Experiences of a Mass Interinstitutional Relocation for Long-Term Care Staff

This research explored long-term care (LTC) staff perceptions and experiences of working in LTC and providing care to residents following a mass interinstitutional relocation. In-depth, semistructured interviews were conducted with 63 LTC workers. Thematic analyses revealed three overarching themes related to how staff members perceived their relationships with other staff members following relocation. The first theme, post-relocation relationships between staff members, included the subthemes “Staff are segregated from each other” (physical distance) and “We were a family” to “barely say hi” (psychological distance). The second theme, post-relocation stress, has two subthemes: “Staffing is our big issue” and consequences of stress: absenteeism and leave. The third theme is recommendations for improving and managing staff relationships post-relocation. Relationships among staff members are integral to working in LTC and providing care to residents following a mass interinstitutional relocation. Recommendations for improving staff relationships and morale are suggested.     

Long-Term Care Policy: Singapore’s Experience

Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government’s philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers.     

Aging in Timorese Exile: (Im)mobilities of Care and Intergenerational Relationships

ABSTRACT

This paper discusses transnational care and border regimes in the context of the East Timorese exile in rural Indonesia. Drawing from multi-sited ethnographic research, it explores the ways older people cope with family separation and life in exile, their aspirations, when and how transnational care becomes “on hold”, and how they deal with the impossibility of meeting intergenerational and cultural obligations. Analyzing care using the lens of “circulation”, the paper attends to the asymmetries entailed in intergenerational relationships as well as to how uneven power relations of border regimes shape transnational care exchanges. In the context of “aging in exile”, the paper underlines the importance of understanding older persons’ narratives as they are linked with the ambivalences of other family members across generations. The paper argues that the forms of immobility withholding or limiting caregiving can transcend physical boundaries. They can include the social and emotional borders conflict-divided communities build against one another over time. These “imaginary” borders require us to think about the additional asymmetries entailed in precarious familial relations and how this affects the multiple meanings of care in the context of contemporary border regimes and amid enduring legacies of violence.     

A Generic Model of Long Term Care for Social Work Education

Abstract

With the “graying” of America and the increasing life expectancy for the developmentally disabled, there is an increasing demand for long-term care (LTC). As in the past, provision of this care will depend heavily on families. Professional social work can expect an increased role in facilitating the balance of LTC resources. As this role evolves, social work educators may develop anticipatory responses by incorporating a generic but comprehensive framework of LTC in social work curricula. Such a framework is presented in this paper. It is neither age- nor etiology-specific; it is appropriate for use with the developmentally disabled, the frail elderly, or any other population in need of LTC.     

The Perspectives of Older Greek-Australians Toward Changes in the Nature of Family Support: Implications for Family Care Policies

Internationally, public policies encourage “aging in place,” and the majority of older Australians requiring care in the community receive informal care, supplemented by publicly subsidized formal services. The effect of contemporary social changes on informal care in aging migrant communities is poorly understood. This articles explores the perceptions of older Greek-Australians toward changes in the nature of family support. Bicultural and bilingual researchers carried out in-depth interviews (n?=?27) and five focus groups (n?=?63 total participants) with older Greek-Australians in modern Greek. While “cultures of care” remain among Greek-Australian families, the means for a family to assist have shifted, and these compromises are met with considerable powerlessness among older Greek-Australians. Implications for policy include the need to better involve older migrants and their families in decisions about their care needs, potentially involving consumer-directed care models. Service providers may also need to adopt the use of new technologies to communicate with increasingly time-pressured family members.     

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

Abstract

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons.

This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva.

Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Approaching Adoption and Foster Care in Brazil

Adoption and foster care have recently undergone various changes in Brazil. Nonetheless, there is a lack of official research data on children who have been adopted or have been living in foster families or institutions. In this paper, after a brief account of the historical aspects of adoption and foster care in Brazil, we focus our discussion on two major points: (1) the difficulties in promoting a “new culture of adoption,” which would develop in “the child's best interest,” and (2) the meanings and prejudices related to late adoption that increase the number of children who remain for many years in institutions.     

