Staff-Family Relations and Institutional Care Policies

As institutional care providers increasingly recognize the importance of the family, the quality of staff-family relations has become a concern. This study investigated the relationship between selected facility care policies and staff-family relationships. Data secured from staff members and family members in rural nursing homes revealed a relationship between the family role that the care policy prescribed and the degree of staff-family integration. The study concluded that care policies viewing family members as clients will have positive consequences for staff and families and ultimately the residents.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

Family-Centered Care

Abstract

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider-focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family-centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

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.     

Family-centered care: a resource for social work in end-of-life and palliative care

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider- focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family- centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

A good death for residents of long-term care: family members speak

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 consistency 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.     

Family perspectives on the hospice experience in adult family homes

Growing numbers of terminally ill older adults receive hospice services in adult family homes (AFHs); however, little is known about the provision and receipt of end-of-life care in such environments. This article reports findings from a qualitative exploration of family members' perspectives of the hospice experience in AFHs. Analysis of data obtained during interviews of 15 residents' family members exposed significant challenges associated with transition to an AFH, highlighted the importance of AFH and hospice staff in family members' assessment of overall quality of care, and emphasized the critical nature of communication in AFH settings.     

Parents' involvement in care order decisions: a cross‐country study of front‐line practice

This article examines parents' involvement in care order decision‐making in four countries at one particular point in the care order process, namely, when the child protection worker discusses with the parents his or her considerations regarding child removal. The countries represent different child welfare systems with Norway and Finland categorized as ‘family service systems’ and the USA as a ‘child protection system’, with England somewhere in between. The focus is on whether the forms and intensity of involvement are different in these four countries and whether the system orientation towards family services or child protection influences practice in the social welfare agencies with parents. Involvement is studied in terms of providing information to parents, collecting information from parents and ensuring inclusion in the decision‐making processes. A vignette method is employed in a survey with 768 responses from child protection workers in four countries. The findings do not show a consistent pattern of difference regarding parental involvement in care order preparations that align with the type of child welfare system in which staff work. The goal in each child welfare system is to include parents, but the precise ways in which it is carried out (or not) vary. Methodological suggestions are given for further studies.     

Integrating Health and Social Care at the Micro Level: Health Care Professionals as Care Managers for Older People

A common problem in the provision of coordinated long‐term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user‐centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.     

Youth and parent perceptions of aftercare supports at discharge from residential care

While much is known about youth struggles after reintegration into the home and community settings following stays in out‐of‐home care, little is known about appropriate supports for aftercare, or parent (see Note ¹ ) and youth perceptions during this critical transition period. This study seeks to begin to address these questions through surveys evaluating youth (n = 48) and parent (n = 48) perceptions of (i) transition planning, family preparedness and aftercare; (ii) youth preparedness for the transition period across major life domains (e.g. education, health care, relationships); and (iii) the importance of specific aftercare supports and services. Results indicate differences between youth and parents on perceptions of need for continued supports, likelihood of participation in aftercare programs; and youth preparedness for success in relationships, family and independent living domains. In contrast, similarities were found on youth and parent ratings regarding the importance of specific services and supports, with both groups indicating supports in education as most important and supports in mental health as least. Study limitations, future research and implications are provided.     

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.     

Child Care Caregiver Sensitivity and Attachment

Changes in child care caregivers' sensitivity and in children's attachment security were examined in three studies. Study one involved 55 children enrolled in community based child care. There was no intervention in these sites. Caregiver responsive involvement and children's attachment security did not change over time or when children changed caregivers. Study two involved 71 toddler age children enrolled in family child care homes. The caregivers of these children were enrolled in a family child care training project. Six months after the training security scores increased and caregivers of children who became secure or remained secure were more sensitive following training. Study three involved 36 children enrolled in center-based child care. Children were observed before and after selective staff replacement and in-service training to increase caregiver sensitivity. Six months following intervention security scores increased and caregivers of children who became secure or remained secure were more sensitive following training.     

Lesbian and Gay Elders and Long-Term Care: Identifying the Unique Psychosocial Perspectives and Challenges

This qualitative study of lesbian and gay elders seeks to identify the psychosocial challenges this community faces regarding long-term care. Two focus groups were conducted among 16 gay elders in community and long-term care settings. Participants reported fear of being rejected or neglected by healthcare providers, particularly personal care aides; fear of not being accepted and respected by other residents; fear of having to go back into the closet if placed in long-term care; and a preference for gay-friendly care. Participants suggested staff training to promote acceptance and respect for gay people, and favorably perceived gay-specific and gay-friendly living arrangements.     

