Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform

Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.     

The aging of the Chinese population and the cost of health care

It is projected that by 2050 China could have a staggering 115 million elderly citizens over 80 years old. Serious planning is needed to cope with this demand. This is the direct and inevitable result of the one-child policy that came into effect in 1979, as an independent policy to the Comprehensive Economic Reform; but the complementary nature is unmistakable.In accordance with the objective of this special issue of the Social Science Journal, the modest objective of this paper presents a brief history of the health care reform which really only began in 2002. We borrow from a major pilot study (the CHARLS data set) to provide quantitative measures of the cost of medical insurance. CHARLS samples two provinces, the inland poorer Gangsu and the coastal prosperous Zhejiang. The premium was 13 and 27 Yuan for the rural populations Gansu and Zhejiang. For the urban population, the premium was 289 versus 337 for men versus women in urban Gansu. But for the urban areas of Zhejiang, the pattern is radically different; 324.3 Yuan for women and a much higher 608 Yuan for men.Urban residents have always enjoyed better health care. With the support of the central government, 90% of rural population now received some form of basic health coverage. The issue is the reimbursement rate. For outpatient care, the reimbursement rates max out at under 40% and 32% for the urban and rural patients, respectively. This is certainly not enough to cover catastrophic illness, and that is why many Chinese feel they are just one major illness away from utter poverty. Outpatient care is even worse. The reimbursement rates average around only 10%. As Chinese statistics on full medical cost (especially for the elderly) is lacking, we utilize statistics from Taiwan and try to estimate the health care cost of the aging population.We discuss potential issues observed in the Taiwan experience, and proposed an incentive scheme, Self-Motivated Health Maintenance (SMHM), to deal with moral hazards and to reduce the overall health care cost. We believe the SMHM is a win–win–win solution. China has the possibility of building this into their health insurance.     

Social work and end-of-life care: reviewing the past and moving forward

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

The role of carers in supporting the progress of care leavers in the world of work

The aim of this component of a preliminary cross‐national study (Ireland and Catalonia) of care leavers' experience in the world of work is to explore how carers may influence the entry of young people in care into the world of work and how they may also influence the young people's progress in that world. A total of 22 care leavers, aged 23–33 years, were recruited on the basis of their having substantial employment experience since leaving care. Evidence from the interviews reveals the importance of the role of carers in the work‐related progression of the young care leavers, especially in relation to gaining work experience while they were still in care. The qualitative analysis shows that carers were influential in promoting (and sometimes hindering) progress in work and education. Carers were often reported to play an important role in opening up opportunities, giving support (modelling skill development, giving practical help, etc.), being role models and cultivating the young person's agency. On the basis of these findings, we propose an initial conceptualization of carer roles in positive work support.     

Social work practice in palliative and end-of-life care: a report from the summit

In 2005 a Social Work Summit on End-of-Life and Palliative Care was hosted by the National Association of Social Workers (NASW) with support from the Project on Death in America (PDIA) and National Hospice and Palliative Care Organization (NHPCO). Building on the work of a first summit held in 2002, work groups focused on practice, research, policy, and education with "State of the Field" presentations used as a point of convergence for setting priorities and developing action plans. This article describes a process of document selection and review which was designed to isolate aspects of social work practice and to determine concordance with domains and guidelines detailed in the interdisciplinary consensus document, Clinical Practice Guidelines for Quality Palliative Care, a publication of the National Consensus Project for Quality Palliative Care (http://www.nationalconsensusproject.org). In addition, a group of documents written by colleagues in medicine and nursing were chosen for evaluation as they reflect the emerging and valued incorporation of palliative care principles into specialties such as pediatrics and intensive care. This second review was focused on determining the nature and scope of social work presence and participation and on understanding if the role of the profession was clearly articulated in these specialty areas. This article discusses the historical context and relevant findings that may contribute to the growth of the profession in this rich and burgeoning specialty.     

Environmental ethics for social work: Social work's responsibility to the non‐human world

Gray M, Coates J. Environmental ethics for social work: Social work's responsibility to the non‐human world This lead article in this Special Issue begins discussion on an environmental ethics for social work and raises arguments as to whether and, if so, why social workers have duties, obligations, responsibilities and commitments to the non‐human world. It provides an overview of the field of environmental ethics in searching for a moral stance to affirm an environmental social work. To what extent should social workers engage in fundamental geopolitical issues concerned with climate change, global warming, environmental degradation, pollution, chemical contamination, sustainable agriculture, disaster management, pet therapy, wilderness protection and so on and, if so, why and how? Are these issues incidental and peripheral and only of concern when they impact upon humans or do social workers have a responsibility beyond human interests? What is the significance of the ‘non‐human’ for social work? The article explores the terrain of the burgeoning field of environmental ethics to determine whether convincing ethical grounds for environmental social work might be found beyond hortatory claims of what the profession ought to be doing to address environmental concerns.     

