Consumer Direction in Community-Based Long-Term Care

Abstract

Recently, a growing number of community-based long term care programs have been incorporating a concept of consumer direction (CD). Consumer Direction allows long-term care consumers to take more active roles in their care management, by hiring, training, supervising, and firing care providers. A limited number of existing studies show that CD consumers indeed feel they have more choice and control over their care compared to those under the traditional model. However, other studies show problematic working conditions for care providers under CD. Questions also remain unanswered regarding how CD effects different important stakeholders, including family caregivers, formal paid caregivers, and governments. More research, administrative, and practice efforts are needed to ensure CD can benefit all sectors of communities.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis

ABSTRACT

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although public-private partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources.

Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on state-provided care, use of expensive private care, and waiting lists to secure services.     

Restructuring Long-Term Care in Spain: The Impact of The Economic Crisis on Social Policies and Social Work Practice

ABSTRACT

Care needs of the aging population are increasing in Southern European countries. The purpose of this article is to explore the implications of meeting these needs while taking into account the recent economic crisis, which has deeply affected countries such as Spain. This study is part of a European project (ISCH COST Action IS1102) and is based mainly on qualitative information that focuses on in-depth interviews with social service workers (n = 19) who provide the service and program recipients or their caregivers (n = 14). In addition, two discussion groups were conducted with professionals (n = 9) and program volunteers (n = 5), as well as a workshop/discussion group (n = 28) with politicians, service providers, and participants. Six thematic premises were identified with differing views being highlighted relevant to the participants' roles in the program. Future research should explore social service strategies to deal with the increase in care needs as well as community-based responses.     

The unknown soldiers of foster care: Foster care as loss for the foster parents’ own children

Abstract

This paper explores the effects of the foster care experience on foster parents’ biological children. In spite of having been accepted for over 40 years as the best form of residential care for most children and adolescents requiring alternative living arrangements, very little research has been done into the foster care experience. Almost nothing is known about the effects of foster care on either the foster family as a unit or its individual members, yet one of the major concerns foster parents present is the effect of the foster care experience on their own children. This concern leads many experienced foster families to leave foster care and many potential foster families to decide not to foster. This paper discusses the losses experienced by the children of foster parents.     

“The Persistence of Parent Repayment” and the Anticipation of Filial Obligations of Care in Two Thai Provinces

With an accelerated and sustained decline in fertility and an increase in life expectancy, Thailand has entered its aging phase at a rapid pace. This raises an important question of who should care for the increasing elderly population. Using a survey of adults aged 16–64 years (n = 742) in two provinces in the north‐east (Kalasin) and south (Phang Nga) of Thailand, this paper explores the expectations that individuals have from their children when they become very old. Only one‐third of the respondents expected to live with their children in old age and only one‐fifth anticipated financial assistance. Less than half of them expected personal care and practical care from their children (43% and 38%, respectively). The expectations varied substantially by the number of children and income, with those with higher income reporting lower expectation. Those living in Kalasin, a much poorer province than Phang Nga, had greater expectations from their children in old age. This suggests that, for those with less financial resources, children remain the main care provider for the elderly.     

Grandparent Carers II

Summary

A demonstration project was undertaken in two of New York City's five boroughs using an intervention model to assess how a three-prong approach using outreach, provision of support groups, and case management could be used to aid grandparents acting as primary carers for children with developmental delay or disabilities. Three small community-based agencies participated in the demonstration. Several common themes were identified that warrant attention when working with older adults who assume later-age parenting roles: (1) recruitment, (2) pressing grandparent problems, (3) unresponsive service systems, (4) falling between the cracks, (5) mutual support, and (6) need for long-term planning.     

Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

Understanding Ambiguous Loss in the Context of Dementia Care

Abstract

This study examined the experience of ambiguous loss for family members caring for a person with dementia living in a long-term care facility. Data for this study came from in-depth, active interviews conducted with 38 adult daughters and 23 adult sons caring for a parent with dementia living in a long-term care facility. The stories shared by the adult children revealed that ambiguous loss in the dementia context involves a long, on-going process of several phases including anticipatory loss, progressive loss and acknowledged loss. The nature of the ambiguity shifts and the experience changes for families as they journey through the ambiguous loss process. Acceptance and avoidance were the two most common coping strategies used in dealing with acknowledged loss.     