Institutional Care for Elders in Rural China

The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.     

What's in a Name? Causes and Consequences of Labelling Minorities as “National” or “Migrant”: Roma in Italy and Spain

This article analyses how Roma are represented in official policy narratives in Italy and Spain by comparing the four cycles of the Framework Convention for the Protection of National Minorities in the two countries. By tracing the representations that the Italian and Spanish governments hold (and make) about the Roma, I sketch out the different categories that EU‐ropean countries recur to as organizing principles to “other” underprivileged minorities. Based on the tailored‐approaches in which both Italy and Spain engage in framing Roma as either a “national” minority or not, I suggest that constructing or “producing” a minority in our imagined communities as characterized by national, cultural, social or migrant characteristics relies more on political expediency than on objective analytical categories.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Community Care in Taiwan

SUMMARY

This article explores the policy definitions and the funder roles of central and local governments in community care in Taiwan. The notion of community care has been adopted in Taiwan following the model of Hong Kong but the main question of the article is whether this has resulted in actual service provisions at the community level, forming an alternative to institutional care. The data has been collected from several sources: policy documents, official statistics, surveys, general reports, funding provision reports, and empirical studies. The results show that neither central nor local authorities are seriously involved in caring for elderly people or persons with disabilities in Taiwan's communities. In Taiwan, community care for these groups of people still means, in practice, informal care provided by female family members without any support from public policies.     

Consequences of Teen Parents' Child‐Care Arrangements for Mothers and Children

Using the nationally representative Early Childhood Longitudinal Study, Birth Cohort (2001–2006; N ?7,900), the authors examined child‐care arrangements among teen parents from birth through prekindergarten. Four latent classes of child care arrangements at 9, 24, and 52 months emerged: (a) “parental care,” (b) “center care,” (c) “paid home‐based care,” and (d) “free kin‐based care.” Disadvantaged teen‐parent families were overrepresented in the “parental care” class, which was negatively associated with children's preschool reading, math, and behavior scores and mothers' socioeconomic and fertility outcomes compared with some nonparental care classes. Nonparental care did not predict any negative maternal or child outcomes, and different care arrangements had different benefits for mothers and children. Time spent in nonparental care and improved maternal outcomes contributed to children's increased scores across domains. Child‐care classes predicted maternal outcomes similarly in teen‐parent and nonteen‐parent families, but the “parental care” class predicted some disproportionately negative child outcomes for teen‐parent families.     

Implementation of a Collaborative Care Initiative for PTSD and Depression in the Army Primary Care System

Collaborative care models hold promise as a means to improve the Military Health System (MHS) to better meet the mental health needs of U.S. military personnel. This article describes an Army-wide collaborative care initiative, RESPECT-Mil (“Re-engineering Systems of Primary Care Treatment for Depression and PTSD in the Military”), aimed at improving care for soldiers with depression and post traumatic stress disorder. Essential to the implementation of RESPECT-Mil has been the use of a centralized coordinating team to facilitate collaborative care practice and policy activities across the multiple levels of the MHS. The article explores the relevance of collaborative care frameworks to the social work profession and concludes with a discussion of future directions for the social work field to promote greater involvement in the integrated care movement.     

You Can't Always Get What You Want—Infant Care Preferences and Use Among Employed Mothers

Although much scholarly attention has been paid to the question of whether a “shortage” of adequate child care exists, few studies have framed this issue around the disjuncture between mothers' preferred modes of care and the types of care available to them. In this study, we address that gap by asking what mothers want, what mothers use, and why many don't use the form of care they prefer. Using a regional sample of 247 pregnant women who returned to paid employment within the 1st year postpartum and used nonmaternal child care, we found that the majority of the mothers surveyed preferred father care (53%), but only 23% primarily used father care. Derived from logistic regression models, the significant determinants of achieving the type of care preferred are the presence of additional children under age 5, higher educational attainment, and the mother working an evening or night work shift.     

