Policy Changes in Medicare Home Health Care: Challenges to Providing Family-Centered,Community-Based Care for Older Adults

The Balanced Budget Act of 1997 (BBA) established new reimbursement systems in the Medicare home health fee-for-service benefit. Reimbursements were reduced to 1993 levels and per-beneficiary capitated limits were introduced for the first time. This article analyzes the impact of these changes on chronically ill older adults and their families. The study combined a secondary analysis of the Provider of Service file (1996, 1999, 2002, and the Medicare Current Beneficiary Survey (1996, 1998) with qualitative interviews of home health agency directors. The greatest decreases in staff and visits were for medical social work and home health aide services. Patients with caregivers saw greater decreases in visits and reimbursements for all visits, skilled nursing, medical social work, and home health aide visits. Agency directors reported that they increased caregiver education, training, and involvement in care in order to discharge patients sooner. Additional research is needed to understand the long-term, adverse impact of these policy changes on chronically ill patients and their families.     

Enhancing Critical Reflection amongst Social Work Students: The Contribution of an Experiential Learning Group in Care Homes for Older People

As part of a Practice Learning Centre, representing a partnership between an English University social work department and a non-governmental organisation, 12 students were placed in care homes for older people for their first period of assessed practice. The aims of this initiative were to facilitate: development of critical reflection; deployment of social work skills in a care home setting; and opportunities for social work students to work with care home residents. The learning was captured via four Experiential Groups facilitated by the Practice Educator with responsibility for assessing the students' practice. On-site supervisors also participated. Key learning included understanding of: the importance of critical reflection as a key social work skill; the influence of organisational norms and care home culture on the quality of care practice; the complexity and emotion-rich nature of person-centred care; and the pivotal role of relationships in work with people with dementia. Links made in the Groups—between the experiential and theoretical, the emotional and cognitive, and the structural and personal—demonstrate their value as learning platforms. Placements in care homes have considerable potential to enrich practice education; this is especially important in the context of an ageing population.     

Distance to Hospital and Children's Use of Preventive Care: Is Being Closer Better,and for Whom?

This article examines the effect of distance to hospital on preventive care among children using data from the National Longitudinal Survey of Youth's Child-Mother file matched to data from the 1990 American Hospital Association Survey. Among central-city black children, each additional mile from the hospital is associated with a 3-percentage-point decline in the probability of having had a checkup (from a mean baseline of 74%). Moreover, the effects are similar for privately and publicly insured black children. For this group, access to providers is as important as private insurance coverage in predicting use of preventive care.     

Consultancy to a Care Home: The Influences of Family and Gender Roles,and of Race and Colonialism

This paper is an account and critical analysis of the psychodynamic and systemic consultancy that the author provided to a care home (and the voluntary organisation running it) over a period of about 16 months. In addition two emergent, linked themes are identified and discussed: family and gender roles in care homes, and racism and colonialism. Care homes are of course part of the society in which they exist and of which they are a product. This means that all the overt and covert psychological and social pressures, defences and trends that occur in the wider society, for individuals, families, groups and communities are also to be found in care homes and in the organisations that run them. They are not isolated from these forces, indeed, it is argued in this paper, the forces are intensified in the ‘hot house’ environment of a care home and, if ignored, avoided and denied, result in the exploitation, abuse and neglect of both staff and residents.     

Sibling Roles in the Lives of Older Group Home Residents with Intellectual Disability: Working with Staff to Safeguard Wellbeing

Abstract

When parents die, siblings of older people with intellectual disability are likely to take responsibility for oversight of their wellbeing and negotiation with formal support services. This study explored the roles siblings played in the lives of older people with intellectual disability who live in group homes, and the relationships between residents’ siblings and group home staff. The siblings of 13 group home residents and the 17 supervisory staff associated with these services were interviewed, initially face-to-face and then intermittently by phone over a period of three years. Data were analysed using an inductive analytical approach. Siblings valued the relationship with their brother or sister with intellectual disability and played a significant role in safeguarding their wellbeing. Sibling–staff relationships fluctuated over time, sometimes becoming tense and difficult. Few protocols guided these relationships. A principle-based framework could facilitate negotiation between staff and siblings about expectations of communication and decision making.     

