Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Supporting families: Outcomes of placement in voluntary out-of-home care for children and young people with disabilities and their families

Parents caring for children and young people with disabilities typically have extensive additional demands on their time and resources. This added pressure can significantly impact well-being and mental health. In extreme circumstances, parents may seek an out-of-home placement for their child. Previous research has looked into factors that influence decisions for families to place their child into out-of-home care but little is known about outcomes for these young people and their families. The Supporting Families study aimed to explore the impact of a voluntary out-of-home placement on young people with disabilities, and consequences for their families. Fourteen parents/carers, twenty six case managers, six accommodation services' managers, and four young people with disabilities participated in face-to-face and telephone interviews and focus groups. Participants reported a range of outcomes for young people in care. Positive outcomes included increased levels of respect for themselves and others, an improvement in independent living skills, and reductions in challenging behaviours. Negative outcomes centred on their experiences of grief, loss and rejection, as well as behavioural problems. Positive and negative outcomes were also found for families. For many parents/carers there was a reduction in perceived stress and caring load, as well as improved mental health and wellbeing for them and the child's siblings. However, parents/carers often experienced ongoing feelings of guilt, grief and loss. The study adds to knowledge about outcomes of being in voluntary out-of-home care for this small but vulnerable group of young people in care and their families.     

An examination of the views of young people in the Romanian residential care system regarding their relationship with biological family members and the option of reintegration

This paper reports findings from research conducted in six Romanian residential care homes. The aim of the paper is to examine the views held by young people, currently living in residential care, about the importance of their biological families and the option and challenge of reintegration. The data reflect the ideas and perspectives of 44 young people captured through a narrative interview approach using social mapping activities. The results indicate that most children and young people know at least one birth parent and maintain contact on their own initiative; most do not place a high level of importance on such relationships which are generally characterised by lack of confidence, low security and a presumed limited capacity on the part of the biological family to meet their needs. Family reintegration is considered to be a viable option for a small number of young people; others do not see it as realistic because of the impact of long-term separation and the likelihood of experiencing poorer living conditions.     

Interprofessional collaboration in Swedish health and social care from a care manager's perspective

The aim of this study was to study interprofessional collaboration in health and social care for older people and persons with disabilities from a care manager's perspective. The empirical data was collected at a workshop held during a national conference for care managers and through focus group interviews in two Swedish municipalities. The results showed that the care managers collaborated in different ways with many different professionals from different organisations. The care and discharge planning meetings emerged as the most typical situation where care managers collaborated with different health care professionals. Interprofessional collaboration was seen as a means for care managers to fulfil their assignment and carry out their work. The care manager role encompassed role strain, a relatively weak professional identity, and differences in professional status among those involved in interprofessional collaboration.     

The Effect of Care Setting on Elder Abuse: Results from a Michigan Survey

This study compares abuse rates for elders age 60 and older in three care settings: nursing home, paid home care, and assisted living. The results are based on a 2005 random-digit dial survey of relatives of, or those responsible for, a person in long-term care. Nursing homes have the highest rates of all types of abuse, although paid home care has a relatively high rate of verbal abuse and assisted living has an unexpected high rate of neglect. Even when adjusting for health conditions, care setting is a significant factor in both caretaking and neglect abuses. Moving from paid home care to nursing homes is shown to more than triple the odds of neglect. Furthermore, when computing abuse rates by care setting for persons with specified health conditions, nursing homes no longer have the highest abuse rates.     

Work–home conflict and facilitation across four different family structures in Norway

The purpose of this study was to examine how work–home conflict and facilitation vary among people living in different family structures in Norway, here conceptualized as: two-parent families; single parents; childless couples; and singles. The study used data from a Norwegian study on occupational health (N=2414). We hypothesized that respondents living in two-parent families experience more work–home conflict and facilitation than others due to more complex role expectations. Similarly, we hypothesized that the effect of workload and autonomy on work–home conflict and facilitation would be stronger among this group. The results indicate that conflict between work and home life are more profound among those living in two-parent families and among single parents than among childless couples and singles. Work-to-home facilitation did not vary by family structure, whereas the childless couples reported more home-to-work facilitation. Furthermore, with a few exceptions the effects of workload and autonomy on work–home conflict and facilitation did not differ by family structure.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Bringing Assisted Living Services into Congregate Housing

Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents—the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Mobile crisis services for children and families: Advancing a community-based model in Connecticut

The purpose of this paper is to describe a best practice model of care for children's mobile crisis services in Connecticut: Emergency Mobile Psychiatric Services (EMPS). EMPS responds to homes, schools, emergency departments and other community locations to provide children and their families with mobile crisis stabilization, assessment and brief intervention, and referral and linkage to ongoing care. The system is comprised of a statewide network of contracted providers, a statewide Call Center to manage and triage incoming referrals, and a Performance Improvement Center to provide data analysis, reporting, quality improvement, and standardized training. Data collected since 2009 demonstrate high service utilization, consistently high mobility rates, and rapid response times as well as statistically significant improvements in child outcomes. The paper discusses the role of mobile crisis services within a comprehensive continuum of behavioral health care for children and families.     

Gender differences in immigrant health: the case of Mexican and Middle Eastern immigrants

This article draws on theories of gender inequality and immigrant health to hypothesize differences among the largest immigrant population, Mexicans, and a lesser known population of Middle Easterners. Using data from the 2000-2007 National Health Interview Surveys, we compare health outcomes among immigrants to those among U.S.-born whites and assess gender differences within each group. We find an immigrant story and a gender story. Mexican and Middle Eastern immigrants are healthier than U.S.-born whites, and men report better health than women regardless of nativity or ethnicity. We identify utilization of health care as a primary mechanism that contributes to both patterns. Immigrants are less likely than U.S.-born whites to interact with the health care system, and women are more likely to do so than men. Thus, immigrant and gender health disparities may partly reflect knowledge of health status rather than actual health.     

