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.     

Women and the Family in the British Welfare State: The Thatcher/Major Legacy

This paper reviews the moral agenda of Thatcherism, in terms of maintaining traditional family structures, family roles and family responsibilities for economic support and personal care of family members. It asks to what extent and in what ways this agenda was promoted during the eighteen years of Conservative rule; to what extent contradictory forces within Thatcherism and elsewhere undermined this agenda; and what have been the consequences for women in family and public life. The marketization of life, pursued under Thatcherism, contributed to undermining the family form which has traditionally underpinned the market. Deregulated labour markets and spreading owner-occupation in an unstable housing market have been important contributions to family breakdown, insecurity and women's access to—and need for—jobs. The idea of family responsibility was promulgated, but in practice family members have become less able to support each other.
Nevertheless, one consequence of these changes has been a stronger position for women as women by the end of this Conservative era. Access to paid work makes women less dependent within families and improves their access to public politics. Social policies geared to the Beveridge-type family had become increasingly threadbare and some changes—such as policies enabling lone mothers to do paid work—had been forced by the increasing mismatch between family realities and the Beveridge model. Many changes owed more to the women's movement than to Thatcherism, but Thatcherite policies played a (largely unintentional) part.     

WHAT IT TAKES TO BE A GRANDPARENT IN A NEW COUNTRY: THE LIVED EXPERIENCE AND EMOTIONAL WELL‐BEING OF AUSTRALIAN‐VIETNAMESE GRANDPARENTS

This study attempts to understand the lived experience and emotional well‐being of Australian‐Vietnamese grandparenthood. Thirty‐six grandparents participated in four focus group interviews while three grandparents took part in individual in‐depth interviews where the experiences of the grandparents were further clarified. The findings reveal that Vietnamese grandparents encounter many changes in their lives and their relationships with their children and grandchildren in their new homeland. However, many still seem to play important roles in the family, creating a vital bridge to grandchildren. According to our participants, the grandparents' most important roles are the maintenance of good emotional relationships and support, and the construction of harmony and continuity in their modified extended families. To be able to assume these roles, grandparents need to actively explore and consider accepting new values. For many, a successful grandparenthood brings happiness to the family, positively influences grandparents' life satisfaction and emotional well‐being, and this in turn enhances their quality of life.     

Family Support for Old People in Rural China

In China the family is still the major welfare provider for old people in rural areas. Although the implementation of this role has varied significantly, in different historical periods, owing to social and economic changes in the rural environment, the core functions of the family have remained the same, that is, the provision of welfare for dependants, particularly for the aged. In the more traditional China, providing care for the aged was indeed assumed to be a paramount function of the family. Whereas, following the founding of the PRC in 1949, the welfare function of the family was reduced, as a result of the collectivization of the rural economy, which meant a part of family responsibilities being shared by collective organizations. However, after more than twenty years' experience of agricultural collectivization, China embarked on a course of further rural economic reform in the early 1980s, replacing the commune system with one of private production based on the family unit. As a result, rural welfare responsibilities were shifted back from the commune to the family, which became solely responsible for providing support for its dependent members. This paper attempts to set out the real situation with regard to family support for rural old people in China. The first section offers a brief introduction to the declining family status of rural old people as a consequence of socio-economic change. The second section reviews the implications of rural economic reform for the (declining) status of old people with regard to family support, focusing on patterns of rural old age dependency and the changing roles of family caregivers. Lastly, cases of family support disputes and community responses are presented, drawing on findings from fieldwork conducted by the author between 1995 and 1996 in three rural localities in China.     

Battling parenting: The consequences of secure care interventions on parents

Secure care in Sweden is the most intrusive child welfare intervention, and children and their family members have restricted contact. For each child in secure care, there are at least twice as many affected family members and parents who must manage the consequences of this institutionalization. Clearly, it is just as important to understand how secure care affects parents as it is to understand how secure care affects children. To address this issue, we conducted in-depth interviews with 11 parents to eight children who had been placed in secure care during their childhood, focusing on the institutional and societal structures that affected these parents and their parenting. With a narrative approach, stories alluding to a metaphor of war are identified. These stories reveal how all parents (but especially single mothers) are affected by their diverse socio-economic positions and the rigid frames of family life presumed by child welfare interventions. In these narratives, parenting emerges as a social practice rather than a skill. Above all, the stories demonstrate a great deal of vulnerability and sensitivity of parenting. The findings raise critical questions about the meaning and overarching consequences of institutional interventions in a family life.     

"Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.     

“Maintaining Connections but Wanting More”: The Continuity of Familial Relationships Among Assisted-Living Residents

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.     