The Use of Dialogue in Community Organization Practice: Using Theory,Values, and Skills to Guide Group Decision-Making

The ability to engage diverse community participants in group dialogue to resolve differences, establish common ground, identify problems, set goals, and plan actions is an essential part of community organization. However, there are limited resources in the social work literature about how social work skills can best be used to facilitate group dialogue in this context. In this article, the theories and values associated with the use of group dialogue are discussed. The manner in which these skills are applied in community organizing is described. The interpersonal skills needed for facilitating group dialogue in community organization practice are also examined.     

The Evolution of Housing Typologies for Older Adults in The Netherlands From 1945 to 2016: An Analysis in the Context of Policy,Societal, and Technological Developments

This study aims to examine housing typologies for older adults in the light of three qualitatively examined exogenous factors: policy, societal developments, and technology. The developments in inpatient and assisted ambulatory housing facilities for older adults have been mapped from 1945 to 2016 using quantitative data. Using these data, five transition periods can be distinguished. Within the first transition periods, policy factors were tremendously important, while within the later ones, societal influence empowered by technological change became the primarily driving factor. This research shows that the classification of inpatient, assisted ambulatory housing, and outpatient housing may no longer be applicable in its current form.     

Evidence for the Absence of Stimulus Quality Differences in Tests of the Accuracy of Sexual Orientation Judgments: A Reply to Cox,Devine, Bischmann,and Hyde (2016)

An article recently published in this journal (Cox, Devine, Bischmann, &; Hyde, 2016) questioned the validity of existing research on the accurate judgment of sexual orientation from photographs of faces. Specifically, those authors reported a confound in their stimuli whereby the photos of sexual minorities (gay men and lesbians) were of higher quality than the photos of heterosexuals. Based on this finding, they concluded that the accuracy in judging sexual orientation from faces demonstrated in the broader literature is an artifact of stimulus quality differences. Here, we addressed this claim by systematically testing the numerous photo sets that we have used in 61 studies documenting accurate judgments of sexual orientation from facial cues published since 2007. Contrary to their claim, the overwhelming majority of studies (93%) showed no significant differences in photo quality according to sexual orientation. Of those that did show differences, most revealed that heterosexual targets’ photos were actually of higher quality than sexual minority targets’ photos – opposite of what Cox et al. found. In addition, we highlight additional research using stimuli equated for quality differences overlooked in the recent article by Cox et al., lending further support to the conclusion that sexual orientation is legible from multiple sensory cues.     

‘Fuck It,Shit Happens (FISH)’: a social generations approach to understanding young people’s imaginings of life after school in 2016–2017

ABSTRACT

This article uses a social generations approach to explore the lives of young people transitioning to life after schooling. Drawing on ethnographic research in England during the geopolitical uncertainty of 2016–2017, we track the trajectories and narratives of six individuals. The research begins with final year pupils in schools talking about their futures, during and after their A-Level exams. We then follow these individuals on routes to Higher Education and employment, exploring how they are socialised into imaginings of the future and/or struggle to inhabit these futures. A deeply ingrained, modernist, neoliberal reckoning of future time is normalised through experiences of schooling. However, this logic is troubled profoundly in the transition to life after school. Young people’s experiences in an unpredictable present run in stark contrast to the ordered trajectory of future action they have been socialised to expect. Amidst this uncertainty, ambivalence towards shaping the future (‘Fuck It, Shit Happens’) can in some ways feel like the most agentic stance to take. Furlong et al.’s (2011) social generations approach to understanding youth transitions reveals how we must critique the very concept of ‘the future’ if we are to understand the reality of youth transitions in the present.