The Role of the Economic Sector in the Provision of Care to Trusting Clients

With implications for senior care as well as child care, this article compares for‐profit and nonprofit dependent‐care facilities in areas of service that are not readily visible to consumers. Findings gleaned from the child‐care industry indicate that nonprofit facilities provide a higher quality of service on professionally identified variables than do their for‐profit counterparts. For‐profit directors were more likely to implement cost efficiencies that were not immediately apparent to clients. Despite this, significantly more of the for‐profits were displeased with their financial situation than were their nonprofit counterparts. The study suggests that professional background and training of directors exercises an influence on management satisfaction and decisions, independent of sector.     

Driving to Work: The Front Seat Work of Paramedics to and from the Scene

The work paramedics do in the front of the ambulance on their way to and from the scene is central to the safety and well‐being of both paramedics and patients. However, most research on paramedics and emergency medical services assumes rather than empirically explores the actual happenings of what paramedics do in the front of their ambulance. In this article, I move beyond this taken‐for‐granted understanding of front‐seat work by taking readers in the front of the ambulance and exploring the hidden work paramedics do on their way to and from the scene. I draw on data from an institutional ethnography into the socially organized work and work settings of paramedics, which included over 200 hours of observations and over 100 interviews with paramedics. This article adds to research on the sociology of work and health and illness by focusing explicitly on how paramedics give meaning to their work setting, the social conditions and relations central to their work practices, and how their work knowledge is actually put into practice. In doing so, I shed light on an ever‐important occupational group in health care that has garnered little sociological attention to date.     

Participation in decision-making in out-of-home care in Australia: What do young people say?

Drawing on qualitative research with 28 young people in Australia, this article explores children and young people's views and experiences of participation in decision-making while in out-of-home care. It initially examines the value of participation, before focusing on two key questions. First, do young people feel they had the opportunity to participate in decisions made about their lives during their time in out-of-home care? Second, on which issues do children and young people in care want to have a say?     

'I know I signed something': older people,families and social workers' understanding of the legal aspects of entry to residential care

This purpose of this paper is to report findings that older people are legally vulnerable when entering an aged care facility, that social workers lack knowledge of the legal aspects of this move and do not necessarily view this information as core to their practice. The structure of social work services mirror the disjuncture older people and their families experience at this time and this may, in part, explain social work's lack of attention to these issues. Although many social workers are in contact with older people, the profession in Australia has been slow to develop a knowledge base to support effective practice with this group.     

Care for place: The contributions older people make to their communities

Older people are often positioned as passive recipients of care and dependent on resources or as overly productive and active. In this paper, we seek a more nuanced, middle ground between such stereotypes, by exploring the question: what contributions do older people make to the places they live in? Drawing on qualitative research from Aotearoa New Zealand, involving focus groups and interviews, we examine the varied and active ways many older people are involved in and contribute to their neighbourhoods and communities, or what we term ‘care for place’. In particular, we identify the different forms of older people's care for place, including volunteering, activism, advocacy, and nurturing, and consider how these efforts positively impact on older people and the communities in which they live. Whilst we caution against assumptions that all older people should be productively involved, we argue that greater understanding of older people's care for place is central to challenging stereotypes of older people as either passive and dependent, or highly active.     

TigerPlace, A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

Clothing Workshops: Shaping Services to Individual Needs

The government's community care proposals give importance to the role of voluntary and not-for-profit organisations in meeting the needs of elderly and disabled people, and underline the need for local authorities to foster their development. To do this, they must ensure their financial security. This paper reports the decline of the specialist clothing workshops which, because of changes in government funding, have dwindled from more than 20 in 1988 to five at present. The importance of this service to disabled people is discussed. Although many value skilled advice and sympathetic personal attention, for a few there is no other alternative than specially made or adapted clothing. It enhances self-esteem, independence and participation, as well as practical benefits. However it is an expensive service, so that subsidy is essential. Recommendations for the future of the service are outlined.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

The need for policy direction in the provision of care to the mentally ill: an interdisciplinary view

This paper argues that mental health care is underprovided, and that the role of nonprofit providers should be expanded for three major reasons. First, a positive externality exists since society, as a whole, benefits when those in need of mental health care consume care. External benefits include lower crime rates, lower unemployment, and less homelessness. Second, consumers of mental health care are mentally ill and often do not believe that they need care, underestimate their need, or believe that care is not worth the time or expense. Third, common law, to a large extent, is based on individual liberty, largely ignoring the benefits individuals receive from treatment. It is argued that government policy is needed to increase the supply of mental health care, through nonprofit agencies.     

