Policy Foundations for Case Management:

The Federal Council on the Aging is now developing a national policy for providing home care for the "frail elderly." Case management is specified as the primary delivery mechanism. This article recommends areas, not now included in the policy considerations, that must be examined before case management goals can be achieved.     

Challenges to and Strategies for Formal Service Utilization among Caregivers in an Underserved Community

Family caregivers face enormous challenges when attempting to oversee the medical, legal, financial, and daily affairs of loved ones with chronic or life-limiting illness. While formal services and agencies exist to assist caregivers with some of these tasks, caregivers in underserved communities do not utilize these services, or utilize them with unsatisfactory results. This study used focus groups (N = 5 groups) with underserved, minority caregivers (N = 22) to explore their experiences related to care provision, including barriers to support service use and challenges navigating systems related to the broad spectrum of caregiving demands. Thematic content analysis revealed three main themes: (1) prior difficulties with formal service use, (2) difficulties navigating financial, legal, and medical systems, and (3) caregivers’ personal strategies to address challenges associated with formal service use and systems navigation. Findings from this study identify underserved caregivers’ challenges in utilizing formal services, as well as caregiver-identified strategies for supporting their caregiving activities.     

Caregiving Load and Respite Service Use: A Comparison between Older Caregivers and Younger Caregivers

Study aims were to explore differences in predictors of respite care use between older (aged 65+) and younger caregivers (aged 18–64 years), and associations between caregiving load and respite care use using multivariate logistic regression analysis and unpaid caregiver (n= 10,500) data from the 2009 California Health Interview Survey. Caregiving load comprised number of care recipients, weekly hours in caregiving, and caregiving duration. Variables with a significant association with respite care for older caregivers were female gender, income, and health insurance. For younger caregivers, respite care use associations were with ethnicity, caregiving relationship, education, and availability of substitute help.     

Case Management for Homesharing

The use of a formal organization to create and foster informal helping relationships poses case management issues that are unique. This article explores the case management issues that surface within one type of formally-created informal helping relationships-the homesharing match. A typology of homesharing matches is derived, and case management issues specific to each type are discussed using case study data.     

The Contribution of Practice Skills in a Care Management Process for Family Caregivers

Practice skills are believed to improve practice, yet, little is known about the extent to which skills affect outcomes. This exploratory study examined the extent to which 3 practice skills specific to a care management context for family caregivers, including communication skills, supportive skills, and linking skills, were associated with fidelity of a care management process. Twenty-one care managers who used a single process to serve 113 family caregivers were included in the study. Bivariate correlation analysis revealed the 3 practice skills are positively associated with process fidelity. Implications for social work practice, education, and research are discussed.     

A Support Group for Caregivers of Children with Craniofacial Differences

ABSTRACT

Caregivers of children with craniofacial differences (CFD) experience psychosocial stressors; however, few groups are described for this population. The authors outline an eight-session group and qualitative analysis of caregivers’ experiences. The majority of participants (n = 100) were mothers (76%) of children who were female (75%) and identified as Latino (79%). Children’s mean age was 10.6 (SD = 2.8) years, and they were born with cleft lip/palate (56%) along with other CFD diagnoses. Themes included: group appreciation (21%), mutual acceptance (18%), coping (18%), parenting skills (17%), learning (9%), resiliency (7%), empathy (4%), diagnosis information (3%), and self-care (3%). Caregivers’ reported experiences largely corresponded with group goals.     

The VA Caregiver Support Line: A Gateway of Support for Caregivers of Veterans

In passing the Caregivers and Veterans Omnibus Health Services Act of 2010, Congress created a legislative mandate for the Veterans Administration (VA) to strengthen its program of support services for caregivers of veterans. As part of this expansion, the VA implemented a nationwide toll-free telephone Caregiver Support Line (CSL). The CSL is a single point of entry system to link caregivers to national and local services to support care of a veteran. This article describes the CSL and its role in supporting aging veterans and their caregivers, discusses social workers’ contributions to its development and implementation, and reports utilization data.     

