The roles of adult daughters in long-term care facilities: Alternative role manifestations

Our understanding of the roles of family members within long-term care settings remains limited. Existing research conceptualizes the term “role” as a unidimensional concept and views the caregiving role as static. Employing a multidimensional conceptualization of roles, and guided by symbolic interactionism and the conceptual framework of the caregiving career, the purpose of this study was to gain a deeper and more comprehensive understanding of the roles of adult daughters in long-term care facilities from their perspectives. Specific techniques of the grounded theory approach combined with active interviews and personal logs were used as the research design procedures. Five caregiving role manifestations emerged in the women's stories: active monitors, regular visitors, accepting relinquishers, unaccepting relinquishers, and indirect supporters. Several factors explained differences in the role manifestations such as the focus of the support, perceptions of the psychological presence of the parent, and the sense of obligation and pressure to care.     

The family's role in person-centered care: practice considerations

Effective implementation of person-centered care requires a shared understanding and commitment to make it a reality by administrative personnel, direct care providers, and residents and their family members. Long-term care facilities must seek ways to engage residents' families in person-centered care through its training, policies, care planning, and documentation. Doing so may require revisions to policies and work practices, and ongoing leadership efforts to maintain this care framework within the realities of staff turnover and regulatory requirements. Developing protocols and procedures that facilitate family members' communication with staff and build consensus and shared values will result in a system that represents and honors the unique perspectives, values, and needs of each resident receiving care. It is important for facility leadership to set the tone for acknowledging the importance of family involvement in person-centered care by modeling acceptance of concerns and criticisms as valid and by acknowledging that direct care providers, residents, and their family members have a voice in care decisions. Such an approach has the greatest chance of success in promoting person-centered care and the shared values necessary to ensure its successful implementation.     

Caregiver perceptions of empowerment and self-efficacy following youths’ discharge from residential care

ABSTRACT

Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status.     

Elder abuse and neglect

Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults' family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families.     

A review of satisfaction instruments used in long-term care settings

We review studies in the published literature using satisfaction surveys in long-term care settings. These settings include nursing homes, assisted living facilities, hospital long-term care units, and residential care homes. Rather than simply describe instruments in existence, we compare and contrast the format, content, and administration of these instruments. We identified 50 studies that have either developed or used satisfaction instruments in long-term care facilities. However, we also show that satisfaction instruments in the published literature vary greatly in numerous ways, including the number of questions they contain, the number of respondents included in the study, assessment of psychometric properties, and in the number of domains used.     

Family Members' Reports of Non-Staff Abuse in Michigan Nursing Homes

Recent research showed that mistreatment of nursing home residents by other residents may be highly prevalent. The present study examined the issue from family members' perspectives. The data came from the 2005 and 2007 random-digit dial telephone surveys of Michigan households with a family member in long-term care. Based on family members' reports, about 10% of nursing home residents aged 60 and over were abused by non-staff in nursing homes (e.g., other residents and visitors) during the past 12 months. Family members were more likely to report non-staff abuse when the nursing home residents were younger, were female, had behavior problems, and had greater level of physical functioning. Family members who reported staff abuse were four times more likely to also report non-staff abuse.     

Choosing Privacy over Interaction: Restructuring Expectations and Interpretations of Community Integration in Canadian Small-House Long-Term Care Settings

In Nova Scotia, Canada, the small-house model of care has been introduced as an alternative to institutional care settings, and the province has funded and built 11 new long-term care (LTC) communities in the small-house model. Each of the new facilities was built with multiple cottages housing 12 to 15 residents; each cottage features private bedrooms and a residentially scaled kitchen and dining area. Through smaller numbers of residents living in home areas, the goal of the Provincial Department of Health was to encourage relationship building, as well as to provide opportunities for autonomy and choice in resident daily living. A qualitative case study was conducted in one of these small-house communities, focusing on the model's impact on resident interaction and community integration. Thematic analysis revealed that while resident social patterns were directly impacted by the physical environment and culture of care in the new model, interpretations of these patterns by staff and family members were influenced by preexisting expectations of community integration rooted in institutional care models of the past.     

Social Cognitive Approach to Career Development: An Overview

This article provides an overview of a social cognitive framework for understanding career interest, choice, and performance processes. Derived primarily from Bandura's (1986) general social cognitive theory, the framework features several variables (self-efficacy, outcome expectations, personal goals) through which people help to guide their own career development. It also includes a discussion of how these variables interrelate with other aspects of persons (e.g., gender) and their environments (e.g., supports, barriers) within the process of career development. The framework is intended as a base both for unifying existing career theories and for conceptualizing developmental and remedial career interventions.     