The Role of Family Care and Living Arrangements in Acute Care Discharge Recommendations

This study examined placement recommendations of elderly acute care patients who are identified by hospital discharge planners as vulnerable to institutionalization. The purpose of the research was to determine the role of available family care and living arrangements prior to hospitalization in the placement recommendations made by discharge planners. Results indicated that elderly who lived with family compared to those who lived alone were in poorer mental, physical and functional health but had considerably more available family care and fewer service needs that could not be met in the community. Additionally, available family care was found to be significantly related to nursing home recommendations, even with living arrangements controlled. Analysis of placement recommendations by prior living arrangements indicated that family care may be especially important in mitigating the consequences of deficient activity of daily living skills and mental complications. Implications of this research to the role of family care in placement decisions are discussed.     

A sense of belonging in a changeable everyday life – a follow‐up study of young people in kinship,network, and traditional foster families

This in‐depth follow‐up study of 15 foster youth shows the importance of an ‘open foster family’, open to letting the foster youth into the family life and to cooperating with the adolescent's birth family. Previous findings about the importance of negotiations, mutual rituals, and having fun together in foster families for the creation of social bonds and belonging are strengthened in the follow‐up interview. A lack of these mutual practices is observed prior to disruptions. Most adolescents still living with the same foster family feel a sense of belonging to both their foster and birth families, especially when both families cooperate. This is most evident in kinship families. Over time, adolescents in traditional foster families have also strengthened their social bonds to the foster family, which makes the difference to youth in network foster families less pronounced than in the previous study. Despite life changes, above all changing schools and peers, most adolescents reveal personal agency by still coping with their situation. However, therapeutic support is now more common than 1 year ago, for girls in particular. Methods used are interviews, network maps and text responses (‘beepers’).     

New Labour, Work and the Family

New Labour has put support for the family at the core of its notion of the “strong community”. Across a range of policy areas the Labour government can be seen to be developing a direct and explicit family policy. But what kind of community is the government trying to shape by these policies? On the one hand, Labour appears to support the family as the basis of a more moral, dutiful and cohesive community. On the other hand, the government has given weight to policies that support social inclusion in the community through paid work. This paper examines whether there is a tension in Labour’s social policies between its emphasis on the importance of stable family life and the primacy given to paid work. Are critics like Ruth Levitas right when they argue that the government’s emphasis on paid work devalues, and is unsupportive of, unpaid work, especially caring for children and other family members? Alternatively, can this combination of communitarianisms—community as “stable family” and community as “paid work”—be seen to be marking out some “third way” on the family? We shall show that different aspects of the government’s family policies reflect different perspectives and policy agendas within New Labour and third‐way thinking more broadly. And while recognizing the tensions between work and the family, we shall suggest that they are often overstated and fail to give sufficient weight to the complementary aspects of Labour’s welfare reforms.     

广西农村家庭养老模式分析

广西农村由于有其特定的社会历史条件,传统的家庭养老模式历经变迁,至今仍与其他养老模式并存并居重要地位。需要全社会共同完善和创新这种养老模式,才能应对目前更严峻的挑战,以发挥其在建设社会主义新农村中的积极作用。     

Old,Sad and Alone

This paper reports the findings of a survey of 108 elderly heterosexual and homosexual men and women in urban Central and Southern California. The purpose of the study was to test the assumption that elderly gay men and lesbians are more depressed and socially-isolated than their heterosexual cohort. The findings indicate that there are no significant differences between older heterosexuals and homosexuals in regard to depression and social support. However, the sources of social support from friends, while heterosexual elderly derive more support from family. The findings suggest a need to redefine the concept of family to include "friendship families." Future research which investigates the way in which these friendship families are created and maintained has the potential to benefit all elderly, especially those who have no biological families or whose biological families are unavailable for support.     

北京城市贫困家庭的社会支持网

本文在问卷抽样调查的基础上对北京城市贫困家庭社会支持网的规模、功能、关系构成及各类关系的支持作用进行了分析。研究发现,社会支持网的平均规模为2.21;社会支持网的功能以无偿经济援助和精神支持为主,在劳务支持方面有一定作用,但在为贫困家庭解决就业问题方面,作用十分有限;以近亲(父母、兄弟姐妹)为主的亲属是贫困家庭获取社会支持的最主要来源,其他亲戚在各种支持中的作用都很弱,而非亲属在就业支持方面有较大作用。     

Parent Characteristics and Early Coparenting Behavior at the Transition to Parenthood

This study examined parent characteristics as correlates of coparenting behavior in 57 primiparous couples. Parents' negative emotionality and perceptions of maternal acceptance in childhood, mothers' beliefs about fathers' roles, and observed marital behavior and family socioeconomic status were assessed during the third trimester of pregnancy, and coparenting behavior was observed at 3.5 months postpartum. Couples who exhibited high‐quality marital interaction showed higher supportive coparenting behavior, but couples who showed lower quality marital interaction demonstrated higher supportive coparenting behavior when mothers held more progressive beliefs about fathers' roles. Couples showed more undermining coparenting behavior when family socioeconomic status was lower and when fathers were higher on negative emotionality. Greater perceived maternal acceptance in childhood was only associated with lower levels of undermining behavior when prenatal marital interaction was high in quality. Thus, the characteristics of both parents, especially in combination with preexisting marital behavior, are important determinants of coparenting behavior.     