Coping Strategies Among Mothers of Chronically Ill Children: A Case Study in Malaysia

ABSTRACT

 The purpose of this study is to identify the stresses and coping strategies of five mothers in caring for their chronically ill and disabled children. These mothers were receiving services from a nonprofit hospital in Malaysia. Through an in-depth case study design, the findings indicated that emotional stress caused high levels of depression, which decreased life satisfaction that led to poorer physical health. Issues explored included employment, noncooperation of family members, as well as factors related to the mother's individual abilities and how these factors might affect maternal caregiving. Recommendations for future research include identifying probable psychosocial stresses and other associated factors while emphasizing the importance of community-based programs that minimize these stresses.     

Assessing Models of Case Management:

No studies have assessed whether different models of case management are being implemented. The purpose of this study was to see if case management services given to a sample of chronically mentally ill adults followed any or all of the models postulated by Ross (1980) -Minimal, Coordination, or Comprehensive. Analysis of service data showed that case management services were given according to all three models. Implications for case management practice and for research are discussed.     

Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles

Over the last century, Inuit have experienced rapid social changes that have greatly impacted their way of life, health, and intergenerational traditions. Although there is a growing body of research concerning Inuit youth, relatively little is known about elderly Inuit. In an effort to bridge this knowledge gap, a systematic review of peer-reviewed journal articles was conducted. This review identified a dearth of research on older Inuit, and highlighted limitations in service provision to this primarily rural and isolated population. Implications for policy and practice and recommendations for future research are also discussed.     

Aging in Poverty: Making the Case for Comprehensive Care Management

A model for holistic care management that would enhance outcomes for economically vulnerable older adults who receive an array of disjointed services administered through the older Americans Act (OAA) and local Area Agencies on Aging (AAA) is proposed. Fragmented service delivery is typically wasteful and ineffectual, but comprehensive care management that includes an autonomous care manager, a single interagency plan of care and ongoing monitoring that is client-centered may protect those aging in poverty from negative health outcomes.     

Caregiver Burden: A Comparison Between Elderly Women as Primary and Secondary Caregivers for Their Spouses

The overall purpose of this research was to examine the burdens of caregiving on elderly women who serve as primary and secondary caregivers for their impaired spouses. Fifty women 60 years and older identified as spousal caregivers participated in an in-person structured interview. Data were analyzed to compare primary caregivers (caregivers living with their spouses) and secondary caregivers (caregivers of institutionalized spouses) on the following factors: loneliness, depression, time constraints, perceived health status, financial status and perceived life satisfaction. Findings suggest that both groups of women are equally susceptible to the burdens inherent in caregiving. Time constraints were identified as the one major difference between caregiving groups. In addition, the results indicate that spousal caregivers, both primary and secondary, are an at-risk population and are especially vulnerable to loneliness, mild depression, financial worries and low life satisfaction.     

Iowa Case Management for Rural Drug Abuse

OBJECTIVE: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. METHOD: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. RESULTS: Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. CONCLUSION: Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time.     

Strategies for the Management of Stigma through Social Work

Summary Stigma management should be part of social work practice, inaddition to attempts to combat stigma by social policy initiatives.The objectives of stigma management are to reduce awarenessand length of dependence on social services, to demonstrateclients' contribution to society, and to reduce social and spatialdistance between clients and others. Strategies are identified,which include the selection of various combinations of targetsfor intervention from three aspects of stigma (the attribute,the stereotype and the relationship between them) and from thepossibilities of work with the audience, both public and professionaland the stigmatised person, or both. Factors to evaluate inassessment; methods of intervention, including help in passing,group identification, social exchanges, public reviews, theuse of agents, benefactor relationships and elevation ceremonies;and reducing stigma at the end of social work intervention areconsidered.