Valuing and Integrating Informal Care as a Core Component of Long-Term Care for Older People: A Comparison of Recent Developments in Italy and Spain

The international long-term care (LTC) debate has recently been focusing on how to strengthen home care provision. In this regard, a major role has been played by informal care and how to best integrate it in a holistic care approach. Italy and Spain, usually labeled as “familialist” or “family-based” care models, have been promoting national reforms or actions to support the integration of “informal” actors into the overall LTC system. Through a comparative review of recent trends observed in the two care regimes, this article aims at contributing to improve our cross-national understanding of how LTC is changing across Europe, identifying the basic approaches adopted in Italy and Spain and highlighting both their strengths and drawbacks.     

Sense of Need for Financial Support and Respite Services among Informal Caregivers of Older Americans

ABSTRACT

Financial support and respite services are two of the most frequently reported types of help that caregivers of older adults need. Using an expanded health behavioral model, this study examined the effects of predisposing, enabling, and needs factors on caregivers' sense of need for these two types help. Data were drawn from the 1999 National Long-Term Care Survey and included 1,058 caregiving dyads in the community. The results indicated that caregiver-related factors more than care recipient–related factors affected caregivers' sense of need to seek both types of help. The findings direct to two important implications for long-term care policy for and practice with older adults: improvement of service for caregivers and service delivery systems.     

Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

Living with Dementia: Lay Definitions of Alzheimer's Disease among African American Caregivers and Sufferers

While the medical world aggressively pursues scientific knowledge about Alzheimer's disease, sufferers and caregivers live with this ailment, not as patients, but as people going about their lives, needing and providing care. This article reports explanations of Alzheimer's from the perspectives of African American family caregivers and sufferers. Data were collected from thirty‐six families using participant observation and focus group interviews. Although caregivers sought and used medical expertise, their explanations of Alzheimer's were not only nonmedical, but not necessarily explanations of illness per se. Alzheimer's was presented instead as a way of being, predominantly characterized by views of the sufferer as childlike and by issues of continuity/discontinuity, though some saw Alzheimer's as part of a larger picture.     

Using Generational Intelligence to Examine Community Care Work between Younger and Older Adults

Exploring the factors that contribute to sustainable forms of an intergenerational relationship is becoming an important conceptual and practical challenge, not least because of the growing need for an aged care workforce that is both motivated and suitably trained. Generational intelligence is a means of examining interaction between younger and older people which has been applied to community care settings. Dimensions of generational intelligence include recognising and valuing generational differences, finding common ground, plus negotiating social and practical outcomes from the situation. A case study plus a series of qualitative interviews are used to examine the value of this approach both as a means of exploring the processes involved in generational exchange and in providing recommendations for work preparation and training. It is suggested that intergenerational relations have been a missing factor in the understanding of sustainable care and that in future, service delivery should not simply be analysed as comprising professional and lay perspectives but also as containing generationally distinctive perspectives that require negotiation.     

Informal care and support for carers in Sweden: patterns of service receipt among informal caregivers and care recipients

This study describes and analyses the kinds of support received by different categories of informal carers, and the kinds of help that care recipients receive in addition to that provided by various categories of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61%. The results showed that relatively few carers in any care category received any kind of support aimed directly at them as carers. The most widespread form of support received by providers of personal care was relief services. Those most likely to be receiving care from the public care system were people also receiving personal care from an informal caregiver. Nevertheless, the majority of those receiving personal care from an informal carer did not receive any help from the public care system or from voluntary organizations or for-profit agencies. These results indicate that social policy and social work need to clarify the aims of the services they provide. They also need to take the needs of both caregivers and recipients into account when discussing support systems.     

Incorporating Spirituality and the Strengths Perspective into Social Work Practice with Addicted Individuals

Abstract

In the last two decades, the social work profession began to confront the professional avoidance of alcoholics and other drug addicts, and discussions of spirituality. While acknowledging the importance of 12-Step Programs of Alcoholics/Narcotics Anonymous, we also acknowledge that spirituality is a major aspect of addiction and recovery from an addiction. The authors present the Strengths Perspective and apply key concepts to Steps 1-3 of the 12-Steps to increase our understanding of addiction and recovery from alcoholism and other drug addiction. The article concludes that social workers must continue to increase their understanding of the recovery and spiritual issues of alcoholics and other drug addicts.     

Factors Associated with Adoption and Adoption Intentions of Nonparental Caregivers

ABSTRACT

Data from the 2011–2012 National Survey of Children's Health and the 2013 National Survey of Children in Nonparental Care were used to fit a multinomial logistic model comparing three groups to those who never considered adoption: those who ever considered but are not currently planning adoption, those planning adoption, and those who adopted. Adoption may be more likely when the caregiver is a non-kin foster parent, a foster care agency was involved, and/or financial assistance is available. Those with plans to adopt but who have not adopted may face adoption barriers such as extreme poverty, lower education, and being unmarried.     

Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence

ABSTRACT

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.     

Manufacturing Motherhood: The Shadow Work of Nannies and Au Pairs

This paper explores how working mothers and paid child care providers interpret the division of mothering labor in the context of in-home care. The nannies, au pairs, and working mothers interviewed for this study make sense of their shared mother-work in the context of a dominant belief system that values intensive mothering. Consequently, in addition to negotiating the allocation of mothering tasks, they must also negotiate the meanings assigned to these tasks: specifically, they manufacture an image of shared mothering that contradicts their day-to-day practice.     