THE USE OF SOCIAL SERVICES BY BLACK AND WHITE ELDERLY

Little is known about the roles of the family, kin, and non-kin support networks in determining the use of social services by the elderly. The purpose of this study was to examine the role of the formal and informal support systems in explaining social service utilization by Black and White elderly. Path analytic procedures are used to test an explanatory model of utilization by a national area probability sample of 3.996 non-institutionalized elderly. The findings indicate that informal family support was more important for Black elderly than White elderly. In addition, family aid was found to be supplementary rather than an alternative support system. In the planning, designing, and delivery of social services to the elderly, it is imperative that racial and cultural differences become explicit input factors. Additionally, future researchers have a responsibility to employ research procedures capable of simultaneously dealing with a comprehensive range of variables in investigating this rather complex phenomenon.     

Life stress, social support, coping and depressive symptoms: a comparison between the general population and family caregivers

Major depression is one of the four most prevalent psychiatric diseases in Taiwan. Furthermore, a study showed that 45 per cent of the family caregivers of persons with persistent psychiatric disability were at risk of depression. The present study aimed at examining if caregivers experienced more depressive symptoms than the general population while controlling for other variables (direct effect), and if the constellation of correlates of depressive symptoms was different between the general population and caregivers (interaction effect). Data from 1979 subjects were gathered in a national survey, using stratified random sampling. The results revealed that the caregivers experienced significantly more depressive symptoms than the general population. However, the effect disappeared when other variables were taken into account. Life stress appeared to be more important than coping and social support. The other two common correlates of depressive symptoms were age and being unmarried. Relational stress mattered especially for caregivers. Lastly, social support variables were significant only for the general population; satisfaction with support could buffer the negative effect of survival stress on depressive symptoms.     

Catholicism, Job Security Regulations and Female Employment: A Micro-level Analysis of Esping-Andersen's Social Catholicism Thesis

This article explores the religious roots of job security regulations in Western democracies by putting Esping-Andersen's famous social Catholicism thesis to the test. Esping-Andersen argues that due to religious socialization, Catholics exhibit more conservative family values, i.e. they tend to support the male breadwinner model. To sustain this model of family organization, Catholics are expected to support job security regulations. These regulations have been described in the literature as important determinants of gender-segregated labour markets and low female employment rates. Data from this article show that while Catholics indeed support more conservative family models, so do Reformed Protestants and religious persons in general. Furthermore, no relationship between religious denomination and preferences for job security regulations can be observed. The analysis thus refutes Esping-Andersen's social Catholicism thesis.     

Age Cohort, Ancestry, and Immigrant Generation Influences in Family Relations and Psychological Well-Being among Black Caribbean Family Members

Immigration is contributing to the U.S. population becoming increasingly ethnically diverse. This article examines the role of family relations and well-being among different generations of Black Caribbean immigrants. Family disruptions, such as migration, can have complex effects on the support networks and emotional well-being of family members. Data from a recently completed national study of American Blacks in the United States, however, reveal significant similarities across ancestry and immigrant status in family contact, solidarity and well-being. It is concluded that intrafamilial relations may serve to overcome barriers of geographical distance in providing comparable levels of contact, solidarity, and well-being for both U.S.-born and immigrant Black Caribbean family members of different generations. Because of the increasing numbers of immigrant elders, these sources of family support will become increasingly more important in bridging the gaps between government resources and needed assistance in an aging society.     

Processes of conservation and change in Arab society in Israel: Implications for the health and welfare of the Arab population

Azaiza F. Processes of conservation and change in Arab society in Israel: Implications for the health and welfare of the Arab population This article reports on a study that examined how modernisation processes affect the Arab citizens of Israel on various levels and how the processes are reconciled with traditional ideals. Modernisation affects formal and informal support systems, affects family lifestyles, has resulted in changes in the treatment of elderly people and has seen modern ideas of health and wellness incorporated with traditional values and ideals. For the Arab citizens of Israel, the conflict of tradition versus modernisation is evident throughout society. Studying the processes of both modernisation and preservation and their implications allows us to better understand and address the needs of the Arab population in Israel. Based on the research presented in this review, processes of modernisation and conservation are conceptualised as a continuum along four dimensions: perceptions of self, sources of social support, health roles and gender roles. The implications of these changes are explored as they relate to various phenomena.     

A qualitative perspective of family resources among low income, African American grandmother-caregivers

This ethnographic study describes a group of 7 low-income, African American, grandmother-caregivers' perceptions of family resources. An ethnographic design, enhanced by a genogram, captured those who were available and unavailable to provide support to the grandmother. The analysis used a constant comparative method to thematically capture grandmothers' perceptions of family support resources as absent, unavailable, dependent, and reliable support, and the circumstances that led to that status. The findings reveal that many African American grandmothers are rearing children with little family support, owing mainly to the devastation of negative social and economic conditions. The results suggest areas for improvement in social work assessment and intervention.