Support Network Connectedness in the Lives of Community-Dwelling Rural Elders and Their Families

Rural elders face challenges when accessing assistance from family, neighbors, and paid helpers. This support is essential to allow them to remain community dwelling as they develop physical challenges that limit their ability to care for themselves. This qualitative study followed a group of 16 rural elders with physical limitations for 1 year. In-depth interviews were conducted with them and eight members of their support networks, including five family members, to explore how rural older adults create and maintain support networks that allow them to remain community dwelling despite physical challenges that limit their self-care. The research question is, “How do members of the support network connect with each other to maximize the effectiveness of the network?” Family members coordinated assistance to maximize the abilities and availability of various network members. In addition, family members worked together with other family members, neighbors, and paid helpers to assist the elder. These strategies enhanced the ability of the network to assist the rural elder and also lessened the burden of care by dispersing it among network members.     

Recognizing experiential knowledge in the process of qualification of peer helpers: an analysis of an educational program for service users in France

ABSTRACT

This article analyzes an innovative training program enabling the qualification of peer carers, working within the sector of ‘social inclusion’. Since the French national debate on social work conducted within the ‘Estates General’ of 2015, peer workers have become key players in training programs in virtue of their experiential knowledge and their understanding of issues related to the process of social exclusion. This article addresses the role of peer helpers’ experiential knowledge in the training process. Because of their ‘experiential’ and ‘empirical’ knowledge about questions linked to the process of exclusion, peer helpers have become key players in social work teams and within social institutions, thus contributing to new methods of socio-educational intervention. What impact will this recognition of peer helpers’ and service users’ experiential knowledge have on education in social work? This article gives an account of an 8-month training program for peer helpers examined on the methodological level through a process of Participant observation, and based on data from comprehensive interviews carried out with a panel of peer helpers.     

Incorporating natural helpers to address service disparities for young children with conduct problems

In response to the high levels of unmet need among historically underserved young children with conduct problems, this paper outlines some of the key issues involved in incorporating natural helpers into the delivery of parenting interventions for the treatment of conduct problems among historically underserved children. Strategies for the selection and training of natural helpers are discussed along with challenges that might be encountered in these processes. Directions for future research are also highlighted. With appropriate selection and training procedures in place, natural helpers may increase the accessibility of services for children and families and foster the reduction of service disparities.     

Predictors of Gambling Behaviors in Filipino Americans Living in Honolulu or San Francisco

This study compared the prevalence and predictors of gambling behaviors between Filipino Americans who live in San Francisco (S.F.) or Honolulu. Data from the 1998?C1999 Filipino American Community Epidemiological Survey were used to answer two research questions: (1) What are the prevalence and types of gambling behaviors among Filipino Americans and (2) What are the protective/risk factors of heavy gambling for Filipino Americans in S.F. and Honolulu? Overall, S.F. Filipino Americans had a higher level of participation in gambling, and the odds of gambling increased among older age groups, males, those who were US-born, and those with more health problems. Multinomial logistic regression analyses revealed that factors associated with infrequent and regular gambling participation were different between the S.F. group (older, male, higher education) and Honolulu group (male, US-born, more health concerns). Differential gambling environments, i.e., wide open gambling in S.F. and the restrictive gambling in Honolulu, may contribute to gambling participation and predictors of risk gambling Filipino Americans living in Honolulu and S.F. Policy makers and health professionals need to be aware of these differences to serve this population more effectively.     

Giving up the car: older women's losses and experiences.

Numerous activities, often life-long patterns, are based on driving and access to a car. When driving ceases, the challenge to change and develop new behavior patterns occurs. Women in this study had many losses and challenges to usual ways of doing things. Various coping strategies were described, including types, benefits, and potential challenges of both informal and formal helpers. Implications for health care providers include empathic awareness of the nature and extent of loss initiated by giving up driving and determining how best to support older adults in coping. More work needs to be done to develop strategies that support optimal function and ease this difficult transition for older adults.     

Under new management: the changing role of the state in the care of older people in the United Kingdom

This article examines recent changes and those currently being introduced in the formal care of older people in the United Kingdom. These are part of a general trend in all welfare states towards welfare pluralism but, in addition, the United Kingdom represents something of a special case because of the radical ideological engine that has driven the restructuring of the role of the state. The first part of the article outlines the main changes--the promotion of the private sector, the residualization of the public social services, and the new managerial role of the state in the care of older people. The second part considers the implications of these changes for older people and their informal helpers (or caregivers). The conclusion refers to both the particular changes taking place in the United Kingdom and, in general terms, to welfare pluralism as a policy goal.     

The Needs of Older Persons at Risk of Housing Loss

This chapter explores the implications of some of the earlier findings about elders at risk, especially the significance of social support, mental competence, and income. There is need for research exploring consumer perspectives and preferences, as well as agency constraints and flexibility. Services needed include health and mental health outreach, home maintenance and creative matching of natural helpers and formal care. Fundamentally, a national commitment is needed to "housing for all."     

Land of the Free,Home of the Brave: Voting Accommodations for Older Adults

Voting is a fundamental right for all United States citizens, one that usually continues for elderly people as long as they are alive. As adults age, certain issues regarding voting warrant deeper consideration than in previous years, especially those presenting as a result of impaired sight, hearing difficulty, dementia, or other special needs. What will happen to millions of men and women who have taken the right to vote for granted, but who gradually become immobile or physically impaired? What are states doing to help secure the enfranchisement of an increasing number of older adult voters? The purpose of this article is to address these issues by focusing on the following questions: What has been the historical nature of polling place accommodations for elderly people? What are states doing in terms of accommodating older voters at the polls while ensuring the integrity of the voting process? What effect has recent Help America Vote Act legislation had with regard to polling place accommodations? Our results indicate that accommodations for older voters are being made but are not yet at a level required to serve a rapidly aging population.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.     

