On the frontline or on the side-line? Homelessness care and care avoiders

Homelessness is a social problem that is subject to many definitional issues and problems. These problems can be discerned on both the conceptual and the practical level. Based on research carried out in Ghent, Belgium, this article deals with ways in which social workers involved in homelessness care construe the problem of ‘care avoiders’, who seem to be perceived as a separate category within the homeless population. We show that: (1) different categories of homelessness are created on an organisational and on an individual level (2) specific services have been developed for those who do not enter regular facilities and (3) a residual group has been created, which social work does not really know how to deal with.     

Social images of residential care: How children,youth and residential care institutions are portrayed?

The literature suggests that residential care for children and youth is associated with a negative social image harmful to their wellbeing. However, the social images of children and youth in residential care and of the residential care institutions have received no systematic study. The current study seeks to examine the social images associated with children and youth in residential care and the respective care institutions in Portugal. The sample of 176 participants in the present study was comprised of individuals with and without professional contact with children and youth in residential care. Participants responded to an open-ended questionnaire requesting attributes and characteristics of children and youth living in residential care as well as attributes associated with residential care institutions. The data collected were analysed through Discriminant Analyses, Z Tests and Multiple Correspondence Analyses. Results show that children and youth are primarily described with negative attributes (e.g., sad, rebellious, deprived, lonely) while residential care institutions are mainly described with positive attributes (e.g., cosy, secure, affectionate, comfortable). Results also show that the social images of children and youth in care and the respective care institutions are heterogeneous and present different profiles. Finally, there will be a discussion of the implications of these results for practice, namely the importance of raising awareness about existing biased social images and how to deconstruct them.     

Who should care for our kids? The effects of infant child care on early child development

This paper examines the relationship between various types of child care during the first year of a child's life and the child's language and social development measured at age three. A unique contribution of the paper is the estimation of a general selection-correction model that accounts for non-random selection of children into different types of child care. The analysis uses data from the Fragile Families and Child Wellbeing Study (FFCWS), a birth cohort of children born to predominantly low-income single mothers. The results indicate that compared with maternal care, relative care during infancy has more beneficial effects on a child's language development, while day care centers have more beneficial effects on a child's behavioral development.     

The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.     

Are baby boomers who care for their older parents planning for their own future long-term care needs?

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

Who uses child care subsidies? Comparing recipients to eligible non-recipients on family background characteristics and child care preferences

The federally funded, state-administered child care subsidy program provides subsidies to low-income families. Despite being among the government's most significant investments in early care and education, recent national estimates suggest that fewer than 30% of eligible families receive subsidies and the predictors of subsidy receipt remain poorly understood. This study investigates the predictors of subsidy receipt among eligible families, with data drawn from the nationally representative Early Childhood Longitudinal Study — Birth Cohort (ECLS-B). Using logit regression models, we compare subsidy recipients to the eligible non-recipients of subsidies as a group, and then classified by the type of care the non-recipients do use: Head Start, public pre-kindergarten, or unsubsidized care. Results indicate that subsidy recipients are generally more advantaged than the eligible non-recipients of subsidies. In particular, subsidy recipients have more resources and fewer hassles than eligible non-recipients. These findings can aid state subsidy administrators in more effectively targeting their outreach and enrollment efforts and ultimately in increasing the use of this important program.     

Doing business or leading care work? Intersections of gender,ethnicity and profession in home care entrepreneurship in Sweden

This article critically explores assumptions underpinning Swedish elder care policies that the introduction of market practices in publicly funded eldercare services advances women's entrepreneurship. We argue that gendered privileges and disadvantages are being recreated on tax‐funded home care markets; furthermore, gendered inequalities intersect with ethnicity and profession in the management of small‐scale care companies' dealings with authorities governing home care services and standards for home care work. However, we find that the salience of categories depends on the context in which they emerge. While gender and profession are dominant in management, gender and ethnicity influence interactions with authorities. Only in standards for home care work do all categories simultaneously shape the business approaches of care entrepreneurs. Our analysis, based on data on size and growth of home care companies and interviews with small‐scale care entrepreneurs, suggests that regulations and practices privilege big companies and care entrepreneurs who echo the white, masculine gendering of entrepreneurship as ‘doing business' and disadvantage small‐scale entrepreneurs focusing on leading care work to produce quality care.     