Formal and Informal Community Care to Older Adults: Comparative Analysis of the United States and Great Britain

Support to frail elders is of international and growing importance. This article compared receipt of assistance with ADL limitations, home health help, any assistance received, and unmet needs in functionally impaired individuals aged 70 years old or older in the United States (n = 1847, 80% women, M _age = 80 years) and Great Britain (n = 1203, 57% women, M _age = 78 years). Informal and formal assistance levels were higher in Great Britain, and rates of unmet need did not differ across ADL domains measured. Receipt of formal and informal care were associated positively, which is consistent with both supplementary and complementary perspectives on the formal-informal care interface. Few individuals in either country received formal services alone. Results suggest that community-based formal support does not substitute for family help. Implications for family and economic policy are discussed.     

Child Care and Work Absences: Trade‐Offs by Type of Care

Parents face a trade‐off in the effect of child‐care problems on employment. Whereas large settings may increase problems because of child illness, small group care may relate to provider unavailability. Analyzing the NICHD Study of Early Child Care, we find that child‐care centers and large family day care lead to mothers’ greater work absences because of a sick child, but not to maternal job exits. Greater work absences because of unavailability of small home‐based providers are associated with mothers’ job exits, especially when mothers have low earnings and use nonrelative caregivers. Our findings accentuate the need for improved hygiene practices in child care, expanded personal leave coverage for parents, and greater backup care for sick and well children.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Identity Work,Techniques of Neutralization,and Deviance: Exploring the Relationship Among Older Adult Gamblers

This study investigates the value of techniques of neutralization in understanding how people involved in marginal to widely deviant behaviors perform identity work. Based on 33 in‐depth interviews with older adult gamblers, we show how techniques of neutralization are used to align personal and social identities. We describe the techniques of neutralizations our participants use along a continuum of gambling involvement, showing how techniques differ in variety and content and are contingent on larger narratives about appropriate behaviors, identities, and selves operating in contemporary society. Our research helps to refine sociologists' understandings of relationships between levels of involvement in deviant behaviors and identity work.     

Staying with People Who Slap Us Around: Gender,Juggling Responsibilities and Violence in Paid (and Unpaid) Care Work

Little is actually known about women's occupational health, let alone how men and women may experience similar jobs and health risks differently. Drawing on data from a larger study of social service workers, this article examines four areas where gender is pivotal to the new ways of organizing caring labour, including the expansion of unpaid work and the use of personal resources to subsidize agency resources; gender‐neutral violence; gender‐specific violence and the juggling of home and work responsibilities. Collective assumptions and expectations about how men and women should perform care work result in men's partial insulation from the more intense forms of exploitation, stress and violence. This article looks at health risks, not merely as compensable occupational health concerns, but as avoidable products of forms of work organization that draw on notions of the endlessly stretchable capacity of women to provide care work in any context, including a context of violence. Indeed, the logic of women's elastic caring appear crucial to the survival of some agencies and the gender order in these workplaces.     

Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

Maternal Work Absence: A Longitudinal Study of Language Impairment and Behavior Problems in Preschool Children

Combining work and family responsibilities is challenging when children have special needs, and mothers commonly make employment‐related adjustments. In this study, the authors examined associations between maternal work absence and child language impairment and behavior problems in preschool children. Questionnaire data at child age 3 years from 33,778 mothers participating in the prospective population‐based Norwegian Mother and Child Cohort Study were linked to national register data on employment and long‐term physician‐certified sick leave at child age 3–5 years. Mothers who reported having a child with language impairment had a consistently higher risk of not being employed and were at increased risk of taking long‐term sick leave at child age 5 years. Co‐occurring problems were associated with excess risk. Language impairments in preschool children, in particular when they are co‐occurring with behavior problems, are likely to have a range of negative short‐ and long‐term consequences for the financial and overall health and well‐being of mothers and their families.     

Preparing,Working, Recovering: Gendered Experiences of Night Work among Women and their Families

The negative physiological consequences of night work are well evidenced, but there has been limited research on the gendered consequences of night work for partnered women with children. This paper examines women's experiences of night work by drawing on qualitative interview and audio sleep diary data with 20 UK female nurses working non‐regular rotating shifts, together with interview and diary data from their male partners and children. The analysis shows how the lived experience of women's night work is characterized by three phases, which we discuss within a timescape perspective. Alongside changes to paid work and sleep during the period of night shifts, the ‘preparation’ and ‘recovery’ phases of women's night work involve intense periods of considerable additional unpaid and unrecognized work and anxiety. Gendered expectations for household management and family wellbeing mean that women night workers undertake considerable responsibility for complex planning before night shifts begin, and re‐enter established domestic routines within hours after night shifts end. Women maintain continuity for their families by actively managing the impacts of night work. This enables the fulfilment and ‘display’ of successful and normative gendered patterns of domestic responsibility, which appears to be central to women's own coping with night shifts.     

Women Academics and Work–Life Balance: Gendered Discourses of Work and Care

This article examines how discourses of work–life balance are appropriated and used by women academics. Using data collected from semi‐structured, single person interviews with 31 scholars at an Australian university, it identifies and explores four ways in which participants construct their relationship to work–life balance as: (1) a personal management task; (2) an impossible ideal; (3) detrimental to their careers; and (4) unmentionable at work. Findings reveal that female academics' ways of speaking about work–life balance respond to gendered attitudes about paid work and unpaid care that predominate in Australian socio‐cultural life. By taking a discursive approach to analysing work–life balance, our research makes a unique contribution to the literature by drawing attention to the power of work–life balance discourses in shaping how women configure their attempts to create a work–life balance, and how it functions to position academic women as failing to manage this balance.