Family relations, adjustment and well-being in a longitudinal study of children in care

The article reports on a longitudinal study of children placed in a children's home during the first two years of the 1980s. The 26 children placed when younger than 4 years of age and staying more than 4 weeks were followed up 3 and 9 months after leaving the children's home and 5, 10, 15 and 20 years later. The children's family relations, including early attachments and later parental relationships and the perception of who is their family, have been one of the predominant themes in the recurrent studies. None of them had lived with both parents after leaving the children's home and 20 of them had been in foster care for periods or permanently. At the time of the last study the children were young adults, aged 20–25. They are categorized in three rather distinct categories, one for those with a ‘good’ and one for those with a ‘moderate’ social adjustment and well‐being and one for those with a ‘bad’ social adjustment and well‐being insofar as involvement with drugs, criminal behaviour and legal sanctions are concerned. Their contacts and relationships with birth parents and foster parents and the perception of who is their family are analysed by use of attachment theory and developmental psychopathology.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Peer relationships during late childhood in internationally adopted and institutionalized children

The aim of this study was to analyse the interpersonal relationships in the school context of children living in different care settings (adoptive families, residential care centres, birth families). Participants were 76 children between eight and fourteen years of age (M = 10.78, SD = 1.38), belonging to one of three groups: international adoptees, children living in residential care in Spanish institutions, and a comparison sample of Spanish children living with their birth families with no connection with child protection. Sociometric information was collected in the classroom of each child during school hours. Internationally adopted children from Russia showed considerable difficulties in their relationships with peers; they were more likely to be rejected and their peers described them as less prosocial and somewhat more aggressive. With a better sociometric position than the adoptees, children in residential care were rated by their peers as more aggressive and less prosocial than the normative population. Coordination and integrated work between the family, protection centres, schools, and other social services should be a strategic priority in the promotion of healthy social development in these groups of children.     

The Milieu Standard for Care of Dementia in a Nursing Home

Recent attention has been directed toward providing specialized skilled nursing facility care for patients suffering from dementia. This paper explores and details how The Hebrew Home for the Aged at Riverdale developed such a unit and its applicability for the provision of appropriate care to demented elderly in other settings. The leadership roles of professional care staff, particularly the social worker in the development of this project are highlighted.     

Foster children: a longitudinal study of placements and family relationships

Foster children's family relationships have been one of the themes in a longitudinal study, starting with a disadvantaged group of children, 0–4 years of age when taken into care and placed in a children's home in Sweden. Seven rounds of data collection were carried out; the last two when the children were young adults. This article is about those 20 children in the study group who, in addition to temporary residential care at an early age, have experiences from foster care, either for the remainder of their childhood or before or after a period of reunion. Placement history is put in relation to family relationships, i.e. relationships to birth family and foster family. The categorisation in secure and insecure relationships or attachment patterns is based on interviews with the young adults, with a retrospect of previous relationships. The connection between placement history and family relationship is not obvious in this high-risk group. However, inclusive attitudes from the foster family towards the child's family promote continuity and a sense of security, also in periods of reunion or re-placement, and facilitate foster children's hard work in coming to terms with their family background and finding their own way.     

Towards better preparation and support for health and social care practitioners conducting specialised assessments in remote Indigenous contexts

Remote health professionals encounter many challenges associated with delivering care in poorly serviced remote locations and working across cultures. Despite an identified need for the assessment practices of health and social care professionals to accommodate cultural differences, and for staff training in the area, deficits in preparing the remote workforce for assessment remain. This paper combines the results of two qualitative studies to consider current and improved approaches to preparing and supporting staff for conducting assessments in remote and Indigenous settings. Study A focused on aged care assessment practices within the remote Aboriginal context of Central Australia, and Study B focused on the practice for assessing cognition among Aboriginal Australians in the Northern Territory. Our secondary analysis of these combined data sets provides valuable information to improve planning of approaches to preparing staff for assessments in these contexts. We report themes relating to three categories: the assessment workforce, current approaches to preparing assessment staff, and cross‐cultural knowledge/skill. We discuss which areas require more detailed attention to prepare staff for this work – such as critical reflection and cultural safety – as well as how this may best be achieved – such as through the inclusion of cultural supervisors in practitioners' supervision models, and in follow‐up components to workshop models.