The Economic and Psychological Burden to Hospitals and Care Facilities of Accepting EPA Candidates in Japan

The Japanese government has encouraged the opening of the domestic market to foreign workers under the Economic Partnership Agreement (EPA) as a “special case” in order “to promote the trade relationship between Japan and the countries that sign the agreement” since 2008. According to the literature, the introduction of nurses and care workers is not at all economical. Many empirical studies indicate that the costs of accepting EPA candidates is crucial for accepting institutions. In this study, the authors developed a multiple regression model for the economic and psychological burden of EPA and evaluated the goodness of fit of the model by comparing hospitals and care facilities. The multiple regression analysis indicated a good fit model for hospitals, but not for care facilities. The authors speculate that there are some differences in management between hospitals and care facilities that should be considered in interpreting this phenomenon.     

Adversarial Allies: Care,Harm, and Resistance in the Helping Professions

Professional encounters bestow moral esteem upon professional helpers while denigrating those who access services. Yet society is arranged in such a way that professional services are indispensable for many to survive, and service users can experience them as simultaneously helpful and oppressive. We explore the ambivalent figure of the professional “adversarial ally” working within these systems through accounts from two research studies that straddle or resist the common-sense line that separates care from harm. Professionals need to acknowledge how we are experienced as adversaries in order to better forge relationships of solidarity or “alliance” with those using social and medical services.     

The Impact of Female Emigration on Families and the Welfare State in Countries of Origin: The Case of Romania

The heavy reliance on foreign labour in the care sector by Western countries (particularly those in southern Europe) is fuelling a growing feminization of migration in many emigration countries. This migration has a new impact on the countries of origin: it adds the problem of “care drain” to the better known “skill drain” problem ‐‐ which has already been extensively examined in the literature. In this article, we investigate how this phenomenon is taking place in Romania. In particular, the article explores the compensatory strategies put in place by Romanian families and local welfare states to limit the impact of care drain. Furthermore, it considers the persistence of a “care shortage” problem, which constrains both individuals and local institutions in Romania and requires the establishment of new social and cooperation policies. The research is based on the results of qualitative interviews conducted between the winter and spring of 2006 with 30 Romanian female care‐workers living in Turin and Rome, and with 40 family members of female care‐workers (often belonging to the same family units as the women interviewed in Italy) in Romania. With a view to gaining a more comprehensive overview of the phenomenon, more than 35 privileged observers were also interviewed in both countries in which the field work was carried out.     

Out-Of-School Care and Youth Problem Behaviors in Low-Income,Urban Areas

Using data from Welfare, Children and Families: A 3-City Study, this study explores how change and stability in out-of-school care are associated with changes in problem behaviors among youth from Time 1 (i.e., at ages 10–11) to Time 2 (an average of 16 months later). Girls in at-home, family care or an organized activity at Time 1 and in informal, out-of-home care or self-care at Time 2 experienced greater increases in problem behaviors than girls remaining in at-home family care or an organized activity. Other changes in care were related to youth outcomes differently depending upon maternal psychological distress. Policies must provide a full range of support services related to childcare and mental health care for low-income families.     

Informal Care Substitution:

Empirical studies focusing on the relationships between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.     

Hierarchization and segmentation of informal care markets in Slovenia

The article is the result of qualitative research of informal care markets in Slovenia in the field of childcare, elder care, and cleaning. The author assesses Slovenia's position in the “global care chain” and finds that “local care chains” prevail in the field of childcare and elder care, while a co-occurrence of female gender, “other” ethnicity, and poverty is typical in the field of household cleaning. The main emphasis of the article is on the analysis of hierarchization of the informal market of care work according to following two criteria: social reputation of individual type of care work and citizenship status of care workers.