Youth leaving care: how do they fare?

This chapter summarizes recent Canadian and international research on the outcomes for youth after they age out of the child welfare system. It paints a disturbing picture for this small and vulnerable population. Youth leaving care face many challenges in making the transition from state care to independence and adulthood. They bear the emotional scars of childhood neglect or abuse. They do not have a family support network, have limited or no financial resources, are often lacking in life skills, and usually have not completed school. Despite these setbacks, we expect them to function independently once they reach age eighteen. Research shows that once youth leave care, they do not fare as well as their peers. They are at much greater risk of relying on social assistance, becoming homeless, engaging in substance abuse, becoming single parents, experiencing mental health problems, or coming into contact with the criminal justice system. Some youth aging out, however, have more successful transitions. These typically have completed high school, have role models, have access to postsecondary opportunities, refrain from alcohol or drug use, and obtain life skills and independent living training. Having stable placements while in care is also critical in ensuring more positive outcomes. Canada does not have the capacity to track the outcomes of youth as they leave the child welfare system, nor can it identify the types of interventions showing the most promise in helping them achieve better outcomes. Canadian governments need to improve their transitional planning for youth in care who are approaching the age of majority. Some recommendations include extending the age for services and financial assistance to age twenty-four, developing standards to prepare youth for leaving care, and exploring ways to enable youth to pursue higher education or training. Finally, Canada should develop a national longitudinal survey to monitor the outcomes of youth after they leave care.     

Cultures of care? Animals and science in Britain

It is becoming increasingly common to hear life scientists say that high quality life science research relies upon high quality laboratory animal care. However, the idea that animal care is a crucial part of scientific knowledge production is at odds with previous social science and historical scholarship regarding laboratory animals. How are we to understand this discrepancy? To begin to address this question, this paper seeks to disentangle the values of scientists in identifying animal care as important to the production of high quality scientific research. To do this, we conducted a survey of scientists working in the United Kingdom who use animals in their research. The survey found that being British is associated with thinking that animal care is a crucial part of conducting high quality science. To understand this finding, we draw upon the concept of ‘civic epistemologies’ (Jasanoff 2005; Prainsack 2006) and argue that ‘animals’ and ‘care’ in Britain may converge in taken‐for‐granted assumptions about what constitutes good scientific knowledge. These ideas travel through things like state regulations or the editorial policies of science journals, but do not necessarily carry the embodied civic epistemology of ‘animals’ and ‘science’ from which such modes of regulating laboratory animal welfare comes.     

Inter-rater agreement of scores to assess quality of care in public sector primary health care facilities – A pattern of performance

PurposeTo determine if the scores obtained from the Ideal Clinic Assessment Tool (ICAT) used to assess the quality of care in public Primary Health Care facilities in South Africa showed inter-rater agreement between self-assessments, district peer reviews and cross-district peer reviews. The ICAT scores obtained in the three types of reviews were paired as follows: self-assessments/district peer reviews, self-assessment/cross-district peer reviews and district/cross-district peer reviews. The global scores and averages of the Vital elements for the three paired reviews for 587 facilities across the country were compared using Bland-Altman plots.ResultsThe Bland-Altman plots showed no inter-rater agreement between the global scores and averages of the Vital elements for the facilities in any of the paired reviews (n = 1 761 reviews). Similarly, there was no inter-rater agreement between the global scores of the three paired reviews in any of the nine provinces in the country.ConclusionThere is still a need to continue to conduct both district and cross-district reviews despite the substantial cost of doing so. Further studies are required to determine what factors contributed to the disagreement in scores between the different types of reviews despite the preparatory training of reviewers.     

To work or to care? Working women's decision-making

Recent changes in older people's public care services in Nordic countries in particular in Finland and Sweden are based on implicit expectations that family members will increase their involvement in care. In Nordic countries, the care of small children has been acknowledged to be a social matter that concerns gender equality and the work life participation of both men and women, while the situation of working carers of older people is much less acknowledged. This study addressed the question of how Finnish working women who give care to their older parents argue for and against their decisions of working and caring and the meaning of work and care in these decisions. Majority of the interviewees emphasised the importance of work and refuted the idea of leaving work for care. The decision not to leave work for care was justified with worker identity, commitment to work, having no innate skills to be a carer, availability of support services and other carers and financial necessity. On the other hand, a few interviewees brought forward their willingness to leave work which was justified by constructing care as meaningful and valuable activity as opposed to meaningless paid employment, and with the intensification of work, and with ageing. Lengthy argumentation and several discursive tools indicate that women anticipated moral blame for the decision of giving work primacy over care, but also for leaving work. Thus, working carers balance between contrasting expectations to care and to work.     

