Residential Differences in Filial Responsibility Expectations Among Older Persons1

Abstract This study examines variation in filial responsibility expectations-the extent to which adult children are expected to assist and care for their aging parents-among a sample of 440 older persons. The analysis focuses on the relationship of filial responsibility expectations to residential location and tests the hypothesis that older rural residents have higher expectations for assistance from their children than do older urbanites. Current residential location is found to have little impact on expectations, but older persons who were raised in rural areas, particularly on farms, have significantly higher expectations for filial assistance than do older persons from urban backgrounds. Possible consequences of these patterns for the transmission of expectations from parents to children are discussed.     

State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.     

Who Gets What From Government? Distributional Consequences of Child‐Care Assistance Policies

Given the fragmented structure of child‐care assistance in the United States, it has been difficult to obtain accurate estimates of which families are assisted, through which mechanisms, and at what level. Making use of survey data from New York City, we analyze the distribution of several forms of public child‐care assistance. Results suggest that about 40% of all families with young children receive some form of child‐care assistance. Considering all forms of assistance, the distribution of child‐care help is targeted in both expected and some unexpected ways. Implications of these results are discussed in the context of U.S. child‐care policies governing access and benefit levels.     

Building on users' knowledge as a basis for professional expertise? An example from Swedish social care services

Implementing new occupations in social care services as a solution to social problems challenges the knowledge base for social care. This has been particularly evident in services for persons with disabilities. Social policy has emphasized influence over services for persons with disabilities and hence has implemented personal assistance and case management services. Using these as examples, this article explores the professional logic developed, and the ways it relate to existing social professions. The results are presented in a typology defining two occupations as examples of a professional logic based on users’ knowledge. This logic, here called ‘user-mandated professionalism’, is denoted by wide discretion, relationships with users built on trust, and legitimacy mainly stemming from user organizations. The analysis then raises the challenge for social professionals in social care occupations based on users’ knowledge to be explicit about the knowledge base they build on in their arguments and in decision-making.     

Chapter 6. Issues in Caregiving

SUMMARY

Some 10 to 29% of persons over 65 in the United States are sufficently physically, cognitively, or emotionally impaired to need some level of caregiving from their informal and formal support systems. Unfortunately, there are still some older persons who need care, but care is either not provided, inadequate, or involves some form of mistreatment. This chapter discusses the difficulties of maltreatment and substance abuse.     

Child care assistance and nonstandard work schedules

Child care is a necessary work support for many American families, but can be prohibitively expensive for those with low incomes. The federal government provides assistance through direct child care subsidies, but only a fraction of eligible families are in receipt. One factor that may limit access to child care assistance is work schedule. Research suggests that mothers with nonstandard work schedules use relative care more and day care centers less than those with standard work schedules. Research also shows that child care subsidies are disproportionately used for day care centers. This suggests that mothers who work nonstandard schedules may be less likely to receive child care assistance, but little empirical work addresses this question directly. Using data from a cohort of urban, unmarried mothers, this study explores the direct and indirect relationship between work schedule and receipt of child care assistance. The findings suggest that nonstandard work schedules reduce the odds of receiving child care assistance; a relationship mediated entirely by less day care center use among nonstandard schedule workers. The results imply that more flexible child care assistance is needed to meet the needs of these workers, possibly provided outside of the direct-subsidy system.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

Screening for patients with alcohol problems: severity of patients identified by the CAGE.

Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.     

Chapter 3 Residential Care Facilities for the Elderly

Abstract

Residential Care Facilities for the Elderly (RCFEs), known as board and care homes, are licensed in California and many other states for non-medical care in the community. RCFEs are examined here to provide illustrative issues in the definition of types of long-term residential care. The research examines physical functioning, social supports, and course of residential placement for 109 RCFE residents (mean age 84 years). A significant portion of the residents had personal assistance needs not usually provided at the RCFE level (75% assistance with medication, 52% used walking aids, 29% assistance in bathing). Additionally, a third of the residents had restricted social supports and social activity. Residents report declines in functioning and support as reasons for moving to residential care. Length of residence in the facility (range less than a year to 15 years) was not related to physical functioning or social activity. These findings do not support “aging in place,” within the facility, as the rationale for increased need for assistance in residential care. Implications include the need to maintain the social model of residential care ample for the majority of residents while assuring the availability of a higher need for assistance of a significant portion of the residential care population.     

Employer‐Supported Child Care: Who Participates?

Child‐care vouchers are becoming more common and can provide child‐care assistance to a wide spectrum of the population. There is little empirical research, however, on which workers participate in their employer's child‐care programs. In this exploratory study, employees with children at 1 large university completed questionnaires to gather information on their child‐care arrangements and their experience with the employer's child‐care voucher program (N = 949). Results indicate that the employees who were most in need of child‐care assistance in terms of family structure, job type, and child‐care expenses were more likely to receive vouchers. Federal policy limiting the structure of employer‐sponsored voucher programs appeared to present barriers to participation for certain groups of employees.     