South African social workers' knowledge of attachment theory and their perceptions of attachment relationships in foster care supervision

Despite the prominence of attachment theory in international foster care literature and the importance of attachment relationships in successful foster care, attachment theory and practices do not feature prominently in South African foster care research. Against this backdrop, we interviewed twenty South African social workers' about their knowledge of attachment theory and their perceptions of attachment relationships in their own foster care work. Thematic analysis was used to analyse the interviews. We found that the social workers had limited knowledge of attachment theory and interventions; experienced most biological parents as unmotivated to improve their circumstances and attachment relationships with children; indicated that family reunifications were rare occurrences; reported foster parents were mostly kin; and experienced constraining contextual factors that hindered optimal consideration of attachment relationships in foster care supervision.     

Why youth leave care: Understandings of adulthood and transition successes and challenges among youth aging out of child welfare

Child welfare policies and practices are changing to allow more youth to remain in care beyond age 18. Yet, the majority of youth do not stay. Given recent evidence suggesting that remaining in care may be beneficial, there is a need to understand why youth leave. Using data gathered from in-depth interviews with young people aging out of care, this paper explores this question, relating it to youths' understandings of adulthood and the successes and challenges they face during their transitions. We find that youth leave care because of misunderstanding and misinformation about the requirements for remaining in care, as well as because of a desire for autonomy and independence. Specifically, many youth equated adulthood with independence, and thus felt that they needed to leave care to achieve adulthood. Unfortunately, these efforts to be independent often hinder youths' development of supportive relationships, which they reported to be one of the greatest challenges in their transitions. Based on these findings, we conclude by challenging the conflation of adulthood and independence, as well as of childhood and dependence, calling for connected autonomy as a goal for child welfare involved young people of all ages.     

A Heavenly Collaboration: Social Workers and Churches Working to Increase Advance Directive Completion among African American Elderly

The Patient Self-Determination Act (PSDA) was enacted in 1990 as a guarantee to patients that their wishes surrounding end-of-life care would be honored if they expressed verbally or through advance directives the desired level of care they wished to receive at the end of life. Research shows that African Americans have the lowest percentage of advance directives completed among the major racial groups in the United States despite the PSDA's purpose. African American elderly rely on community supports such as social workers and the church to meet physical and spiritual needs. However, these two entities have yet to collaborate to eradicate the dismal percentages of completed advance directives among African American elderly. This article explores how the religious community and social workers can work toward educating this population on the importance of advance directives and empowering them to take the necessary steps at completion if they choose to do so.     

Caregiver perceptions of children in their care and motivations for the care work in children's homes in Ghana: Children of God or children of white men?

The perceptions and motivations that workers have in their work and work environment are important determinants of the quality of work they do. For people who work in residential institutions where children who have lost the care of their parents receive care, these perceptions and motivations become a crucial part in determining the quality of services or care the children are given. This study set out to explore the perceptions and motivations of caregivers in the institutional context in Ghana. Adopting a qualitative, phenomenological approach, data were collected from 35 caregivers in two children's homes in Ghana through participant observations, focus group discussions and in-depth interviews. It emerged that caregivers perceived the children in their care first as children of God and then as children of white men and were predominantly motivated by their religious convictions to keep doing ‘the work of God’. Other motivations included personal life situations and economic aspects of the job. Implications for the workers and children in this environment are discussed.     