Discounted labour? Disaggregating care work in comparative perspective

This article contrasts the earnings of high‐ and low‐status care workers in Canada, the United States, Japan, the Republic of Korea and Taiwan (China) using the micro‐data files of the Luxembourg Income Study. By disaggregating existing definitions of care work, the author identifies occupations with lower and higher degrees of “social closure”, revealing the associated care penalties and care bonuses cross‐nationally. She also empirically measures the extent of similarities (and differences) between and within care economies in “liberal” and “productivist developmental” welfare regimes, offering support for the argument that globalization has fostered substantial convergence within the international care market.     

Assisted living: will it reduce long-term care costs?

In their quest to reduce nursing home care expenditures, the various states in this country have looked to assisted living as a potentially preferred and lower-cost housing alternative for their Medicaid patients. For an assisted-living program to save costs, states must recognize that some assisted-living residents will not come from nursing homes, but rather from private residences, resulting in cost increases. This article argues that this "woodwork effect"--new clients appearing--is likely to be smaller than the level reported in the home and community care demonstrations, but that the numbers are difficult to predict with the possibility of divestiture. It also argues that the true savings from substitution, or of one form of care for another, depend on the nursing home reimbursement system in effect at the time.     

Person-centred communication in dementia care: a qualitative study of the use of the SPECAL® method by care workers in the UK

Abstract

Communication has featured prominently in person-centred dementia care research, but no consensus has been reached on which communication techniques are most helpful in supporting person-centred care. This qualitative study explored communication techniques used by domiciliary and community care workers of people with dementia in the UK. Care workers trained in the SPECAL® method (Specialised Early Care for Alzheimer’s) were invited to semi-structured interviews. The data were analysed using a constructivist grounded theory approach. Themes from the data were discussed as a potential basis for developing a substantive theory. The care workers contributed to client well-being through modifying their communication techniques, expressing a protective, empathetic and reassuring approach, underpinned by reflection. Clients exhibited greater well-being and less anxious behaviour. The care workers’ use of SPECAL® communication methods, supported by supervision, may provide a unique combination of techniques, contributing to the development of caring relationships, to care worker and client well-being, and to the maintenance of client personhood.     

Bring back orphanages—An alternative to foster care?

The current foster care system in America has not been successful in transitioning youth who are in the system to become productive, independent adults in today's society. Study after study cites the poor adjustment of foster care youth in school settings because of constant change in foster care placements and the corresponding poor achievement of these students. We find many of the youth needing public aide, working at low-paying jobs (if working at all), often caught up in the criminal corrections system, and homeless. Having had no permanent home and very often lacking positive role models, these children have little opportunity to build a solid foundation that might give them the chance to succeed.In addition, the current foster care system has in place short-term home placements, and this system is failing. What is needed are long-term placements for these children-placements that last until adulthood. What we are suggesting is that we as a society consider bringing back orphanages-wellrun facilities that provide a stable environment over time, good educational opportunities, and the chance for the children to develop emotionally in a secure, nurturing environment such as those found at Boys Town, the Hershey School, Kinderhaus and The SEED Foundation.     

The “Costs” of informal care: an analysis of the impact of elderly care on caregivers’ subjective well-being in Japan

This paper examines the impact of providing informal care to elderly parents on caregivers’ subjective well-being using unique data from the “Preference Parameters Study” of Osaka University, a nationally representative survey conducted in Japan. The estimation results indicate heterogeneous effects: while informal elderly care does not have a significant impact on the happiness level of married caregivers regardless of whether they take care of their own parents or parents-in-law and whether or not they reside with them, it has a negative and significant impact on the happiness level of unmarried caregivers. These findings call for more attention to be paid to unmarried caregivers, who presumably receive less support from family members and tend to be more vulnerable to negative income shocks than their married counterparts.