Progress of the social service professions in South Africa's developmental social welfare system: Social work,and child and youth care work

This paper examines the progress of the social service professions delivering developmental social welfare in South Africa, a subject we have followed closely over the last 20 years. Being policy-driven, developmental social welfare stemmed from expert social analyses that resulted in technically oriented solutions, including the broadening of social service professions. Twenty years on, it is hard to see developmental social welfare, as envisaged in government policy, in action, since the practice reality does not differ drastically from the prior apartheid system with the government's heavy reliance on social security as a poverty-alleviation measure. The expanded social security budget has led to underfunded services and a crisis for social service professionals. This paper focuses on the regulated professions of social workers, and child and youth care workers. Our examination of critical issues for these occupational groups revealed that South Africa still has a long way to go in building a strong social service workforce.     

Growing health disparities for persons who are aging with intellectual and developmental disabilities: the social work linchpin

Similar to the general population, adults with intellectual and developmental disabilities (IDD) are living into their 70s and beyond. Health care disparities have been well-documented for this vulnerable and underserved population. Social workers are often responsible for assessment, coordination of care, and negotiation of needed services for people with IDD. This article explores the challenges facing social workers in meeting the growing health and social needs of aging adults with IDD and their families. Trends in social work practice and gaps in education are discussed as they relate to addressing and reducing current health disparities.     

Social security in a globalizing world

The main burden of the paper is to argue for enlarging both the concept and the coverage of social security, especially in developing countries, to address the twin problems of "deficiency" and "adversity". The two parts of this enlarged concept of social security are Basic Social Security (BSS) and Contingent Social Security (CSS). To strengthen the argument, lessons have been highlighted from the historical experience of Western countries, where the State played a leading role. Having argued for the extension of BSS, the paper also deals with the extension of CSS. This is best done through the informal economy, which employs a large majority of workers in developing countries. While the primacy of the State has been highlighted, the paper develops a typology of various social security models that could be used to study and understand the existing arrangements as well as the potentialities for extension.     

Social work and transitions of care: observations from an intervention for older adults

Making the transition from hospital to home can be challenging for many older adults. This article presents practice perspectives on these transitions, based on a social work intervention for older adults discharged from an acute care setting to home. An analysis of interviews with clinical social workers who managed 356 cases (n = 3) and a review of their clinical notes (n = 581) were used to identify salient themes relevant to care transitions. Concepts developed and discussed identify the role of surprises after discharge, an expanded view of the client system, and relationship building as instrumental in carrying out effective care transitions.     

Social work in the making: The state and social work development in China

The instrumental role of government in the development of social work in China has led to questions about its political function. So far, little has been reported on how the government has “made” social work in China. To fill this gap, we first provide a brief chronological review of major policies and activities of the Chinese government in its making of social work in China. The state's intervention has indeed been massive and crucial although, politically, it may limit the mandate of social work in China. Yet, we argue that the development of the social work profession in China is generating institutional space for the emerging civil society to take a more active role in welfare service delivery. Situated and mediating between the state and the emerging civil society, the social work profession in China will need to constantly negotiate its mandate to meet the needs of both sides.     

Research, macro practice and aging in the social work education curriculum

This paper presents a model that used a macro emphasis for teaching research using older adults. Faculty developed the teaching model to address three key areas of concern in the education of Bachelor of Social Work (BSW) students for generalist practice: (1) research, (2) macro-level practice, and (3) aging. The paper explores the nature of these concerns and draws upon previous literature to delineate a teaching model designed to strengthen these areas of generalist practice by integrating content on macro-level concerns and aging into the curriculum of a research course. The development and evaluation of the research course within the context of a community and college project are described, as are the benefits for students, the social work program and the community. Preliminary findings indicate some support for the use of such a model.     

Social work is beautiful On the characteristics of social work

Social work is frequently described as a problem-solving activity. Social workers are expected to identify social problems, thoroughly investigate them and take proper measures to solve them. Superficially, this kind of definition is unassailable and harmless (and, of course, partly valid), but in a deeper sense it denies us access to important concepts, perspectives and, hence, possibilities of interpretation, regarding the activity we call social work. Following this line of thought, there is a blind spot in the self-understanding of social work. This article outlines an alternative perspective on social work emphasizing making visible new possibilities of interpretation and action rather than solving problems. In connection with a recently reported research project, Organization and Human Change in Social Work, specific features of social work are suggested and discussed. The aim is to contribute to the development of a theoretical identity of social work, based on its own specific characteristics.     

Spirituality and social work in long-term care

The spiritual aspect of care of elders in long term care has only recently been re-affirmed. A social worker who has volunteered, worked, and consulted in nursing homes shares her perspective on the importance of the "spiritual" to nursing home social work. From the perspective of 40 years of involvement in long term care, she offers suggestions for assessment, education of staff, affirming rights in the religious arena. Workers are encouraged to keep hope alive for themselves as well as for those with whom they work.