The development and evaluation of a natural helpers' training program to increase the engagement of urban,Latina/o families in parent-child interaction therapy

Latina/o immigrant children are at increased risk for developing conduct disorders, and are simultaneously less likely to access services. Natural helpers are uniquely positioned to promote effective parent training programs to address service disparities in these communities. This study describes one effort to train natural helpers to increase engagement in parent-child interaction therapy (PCIT), an evidence-based parent training program. An academic-community partnership prompted the development and evaluation of this natural helpers training program. Five natural helpers were trained to recruit Latina/o families into PCIT, address barriers to treatment, and support parents' skill development. Over the course of training, natural helpers increased their knowledge of PCIT and their ability to use and model treatment targeted parenting skills. Additional consultation was necessary to improve the natural helpers' abilities to conduct behavioral observations of parent skill use and provide feedback on these skills. Natural helpers expressed overall satisfaction with PCIT and the training program. Suggestions for incorporating natural helpers into PCIT services are discussed based on the strengths and challenges identified from the evaluation of this training program.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.     

Caregiver burden, dementia, and elder abuse in South Korea

The purpose of this study is to identify characteristics that would increase the likelihood that a Korean older adult with dementia being cared for by a family caregiver is at risk of being abused. This analysis was based on a sample of 481 primary family caregivers from the data of Comprehensive Study for the Elderly Welfare Policy in Seoul (2003). Multiple regression analysis was used to examine predictors among the demographic characteristics of caregivers and care recipients, the severity of cognitive impairment, functional ability, caregiver burden, and social support for the degree of elder abuse. The degree of elder abuse was significantly associated with caregiver burden, mental impairment, dependency of daily living of care recipient, and use of formal services.     

Effect of childlessness on nursing home and home health care use

This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: (1) Are the childless elderly at a greater risk of nursing home and home health care use? (2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? (3) Does having additional children beyond the first one have a significant effect on the use of these services? (4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old Survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed.     

The Perspectives of Older Greek-Australians Toward Changes in the Nature of Family Support: Implications for Family Care Policies

Internationally, public policies encourage “aging in place,” and the majority of older Australians requiring care in the community receive informal care, supplemented by publicly subsidized formal services. The effect of contemporary social changes on informal care in aging migrant communities is poorly understood. This articles explores the perceptions of older Greek-Australians toward changes in the nature of family support. Bicultural and bilingual researchers carried out in-depth interviews (n?=?27) and five focus groups (n?=?63 total participants) with older Greek-Australians in modern Greek. While “cultures of care” remain among Greek-Australian families, the means for a family to assist have shifted, and these compromises are met with considerable powerlessness among older Greek-Australians. Implications for policy include the need to better involve older migrants and their families in decisions about their care needs, potentially involving consumer-directed care models. Service providers may also need to adopt the use of new technologies to communicate with increasingly time-pressured family members.     

The impact by race of changing long-term care policy

Long-term care policy has evolved with little attention to racial differences in the need for and use of services. Using 1987 National Medical Expenditure Survey data on nursing home care, formal in-home personal care, and informal-only help, a model was created to show how different races would use each type of care if: (1) a universal home-care benefit was established, (2) existing Medicaid home-care benefits were ended, or (3) the income level for Medicaid eligibility was substantially reduced. Expanded community care benefits would primarily serve severely disabled older whites. Reductions in long-term care benefits or eligibility would disproportionately impede access to long-term care for severely disabled older African-Americans. These differences indicate that race must be taken into account in long-term care policy initiatives.     

Older Adults Developing a Preference for Living Apart Together

What is understood about late life partner relationships is largely based on long‐term marriage, with little attention given to understanding the process of forming new partnerships in older adulthood. However, marked growth in cohabitation and greater awareness of living apart together (LAT) suggests a need for further investigation. The purpose of this grounded theory study was to explore how decisions about LAT are made among later‐life men and women. Twenty‐five participants completed life history calendars and semistructured interviews that examined how their current relationships evolved into LAT. Seven contributing factors were identified: relational and personal goals, age, caregiver burden, partner factors, relationship histories, and shifts in social mores. What participants were “doing” during the process of deciding to live apart together was working to resolve their long‐held and often ingrained beliefs about romantic relationships. Three preferences for LAT emerged from this study: opposing, ambivalent, and advocating. Future directions for research are discussed.     

Help seeking among addicted and nonaddicted women of low socioeconomic status

Concern with the provision of health and welfare services to underserved or inappropriately served groups has led to numerous studies of patterns of service utilization. This article focuses on the help-seeking patterns of heroin-addicted and nonaddicted women of lower socioeconomic status. The results suggest addicts generally experience more problems than nonaddicts; those with few problems are less likely to use formal support systems; and black respondents, both addicts and nonaddicts, are less likely to use formal support systems. The evidence indicates that while addicts tend to use natural support systems less frequently than nonaddicts, addiction per se does not explain help seeking when race and number of problems are taken into account. The heavy reliance of both addicts and nonaddicts on informal helpers supports the value of professional efforts designed to facilitate or enhance these networks.     

Friendship support patterns of older American women

Research during the past decade has firmly established the informal support of family, friends, and neighbors as critical in older people's health and well-being. The decade has also seen increasing attention to informal supports in social policy and services addressing the needs of older people. The support of friends in particular is agreed to be important but the details of its nature and consequence require more research. This article draws on field research of friendship among a population of older American women to ask: (1) How do older women themselves perceive their friendship involvement and its significance as a source of support?; (2) How do the friendship support patterns of later life compare and connect with those of earlier stages?; (3) How do friends relate to other sources of informal support in terms of support exchanged?; and (4) What are the implications for human service professionals concerned with effective use of informal support in later life?