Stereotypes about caregiving and lessons from the Swedish panorama of care

This article analyzes the panorama of care provision in Sweden from the informal carers' perspective. We consider informal care, publicly financed services, for-profit agencies and voluntary organizations, using a survey conducted in 2009. Most cared-for persons with minor needs living in a separate household are helped also by others, but only a tenth use public services or other providers. About half of cared-for persons with major needs living in a separate household receive care also from other informal carers as well as public services. Only 1 in 10 of them relied on no one else beyond the carer interviewed. Among intra household carers—a minority of all persons cared for—it was common that the carer was alone in his/her commitment, without any contributions from public services or others. For the large majority of informal carers it is not a solitary undertaking as the commitment is often shared with family members and others and/or public services. The results suggest that ideal types about complementarity and substitution may understate the complex interplay between informal care and the public services (and potential other providers). The findings may suggest a need for more empirical research about ‘Care Cultures’ and expose simplistic representations of welfare societies; informal care plays a major—and increasing—role also in Sweden, a country with extensive public services.     

Intergenerational transfers in long term care

How are parental inter-vivos transfers to their children and children’s informal care of parents influenced by personal characteristics, family conditions and state specific long term care policies? AHEAD data from 1993 and 1995 and a two-party choice model are used to guide the estimation of OLS and binary logit models of the amount and likelihood of inter-vivos transfers to children and informal care of parents. Results suggest that both parents’ characteristics and their offspring’s characteristics affect parental gifts to children and children’s time assistance to their parents, highlighting the interdependent nature of these decisions. Furthermore, though state policies did not consistently affect parental gift giving, the availability of state respite care support -short-term “breaks” for informal family caregivers- (1 % significance level) and adult day care centers (5 % significance level) were positively related to the amount and likelihood of children’s time assistance to their parents. These findings highlight the importance of some state programs such as respite care support in encouraging intra-family support for the elderly. Support for programs that reduce the caregiving burden may encourage more children to care for their elderly parents.     

Report on the Workshop on Practical Protection in Humanitarian Crises

With a global crisis of approximately 15 million refugees and an estimated 20 to 25 million internally displaced persons (IDPs) in need of protection, the current protection regime is under increased scrutiny. "Practical Protection" is a fairly new concept. Those pursuing it aim to expand understanding and responsibilities for protection beyond those institutions with a specific protection mandate. "The Workshop on Practical Protection in Humanitarian Crises" was organized to bring the practical protection concept to representatives from a wide range of international agencies, governmental agencies and non-governmental organizations (NGOs), who discussed its implications for their work in humanitarian crises.
Organizations with specific protection mandates, primarily the United Nations High Commissioner for Refugees (UNHCR) and the International Committee for the Red Cross (ICRC), work to protect uprooted groups through legal tools and recognized principles, often in the context of assistance programmes that provide shelter, food, water, medical care, education and other forms of humanitarian assistance. They work in collaboration with NGOs and other international organizations that focus primarily on assisting forced migrants. These latter agencies have traditionally avoided overt involvement in protection activities. When UNHCR and ICRC are not present or are over-extended, gaps in the protection regime emerge. The gap is particularly evident with regard to internally displaced and other war-affected populations, but it is present in most refugee situations as well.     

Demography,Sociology and Schizophrenia

The problem of schizophrenia is one of considerable magnitude. Davies and Rorke (1964) quote the summary of findings that for every 100,000 persons in the community, 30 are admitted to hospital as emergency psychiatric patients each year; 300 occupy hospital beds for the mentally ill or defective; 3,000 are seen in psychiatric clinics or receive some sort of specialist psychiatric assistance. Many of the patients included in the above numbers are likely to be diagnosed as schizophrenics.     

Violence and the costs of caring for a family member with severe mental illness

Drawing on the stress paradigm and using data from the Duke Mental Health Study, this paper investigates the links between violence by and against persons with severe mental illness and their caregivers' financial burden (e.g., number of financial contributions and perceived financial strain). In addition to violence, substance use and medication noncompliance are included in a series of multivariate regression models predicting caregiver financial burden that include measures for disruptive behaviors, personal needs, social supports, and caregiver characteristics. The findings show that violent perpetration and violent victimization increase the number of financial contributions and perceived financial strain. Nonviolent victimization, in contrast, decreases caregiver financial burden. Number of financial contributions and perceived financial strain are greatest when the family member is violent and extremely disruptive or needs assistance with personal care. Neither substance use nor medication noncompliance contributed to caregiver financial burden. Co-residence, female sex, parenthood, and instrumental social support were also associated with financial burden.     

Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm 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 sociodemographic 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.     

When a loved one has AIDS: care for the significant other

1. The significant others of persons with AIDS, whether they assume the role of primary caregiver or not, have a number of unique experiences, concerns, and needs specifically related to their situations. 2. During the initial period following the diagnosis of a loved one, the significant others indicated their primary needs as sensitivity to their situations, assistance in securing appropriate information, and psychological support in dealing with uncertainty, and a general sense of dread. 3. Other common concerns and needs expressed by the significant others included support and reassurance, assistance in adjusting to a myriad of personal relationship changes, and help in meeting needs for active involvement in some form of AIDS-related work.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

Changes in Health,Mortality, and Disability and Their Impact on Long-Term Care Needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. knong those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes-such as the increasing educational level of thc elderly population-is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.