Comparison of the characteristics of homes for older people in Slovenia with Goffman's concept of the total institution

The past concepts of life and work in homes for older people in Slovenia are no longer adequate to meet the needs, wishes and requirements of their current users. One of the basic premises, relying on Goffman's concept of the total institution, is that the first and foremost characteristic of homes for older people is that they are institutions. The theoretical starting point, namely that Goffman's concept of the total institution is ideal-typical, was corroborated by an investigation of the presence of elements of the total institution in Slovenian homes for older people, proving that not all features of the total institution can be found in any chosen empirical selection of institutions, with the data showing that those characteristics which are present do not exist in the ideal, that is in the most pronounced form. The homes’ users are given consideration, their personnel are adapting to their needs and requirements, even though this occurs within the functioning of an institution whose aims, i.e. to care for a large number of people living in one place, make life in such an institution subordinated to rules, along with the bureaucratisation and routinisation of services.     

Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

Influence of Late Life Stressors on the Decisions of Older Women to Relocate into Congregate Senior Housing

Late-life stressors often require individuals to make substantial alterations in behavior and lifestyle and can affect their overall health and well-being. Relocation is a significant life stress, regardless of age. The primary aim of this study is to elucidate the push-pull factors associated with moving into congregate senior housing. The secondary aim is to investigate the decision-making processes and stresses associated with moving into a congregate living environment. Interviews were conducted with 26 women who were new residents in congregate senior housing. Relocation, as expected, was considered to be stressful, although individual differences were found among perceptions of relocation stresses. Women who had made the decision to relocate on their own showed evidence of better psychosocial well-being at the time of the move. One-quarter of the sample chose to move to provide care to another person. As the options for senior housing continue to evolve and the number of adults reaching advanced age continues to increase, it is important to understand the factors that contribute to successful adaptation. This knowledge will enable facility administrators to implement programs and procedures to assist incoming residents with acclimating to their new homes.     

Successful Adoption of Children with Down Syndrome and Other Developmental Disabilities

Abstract

Children with many types of developmental disabilities have been successfully adopted. Nonetheless, there appears to be a belief among both adopters and some adoption workers that children with Down syndrome are especially easy to rear. The current paper uses different methodological strategies, including case-by-case matching and regression techniques, to test hypotheses relating to better outcomes for parents and families who have adopted children with Down syndrome in comparison to children with other developmental disabilities. The results demonstrated successful functioning for parents and families on a variety of measures, regardless of whether the adopted children had Down syndrome or other developmental disabilities. The positive stereotype for Down syndrome was not supported.     

‘The Older I Get,the Colder I Get’—Older People’s Perspectives on Coping in Cold Homes

Abstract

An average of 26,560 UK excess winter deaths occur in people 65+ years old each winter, of which 30% are attributed to cold homes. Cold homes are known to exacerbate health problems prevalent in the 65+ demographic. Through conducting interviews in homes occupied by 65+-year-olds known to be achieving less than the World Health Organization (WHO) minimum recommended temperature (18ºC), this article highlights their struggles in maintaining health and managing their homes, with instances of extreme and potentially dangerous methods to achieve thermal comfort identified. Fairer energy provision, better targeted financial aid, and improved support networks are necessary to alleviate current problems.     

Issues Affecting Utilization of Hospice Services by Rural Hispanics

Abstract

As the population of Hispanics in the U.S. is growing, their utilization of hospice care remains low. In a study of 110 rural His-panics, most (88%) were not familiar with hospice, but did report willingness to accept such service in their homes. The most important possible barrier to receiving hospice care was language, along with poverty, lack of health insurance, and low levels of education. Hospice social workers can contribute greatly to an effort to increase access to hospice by offering education to the Hispanic community and promoting cultural awareness among hospice staff.     

Controlling behaviour using neuroleptic drugs: the role of the Mental capacity act 2005 in protecting the liberty of people with dementia

The use of neuroleptic drugs to mediate the behaviour of people with dementia living in care homes can lead to them being deprived of their liberty. Whilst regulation has been successful in reducing neuroleptic prescribing in the USA, policy guidance has been unsuccessful in reducing the use of these drugs in the UK. Yet the Mental capacity act 2005 aimed to protect the liberty of people lacking capacity and provided safeguards to ensure that they are not inappropriately deprived of their liberty in institutions. This article highlights the potential for using this law to identify when neuroleptic prescribing in care homes would deprive people with dementia of their liberty and, in turn, to act as a check on prescribing levels. However, the extent to which the Act can promote and protect the right to liberty of people with dementia is constrained by a lack of access to social rights.     

The abuse of children in out of home care

SUMMARY: One of the major paradoxes in child protective services in the United States is that children removed from their homes on protective orders and placed in foster and group care face continued abuse. These children are reported at two to three times the rates of children living with their families. Investigations are performed by the very system that marks placements. In the US, some recommend resolving these problems by withdrawing from the active protection of children in care. Others hold that because children are in the care and custody of the state, and demand a higher standard of care, specialised prevention, identification. reporting and investigation initiatives are necessary to ensure their safety. This has important implications for other countries, especially the United Kingdom with its recent spate of inquiries into abuse in residential care.