Long-term care policy and financing as a public or private matter in the United States

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.     

The Lived Experience of Family Members of Persons Who Compulsively Hoard: A Qualitative Study

The current study took an Interpretive Phenomenological Analysis approach to investigate the lived experiences of 12 family members of persons who hoard to better understand family members’ cognitions, emotions, perceptions, experiences, and responses in their interactions with their loved ones who hoard. Five overarching themes for the participants’ experiences of having a person who hoards in the family emerged: negative feelings toward the persons who hoard; lack of understanding of hoarding behavior; experiences of loss; internal barriers to seeking support; and internal conflicts. Clinical implications and recommendations for future research are discussed, including a proposed application of an ambiguous loss framework for understanding and working with the experiences of family members of persons who hoard.     

Family Matters: Research on Family Ties and Health, 2010 to 2020

Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status) and family dynamics and quality (e.g., emotional support from family members) on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another's health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a “family biography” framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.     

Families With Children and Adolescents: A Review,Critique, and Future Agenda

This decade's literature on families with children and adolescents can be broadly organized around the implications for youth of family statuses (e.g., family structure) and family processes (e.g., parenting). These overlapping bodies of research built on past work by emphasizing the dynamic nature of family life and the intersection of families with other ecological settings, exploring race/ethnic diversity, identifying mechanisms connecting family and child/adolescent factors, and taking steps to address the threats to causal inference that have long been a problem for family studies. Continuing these trends in the future will be valuable, as will increasing the number of international comparisons, exploring “new” kinds of family diversity, and capturing the convergence of multiple statuses and processes over time.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Elder abuse in nursing homes: an ecological perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.     

Harvesting Human Capital: Family Structure and Education Among Rural Youth1

Abstract Coleman's (1988) theory of family social capital provides a conceptual framework for assessing the relationship between several dimensions of family structure and school dropout rates among nonmetro-politan youth. This paper evaluates the extent to which higher rural than urban dropout rates are attributable to spatial differences in family structure (e.g., living arrangements, family size, and early childbearing) or economic resources (e.g., poverty) and estimates the differential effects of family structure and poverty on school dropout rates in nonmetropolitan areas, suburbs, and central cities. Data are drawn from the March 1990 Current Population Survey. Results indicate that residential differences in family structure account for a relatively small part of the higher dropout rates found in rural areas. Rural youth's experience with poverty appears to matter more. The educational effects of family structure are nevertheless strong in rural areas, albeit somewhat smaller than in suburban areas, owing perhaps to compensating forms of social capital found in rural areas. The results suggest that studies of dropout behavior—in rural or urban areas—must acknowledge the potentially large role of family structure and economic resources on the educational achievement process.     

Financing Long-Term Care: Examining Decision Outcomes and Systemic Influences from the Perspective of Family Members

This study examined financing long-term care from a micro-level family perspective. Qualitative analysis of interviews conducted with 45 families coping with paying for an elder's long-term care provided insight into what decisions were made as well as what factors influenced those decisions. Family members articulate systemic factors within and outside of the family system influencing three decision making outcomes: (a) using and preserving private resources, (b) Medicaid estate planning and (c) deciding not to decide. Case examples and a discussion of the emerging framework provide insight for researchers working to inform long-term care issues and for educational focused practitioners.     

Working with neglected children and their families

Child neglect has proved a particularly difficult area for social work to address. In the first part of the paper a number of reasons for this are discussed. We go on to suggest that chronic child neglect characteristically involves the breakdown or absence of a relationship of care. Therefore, the social work response needs to include a focus on the relationship difficulties between parent and child which manifest as either an unwillingness or inability on the part of the primary carer to offer reliable, adequate care, and on broader relationship difficulties within the family. In arguing for an approach that pays attention to the intra-personal and relational dynamics of neglect, we draw specifically on attachment theory and consider how Ainsworth's (1978) typology of attachment patterns can shed light on parenting styles and patterns of family functioning associated with chronic neglect. We use the concept of the 'internal working model' to develop an understanding of the ways in which family members understand and live out their relationships—with each other and with the worker. We conclude by suggesting that this relational approach requires an ability on the part of the social worker to work both with and within relationships, and look at the contribution that a critically informed relationship-based approach can make to work with families where child neglect occurs.