Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Civic Engagement for Nursing Home Residents: A Call for Social Work Action

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.     

Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Challenges to Treating the Elderly Latino Substance Abuser

Summary

The Friendly Companion Program was initiated in May of 1999 to enhance social support for VAMC Northport Nursing Home residents who have infrequent or no visitation by family, friends, or significant others. Friendly Companions are adult and youth volunteers who make a commitment to visit residents on a regular basis. The resulting relationship appears to stimulate increased social interaction and maximize quality of life for nursing home residents. The program is considered part of the overall patient clinical care with multi-disciplinary involvement for volunteer training, patient referral, and evaluation by staff and patients. Social Work Performance Improvement measures and outcomes are discussed.     

Contact person as a court-ordered solution in child visitation disputes in Sweden

Separated parents have the joint responsibility to give their children access to the other parent. If they fail to reach a visitation agreement, the District Court will decide on one for them. In Sweden one demand can be supervision by a contact person. This paper is about court‐ordered visitations including supervision by a contact person. Different public systems, with different interpretations of the best interest of the child, have to interact in these cases: the District Court makes the decision on supervised visitation and the Social Services appoint a contact person and follow the intervention up. There is a shortage of research on this use of a contact person, and an exploratory research project is carried through: Three small‐scale studies, based on group‐interviews with family law social workers, social files and individual interviews with contact persons, supplement each other and form together a Social Services perspective on the intervention. The results are presented according to five themes: Social Services and the court; the families and children concerned; contact arrangements; termination of the intervention; Social Services' perceptions of the intervention. The conclusion is that contact person is perceived as a positive solution for children in visitation disputes involving risk. However, the intervention brings up some contradictory interests important to be conscious of.     

Social work and the shadow father: lessons for engaging fathers in Northern Ireland

The legislative framework of social work practice has consistently highlighted the need to work in partnership with parents, with far‐reaching implications for families. However, the importance of engaging fathers in social work practice is an issue that has received limited attention within academic debate and research. A research study undertaken across six family centres, investigated paternal involvement in family centre social work in Northern Ireland. The study involved 46 semi‐structured interviews with social workers, fathers and mothers. This paper presents the views of 22 social workers on the barriers to paternal involvement in family centre interventions. A range of factors were identified which served to inhibit or promote engagement of fathers. There were substantially more deterrents than promoters, a clear indicator of the problematic nature of paternal involvement. The findings highlight that both attitudes and practices of social workers influence the engagement of fathers. Recommendations drawn from the findings are presented for the development of father – inclusive social work practices and research.     

Inside the interdisciplinary team experiences of hospice social workers

Interdisciplinary teamwork is the foundation for the delivery of hospice care. This project interviewed 23 hospice social workers by telephone to explore their experiences with hospice team collaboration. Two research questions were explored: (1) What do social workers perceive as the strengths of interdisciplinary collaboration and (2) What are the challenges for social workers on interdisciplinary hospice teams? Participants identified issues related to team process, administrative processes, and barriers to effective team collaboration. Collaboration was said to be fostered by good communication, trust, roles, joint visitation, respect, team building activities, and administrative interest and support. Challenges to collaboration included large caseloads, a focus on the medical model, limited visits, personality and team conflict. Opportunities for improved collaboration between social workers and hospice team members exist through active evaluation of collaboration and strategic initiatives aimed at improving collaboration.     

应对地震灾害的社会工作的方法与开发——借鉴阪神淡路大地震、中越大地震、东日本大地震的经验教训

日本3.11大地震后,各种专业组织、社会福利组织致力于灾后重建的社会工作,有力佐证了日本护理保险制度中的护理管理在震灾救援中的巨大威力。针对震灾的社会工作,需要注重以个人援助为主的护理管理,与以地域社会为主的网络相结合。在灾害社会工作的发展方向上,需要社会工作把医疗和团队结合起来,通过加深相互之间的配合,建立在灾害医疗援助小组(DMAT)或日本医师会灾害医疗团队(JMAT)进行治疗后开展生活援助的机制。在社会工作中导入与灾害医疗援助小组同样的体系,平时就要培养好应对震灾的社会工作者。注重培养社会工作者应用现存的社会资源的能力,以及动员、调动灾区以外地区的社会资源的能力。重建受灾者的社区,非常有必要保持并进一步强化以往的居民间的关系。需要建立区域综合援助中心,配有保健师、社会福利士(社会工作者)、主任护理经理。以区域综合援助中心为主来开展灾区和灾区以外地区的社会工作者互相合作的"区域综合照顾"。在生活圈里重建各种组织机构的网络,社会工作者在各自的生活圈内,以地区的需求为基础,制定解决这些需求的计划,动员灾区居民参加,力求实现正式和非正式组织、机构的组织化,并在各种组织、机构的合作下进行实施推广,为社区复苏提供援助,促进地域社会中的各种组织的网络建设,从而形成地区的组织化。     

The living-dying interval in nursing home-based end-of-life care: family caregivers' experiences

Guided by concepts from the living-dying interval ( Pattison, 1977 ) this study sought to explore family members' experiences with a dying nursing home resident. In-depth interviews were conducted with 31 caregivers of residents who had died. Interviews were audiotaped and transcribed. Themes that illuminated families' experiences on the living-dying interval were: an acute medical crisis (trigger events, accumulation of stressors, level of care crisis); the living-dying phase (advance care planning, hospitalization, end-stage decisions); and the terminal phase (beginning of the end, awareness of dying). The results illustrate critical periods for social work intervention with families of dying nursing home residents.     

Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

ABSTRACT

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults’ abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.     