Cultures of care? Animals and science in Britain

It is becoming increasingly common to hear life scientists say that high quality life science research relies upon high quality laboratory animal care. However, the idea that animal care is a crucial part of scientific knowledge production is at odds with previous social science and historical scholarship regarding laboratory animals. How are we to understand this discrepancy? To begin to address this question, this paper seeks to disentangle the values of scientists in identifying animal care as important to the production of high quality scientific research. To do this, we conducted a survey of scientists working in the United Kingdom who use animals in their research. The survey found that being British is associated with thinking that animal care is a crucial part of conducting high quality science. To understand this finding, we draw upon the concept of ‘civic epistemologies’ (Jasanoff 2005; Prainsack 2006) and argue that ‘animals’ and ‘care’ in Britain may converge in taken‐for‐granted assumptions about what constitutes good scientific knowledge. These ideas travel through things like state regulations or the editorial policies of science journals, but do not necessarily carry the embodied civic epistemology of ‘animals’ and ‘science’ from which such modes of regulating laboratory animal welfare comes.     

‘I couldn’t just entirely be her sister’: the relational and social policy implications of care between young adult siblings with and without disabilities

Research has commonly explored siblings of people with disabilities’ roles in care for their brothers or sisters with disabilities. Social policy has also commonly framed young adult siblings of people with disabilities as ‘young carers’. However, there has been less consideration of the implications of care for the relationship shared between young adult siblings with and without disabilities and of what this may mean for social policy. What do different types of care mean for sibling relationships? What are the relational and social policy implications of care between siblings? Drawing on a qualitative study of 25 siblings with disabilities and 21 siblings without disabilities aged 15–29, this article explores how young adult siblings perceive, talk and act with regard to the different types of care enacted between them. The article identifies how, during young adulthood, some types of care can endanger siblings’ capacity to feel like siblings and discusses ways that young adult siblings talk and act in order to – as best they can – keep their role within the bounds of a normative sibling relationship. The findings are discussed in light of implications for social policy, particularly with regard to seeing siblings of people with disabilities as ‘young carers’.     

Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.     

Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.     

Factors Affecting Older Women's Adherence to Medication and Treatment

Over the past 25 years, there has been a growing interest in why many patients do not take prescribed medications or fail to follow medical advice. As many as 50% of all patients fail to adhere adequately to therapeutic advice or engage in inappropriate use of prescribed medications. Additionally, there has been a struggle over how best to describe this variance between what medical practitioners recommend and what patients actually do. This article examines factors thought to affect women's adherence to medication and treatment regimens. Literature on age, comorbid conditions, socioeconomic factors, environmental factors, and perceived susceptibility for an illness is reviewed as are individual psychological idiosyncratic dynamics that may influence health care behaviors.     

"Macho men" and preventive health care: implications for older men in different social classes

The gender paradox in mortality--where men die earlier than women despite having more socioeconomic resources--may be partly explained by men's lower levels of preventive health care. Stereotypical notions of masculinity reduce preventive health care; however, the relationship between masculinity, socioeconomic status (SES), and preventive health care is unknown. Using the Wisconsin Longitudinal Study, the authors conduct a population-based assessment of masculinity beliefs and preventive health care, including whether these relationships vary by SES. The results show that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care. Furthermore, in contrast to the well-established SES gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases. Masculinity may be a partial explanation for the paradox of men's lower life expectancy, despite their higher SES.     

The potential of domiciliary care service in the Czech Republic to promote ageing in place

Due to population ageing, the need for long-term care is increasing. In many European countries, there is now a firm policy preference for care in the home as opposed to institutional care and policies at the local level support this preference. The purpose of this study is to report on the position of domiciliary care service within the Czech social services for the elderly and to explore its potential to promote ‘ageing in place’. The aim of the research was to perceive this issue from the viewpoint of the different parties: service users, service workers, service managers as well as policy-makers. Therefore, the qualitative methodology (case study method) was used. The results revealed that users considered domiciliary care as the only service in the Czech Republic that allowed them to remain at home despite their worsening capacity to manage the activities of daily living. On the part of the domiciliary care service, however, we found that this was strong in the provision of practical help, as well as assistance with users' self-maintenance, whereas their supervision and care management were not explicitly included either in the concept or the practice of this type of service.