Availability of Caregiver Support Services

Abstract

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAA Area Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.     

Availability of caregiver support services: implications for implementation of the National Family Caregiver Support Program

This study examines the scope and range of existing resources for family caregivers from the perspective of the Area Agencies on Aging (AAAs), which are charged with implementing Title III-E of the reauthorized Older Americans Act. California is used as a case example because of its substantial experience in providing caregiver support services. In particular, we examine the extent and adequacy of resources available in California corresponding to each of the five Title III-E service areas, utilizing data from AAAArea Plans, a follow-up survey of AAAs, and an Internet search. AAAs identified more than 276 providers of caregiver support services, and our Internet search identified another 195. Nearly two-thirds of these programs offer access to respite care, while other support services (e.g., counseling, training, support groups) are less often available. Service gaps most frequently identified included culturally and linguistically appropriate caregiver services, transportation, respite care, financial assistance, and services in rural areas. These findings suggest the need for enhanced efforts to improve the service network for supporting family caregivers, as states implement the National Family Caregiver Support Program.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

Elderly migration and its implications for service provision in rural communities: an Ontario perspective

Following a discussion of the role of migration in the aging of rural populations and of consequent implications for service provision in rural communities, a case study featuring demographic and service use data for Grey County, Ontario, is presented. Cohort Survival Analysis of census data for the period 1971–1986 indicates a consistent net in-migration of elderly into the county and a complex but predictable pattern of elderly relocation from townships to villages and towns within Grey. The demographic analysis is complemented and extended by the examination of survey data on the residential history and service use of a sample of elderly residents drawn from two communities in Grey County. The survey results provide valuable clues for the interpretation of the demographic analysis and reveal residential history to be a potentially important pre-condition of dependence on formal services intended for the maintenance of elderly persons in the community. The paper concludes with a discussion of the need for local analysis of migration impacts and of the relationship between such impacts and longstanding problems of rural service provision.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

The peri-urban fringe: Europe's forgotten rural areas

The EC White Paper — The Future of Rural Society — identifies three “standard problems” of rural areas, but the first, which characterises areas associated with “the pressures of modern development”, receives little attention in the remainder of the document. This paper explains why it is particularly important that the peri-urban areas are not ignored in the development of rural policy. In the first place, the problems of these areas are inextricably linked to those of areas of rural decline and if such links are ignored the resulting partial analysis of rural problems may cause some important policy-options to be overlooked. Second, there continue to be pockets of disadvantage within the peri-urban areas where deprivation is likely to be increased by close proximity to an affluent majority. Finally, the paper analyses the Rural Community Strategy for Berkshire, a nonstatutory document prepared by a group drawn from governmental, quasi-governmental and non-governmental organisations in one peri-urban area of southern England. This shows that while the broad agenda of rural policy issues (covering employment, housing and services), may be very similar to that found in areas of rural decline the rationale for intervention is somewhat different, and transport issues may lie at the heart of the “standard problem” of these areas.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

Implementing public policies and services in rural Japan: issues and problems

While the sharply increased services for the elderly in the revised Gold Plan--announced in 1994--are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Changes in service provision in rural areas. Part 1: The use of GIS in analysing accessibility to services in rural deprivation research

Previous work has highlighted the importance of public service provision in rural areas particularly for potentially vulnerable groups such as the elderly, unemployed and single parents especially where this coincides with a lack of access to either private or public transport. Disadvantage can often be compounded by limited access to services for such groups with the superior resources of more affluent social groups enabling them to respond and adapt to the increasing centralisation and reduction of services. This paper reviews previous investigations of the implications of changing accessibility to services in rural areas and draws attention to the need for a new research agenda which uses spatial analytical techniques to gauge the current levels of (in)accessibility to key services at the community level. These techniques are illustrated in Part 2 of the paper with reference to changes in post office provision in mid Wales, and the policy significance of incorporating geographical information systems-based measures of provision into traditional area-based indicators of disadvantage is discussed.     

Implementing Public Policies and Services in Rural Japan

While the sharply increased services for the elderly in the revised Gold Plan-announced in 1994-are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Health,personal mobility and the use of health services in rural Norfolk

Trends towards the centralisation of both primary care and hospital services are increasing the distances that rural residents must travel to receive health care. Contradicting the widely held image of the healthiness of rural people, data from social surveys in Norfolk show that some of the remoter rural areas have populations with a relatively high need for health care. Furthermore, the groups with most need for health care (the old, the disabled, the poor, etc.) are also those with low levels of personal mobility, for whom travelling long distances to centralised health services is particularly difficult. After adjustments have been made for variations in need, it is shown that people in the remoter areas receive much less health care than comparable people in more accessible areas. However, branch surgeries do seem to make the general practitioner service more accessible, particularly to less mobile rural residents.     

