eligibility criteria that focus on medical evidence actually reduces the number of benefit recipients and makes access to employee benefit arrangements fairer. This ethnographic study shows that physicians working in Dutch illness certification practices use alternative methods to restrict access to sick leave programmes. Doctors do not control their clients in a restrictive sense of the word. Rather, they exercise control over their clients by inciting them to internalize norms about being active and responsible. While we do not claim that this is good per se, we do contend that this control style may have some advantages over and above more restrictive control mechanisms. Elaborating on policy that supports this alternative notion of control, therefore, seems worthwhile.     

Are Methadone Counselors Properly Equipped to Meet the Palliative Care Needs of Older Adults in Methadone Maintenance Treatment? Implications for Training

Today's methadone patients differ greatly from those of the past. Because of the rise of polydrug use and the HIV and hepatitis epidemics, treatment has become much more complex, which multiply the concerns and complexities of treatment. Patients entering methadone programs are also more commonly presenting at ages well into their 50s, 60s, and 70s; and this phenomenon of high rates continues to grow. The majority of these individuals in treatment have presented with a number of significant comorbid medical conditions that will progress and eventually lead to death. This aging cohort must be approached with a modified treatment plan that focuses on management and promoting healthy aging, while attending to their maximum delay of illness, disease, and disability. This article argues that it is necessary for counselors working with this group to adopt a palliative care philosophy. This article also makes recommendations in areas that counselors need to be knowledgeable and skilled in to provide appropriate palliative services specific to this aging population with multiple needs as they near end of life.     

Using the Therapeutic Relationship to Promote an Internal Locus of Control in Elderly Mental Health Clients

Seniors who feel powerless to effect change on their environment or who feel that their lives are controlled by external circumstances are said to have an external locus of control. This may adversely affect commitment to and participation in mental health treatment. This article presents the conce t of using the therapeutic relationship to encourage internal contro f' beliefs in elderly mental health clients, with the goal of promoting personal empowerment and improving the efficacy of therapy. Included is a review of litera- ture relevant to aging and locus of control. The develoament of an external locus of conbol is explained by the theories of self psychol- ogy and the social breakdown syndrome.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

Somatic illness and psychosocial risk among military Amerasian adolescents and young adults in Luzon,the Philippines

There are very few empirical mental health studies of military Filipino Amerasians, progeny of United States servicemen and Filipina national mothers abandoned during overseas duty. A preliminary finding in a 3-year, multiple-case study focusing primarily on stigmatization-related psychosocial risk and stress and their relationship to core mental health symptomatology showed elevated prevalence (56%) of somatic illness and probable somatization disorder among the sample (N = 16). Somatic complaints were categorized as a mental stress factor in the overall study showing (62.5%) scoring severe levels of anxiety, depression or stress using the Depression, Anxiety Stress Scales (DASS-21). The unexpected presence of somatic illness is noteworthy and with palliative implications for medical and clinical social workers and allied health professionals. Such practitioners are likely to encounter Amerasian clients who apparently number well over 50,000 throughout the archipelago, and treat Amerasians having experienced racial stigmatization and presenting psychosomatic physical ailments possibly masking somatization complications and psychopathological disorder.     

The Medical Center's Impact in the Network to Sustain the Aged in the Community

A process is described to show how a Social Work Department of a Medical Center ascertained the need to offer a continuum of comprehensive services to a high risk elderly population. This includes aiding and participating with the board and administration of the Medical Center to develop a varied network of services programs. A community based program model is used to show the utilization of individual and group modalities in working with this age population. Clinical material is incorporated to emphasize that aging clients are accessible for psychosocial interventions and can utilize their ego strengths through group living and group counseling. Experiences will highlight that behavioral changes can be brought about through a reintegration of social, emotional, and environmental forces.