Nonpharmacological Pain Management by Ethnically Diverse Older Adults With Chronic Pain: Barriers and Facilitators

As key players in multidisciplinary health care systems, geriatric social workers must understand the dynamics of pain management among older adults with chronic pain. This study identified perceived barriers to, and facilitators for, utilizing nonpharmacological pain management through face-to-face interviews with 44 ethnically diverse community-dwelling older adults. Constant comparative analysis identified barriers not recognized in prior studies: (a) embarrassment/self-consciousness, (b) unavailability of certain treatments, and (c) lack of faith in effectiveness of nonpharmacological treatments. Most frequently reported facilitators were (a) social support, (b) positive attitude, and (c) available resources. Social workers can provide counseling to motivate older adults to exercise to manage chronic pain and refer them to exercise programs tailored for older adults. To resolve the most frequently reported barrier—transportation—social workers can link older adults with transportation services offered by senior centers or other nonprofit agencies.     

Challenges in Multidisciplinary Systematic Reviewing: A Study on Social Exclusion and Mental Health Policy

In the clinical sciences, systematic reviews have proved useful in the aggregation of diverse sources of evidence. They identify, characterize and summate evidence, but these methodologies have not always proved suitable for the social sciences. We discuss some of the practical problems faced by researchers undertaking reviews of complex and cross‐disciplinary topics, using the example of mental health and social exclusion. The barriers to carrying out social science and cross‐disciplinary reviews are reported and some proposals for overcoming these barriers are made, not all of them tried and tested, and some of them controversial. Using a mapping approach, a wide‐ranging search of both clinical and social science databases was undertaken and a large volume of references was identified and characterized. Population sampling techniques were used to manage these references. The challenges encountered include: inconsistent definitions of social phenomena, differing use of key concepts across research fields and practical problems relating to database compatibility and computer processing power. The challenges and opportunities for social scientists or multidisciplinary research teams carrying out reviews are discussed. Literature mapping and systematic reviews are useful tools but methods need to be tailored to optimize their usefulness in the social sciences.     

农村留守老人的社会支持探析——以河南省罗山县F乡Z村为例

农村留守老人成为当前一个亟需关注的群体。本文通过对河南省罗山县F乡Z村的25位留守老人进行了深度访谈,分析农村留守老人的社会支持现状,找出了其中存在的不足之处,探究其原因,并尝试构建包括家庭成员、家庭成员以外其他个体、政府、村委会和民间社会组织在内的农村留守老人社会支持体系。     

‘His mam,my dad,my girlfriend,loads of people used to bring him up’: the value of social support for (ex) offender fathers

This research analyses key findings from qualitative research conducted with (ex) offender fathers and their probation officers. This paper focuses on the critical role of family and social support for (ex) offender fathers who seek to build and maintain relationships with their children. The research reported in this paper shows that the men receive social support, both formal and informal from a wide ranging and complex network of family, friends and practitioners, which facilitates and enables their commitment to fathering. Drawing on social support theory, I argue that identification of support networks recognizes the productive possibilities of vulnerable families which constitute a source of strength and connection to be nurtured in contexts of adversity. This strengths‐based paradigm advocates the need to identify and facilitate family, friendship and professional networks in the context of social work with offenders and their families.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Agency-Family Partnerships

This paper describes a research and demonstration project in which partnerships are formed between agency social workers and family members of elderly clients. While the social worker retains responsibility for counseling and provision of support to the elderly client, the family member is taught by the social worker to assume responsibility for the case management of services provided to his/her elderly relative. Practice issues which have emerged during the first year of this three-year project include: the generalizability of findings in light of the special characteristics of agency clients, the definition of the agency-family partnership, confidentiality in the context of this partnership, exceptions to family involvement, clients without families, and our experiences with research-practice collaboration. Each of these issues is discussed in this paper.     

Resident interaction and social well-being in an oil boomtown in western North Dakota

Previous studies on the social well-being of residents living in energy boomtowns focus primarily on demographic characteristics of residents. These studies do not consider that there could be a relationship between residents’ social well-being and whether they interact with new residents moving into their community. The current study includes a measure of interaction with new residents as it examines five dimensions of the social well-being of residents living in an oil boomtown in western North Dakota. Surveys were distributed door-to-door to residents living in Williston North Dakota during the fall of 2015. Research findings show that people who reported that they interact with new residents moving into their community felt safe from crime and violence in their community; felt more socially integrated in their community; had high levels of community trust and community satisfaction, and believed that they could count on their neighbors. These findings are important because they highlight the significance of social interaction in communities that experience rapid population growth resulting from increased energy production.     

Informal Caregivers of Institutionalized Dementia Residents

When older adults are placed in nursing homes, care- giving responsibility continues, despite long held beliefs to the con- trary. Although the American family is in transition, bonds of care- giving and of filial responsibility are strong and persist into old age. Knowledge about characteristics of caregivers who have actually placed their relative in a nursing home is limited. The purpose of this study is to examine whether demographic and facility-related char- acteristics as well as knowledge about dementia and participation in support groups and workshops are signif~cant predictors of burden in caregivers of institutionalized dementia residents. Sixty-seven per- cent of caregivers of residents in a dementia unit in a nursing home participated in the study. Overall, the regression explained 68% of the variance in burden and was highly simcant statistically. In- formation gained from this study will assist social workers in mak- ing referrals to nursing homes or in direct practice with cognitively impaired nursing home residents and their families.     

从城市低保户的社会支持网络看社会工作介入空间——对苏北H市H社区的研究

本文分析城市低保户的社会支持网络,包括以政府机构、居委会为主的正式支持和以家人、亲朋、邻里为主的非正式支持,通过对照两者的缺陷,探讨社会工作介入的空间。从资源的连结与拓展、帮助方式的可接受性来谈社会工作对正式支持的弥合;从增强社区居民与低保户之间的互动、增强低保群体之间的联系来谈社会工作对非正式支持的弥合。