Entrepreneurs in the rural environment

Change in rural activities is frequently seen as: (1) reaction to changes in other areas and sectors, and (2) negative. This downplays the role and importance of entrepreneurs, both farm and non-farm, in sustaining the vitality of rural areas. The notion of entrepreneur can be extended to entrepreneurial activity by other people, e.g. local government activity, which is an integral part of rural community economic development. Both the entrepreneur and the quasi-entrepreneur in local government are critical leaders in urban fringes and other rural areas alike. Their activity in an area is partly dependent upon the broader political, social and economic environment which influences: (1) the need to change and (2) whether any “benefit” can be derived from entrepreneurial activity. A framework is presented in this paper to place entrepreneurs and entrepreneurial activity into the context first, of decision-taking generally in the rural environment, and second, of the broader “enabling” environment. It is argued that constraints originating in this broader environment are often necessary, but they may have unforeseen side-effects in discouraging innovation. Changes in such constraints or in the manner in which they are implemented may be a necessary ingredient to maintain rural vitality through encouraging entrepreneurial activity.     

Accessibility in Rural Social Service Agencies

ABSTRACT

This study explores the degree that social service agencies are aware of the ADA, the degree that agencies perceive they comply with the ADA, and the barriers these agencies face in making their services accessible. The directors of 28 randomly selected rural social service agencies in a midwestern state completed semi-structured telephone interviews. Interviews explored respondents& knowledge of the ADA, barriers rural agencies face in providing accessible services, types of accommodations they have made and degree of fit between the ADA and rural agencies. The findings suggest that while the ADA is not a significant burden for rural agencies, there is a need for enhanced training and outreach.     

A suggestion for future research on interface design of an Internet-based telemedicine system for the elderly

Telemedicine has emerged as an effective tool for providing high quality healthcare service and health-related information, especially in rural areas. Rural areas often have a larger elderly population with greater rates of preventable disease. These areas also have fewer medical resources and specialists, and have limited access to health services, all of which can influence overall health. An Internet-based telemedicine system can be one solution to provide the rural elderly with the proper health information when needed. The elderly obviously have limited capabilities compared with younger adults in the use of internet technology. However, the interfaces of the currently existing Internet-based telemedicine systems are not specifically developed for elderly users. This paper suggests future interface design research for an Internet-based telemedicine system specifically for the elderly.     

Les députés, leurs assistants et les usages du crédit collaborateurs. Une sociologie du travail politique

This analysis of how the staffs of members of the French parliament are organized focuses on the tasks that deputies assign to their parliamentary assistants. The distribution of tasks among assistants suggests that the organization and division of labor should be understood mainly in relation to the pressures generated by elections in the home district. Most staff-members are assigned to this work, since a seat in the National Assembly very much depends on providing services to constituents. The staff is so involved in solving constituents’ “personal” problems of various sorts that its members are forced to devise strategies for regulating demand and providing often token responses. Developing relations with constituents even affects the staff's legislative tasks. For deputies, it is a way to reduce the “occupational” risks inherent in elective office. Deputies adapt to a voting system that pushes them to adopt a conception of representation closer to being a spokesperson for a district's inhabitants than being a representative of the Nation.     

Changes in service provision in rural areas. Part 2: Changes in post office provision in mid Wales: A GIS-based evaluation

This paper develops themes set out in Part 1 of this paper relating to the importance of public service provision in rural areas, particularly for potentially vulnerable members of the community such as the elderly, unemployed and single parents. Changes in a key service sector, post office services, in rural mid Wales over a 15-year period are assessed and analysed in relation to the developing sociodemographic profile of the underlying population. A Geographic Information System (GIS) approach is adopted to chart changing levels of post office provision in the study area, and the subsequent impacts on accessibility to those post offices. The policy significance of developing measures of accessibility to services with a view to incorporating these GIS-generated measures into traditional area-based indicators of disadvantage is highlighted.     

The risk climate and the delivery of child welfare services

The community is conceptualized as a “risk climate” in which the traditional child welfare services such as own-home services, foster placement, adoption and institutionalization are delivered. The community generates incidence of child welfare cases through the pressure of conditions, and affects prevalence by the extent of its response. Any method of allocating scarce resources should take variations in the risk climate into account in order to put resources where the problem is. This report presents an effort to achieve such a procedure through (1) a literature review to isolate variables related to child welfare service delivery; (2) a report of zero order relationships between these variables and outcome measures; and (3) the use of a multiple regression analysis to develop predictive procedures. The process developed is put forward as an equitable way of distributing scarce resources.     

The economic importance of air travel in high-amenity rural areas

The western United States offers a case study on the importance of access to large population centers and their markets, via road and air travel, for economic development. The vast distances between towns and cities in the American West can be a detriment to business, yet they also serve to attract technology and knowledge-based workers seeking to live in a picturesque setting. In spite of the increasing importance of amenities to migration and business location, also needed is access to markets, particularly via commercial air service. We test a new county classification system for the western United States to reflect differing degrees of access to population centers and account for the increasing importance of airports. Past classifications are based on population size and cross-county commuting. We examine the validity of this new classification and test for differences in economic performance among the three county types. Our findings show that there are three distinct Wests that can be classified using economic performance measures and socioeconomic characteristics. The results show that “metro” and “isolated” counties are clearly distinct, but “connected” counties, those that are rural in nature but have ready access to metropolitan areas via air travel, can be difficult to distinguish from “metro” and “isolated” counties. Much of the variation is explained by travel distance to airports. The findings illustrate the importance of airports in rural development, and the limitations facing those communities that are isolated from markets and population centers. The results apply to other parts of the world with similar characteristics that include large expanses of open space, natural amenities that attract migrants and stimulate new business, and different degrees of access to large population centers via road or air travel, and therefore different rates of economic growth.     

Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.