Pediatric Palliative and End-of-Life Care

Abstract

Pediatric oncology social workers are often engaged in the psychosocial care of dying children and their families. Despite their participation on the interdisciplinary team, the role for social work in pe-diatric palliative and end-of-life care has not been clearly defined. This survey of 131 pediatric oncology social workers identified current and best social work practices for care of children and their families at the end of life. Implications for practice, education, and research are discussed.     

The “Socialization of Elderly Hospitalization” in China: Development,Problems, and Solutions

ABSTRACT

Objectives to analyze the development of the elderly patients with chronic diseases and to make some suggestions for the elderly social hospitalization. Methods By using yearbook data and theoretical analyses, the paper respectively presents the problems and furthermore solutions of China's elderly services. Results The elderly patients with chronic illnesses have formed a new group, and the phenomenon of “socialization of elderly hospitalization” has become a major social risk. Discussions China needs to promote the idea of “long-term care” in elderly social security, establishing long-term care insurance and fostering a private, professional elderly service system.     

Psychological Distress Experienced by Parents of Young Children With Congenital Heart Defects: A Comprehensive Review of Literature

ABSTRACT

The purpose of this study was to examine the existing research on the psychological distress experienced by parents whose young children (between the ages of 0 and 5 years old) have a congenital heart defect (CHD). A more detailed understanding of the distress experienced by these parents, including stress associated with the child's age, the severity of the child's diagnosis, and parent characteristics, is vital as it would allow for more targeted and individualized support for this population to enhance parental coping strategies and increase the likelihood of more positive parent–child interactions. This review of 25 studies contributes to the parenting stress literature by focusing on parents of young children and categorizing studies by publication characteristics, research methodology, and findings. The research clearly demonstrates that parents report a great deal of stress throughout the continuum of their child's health care experience. Recommendations for future research and practice implications, such as developing a stress vulnerability model specific to parenting children with CHD, clarifying the role between interdisciplinary team members regarding provision of psychosocial support to parents, and referring parents to specific community-based ongoing social support services, are presented.     

The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations

Winterton R, Warburton J, Oppenheimer M. The future for Meals on Wheels? Reviewing innovative approaches to meal provision for ageing populations The global phenomenon of population ageing is impacting on how community care is delivered, and a key component of health and social care services for the frail elderly is Meals on Wheels (MOW), a service that has traditionally encompassed delivering meals to older people in their homes. However, aspects of this conceptualisation of MOW are being redefined in order to address challenges posed by tightening global financial contexts, a reliance on volunteers and increasing social isolation among ageing populations. Through a review of the literature and websites from selected countries (UK, USA, Canada, Australia), this article explores and critically evaluates models of MOW delivery addressing these challenges. Findings suggest that MOW services are utilising a marketised approach, moving outside of the home and incorporating diverse volunteer roles. These findings demonstrate how services such as MOW can develop sustainable approaches to service delivery in a contemporary context. Key Practitioner Message: ?A review of innovative MOW highlights service models of broader applicability;?Varied delivery models and more diverse volunteer roles appeal to new sources of volunteers;?Research into the development of sustainable models with positive client social outcomes is now required.     

Learning from Japanese Experience in Aged Care Policy

Like Singapore, Japan is projected to age rapidly. Japan is the first country in the world where more than 20% of the total population is over 65. Even as Japan adapts from western Europe and America where population ageing is more advanced up till now, it has been pioneering its own aged care policy, given the differences in sociocultural and political contexts. Of particular interest is its introduction of long-term care insurance and its effectiveness in meeting the needs of the long-term care of the aged and their family caregivers. In this article I seek to compare and contrast Singapore and Japan in terms of their demographic changes leading to rapid ageing, and their respective policy and program responses to a rapidly ageing population, drawing lessons from the Japanese experience.     

Relative foster care: An emerging trend in foster care placement policy and practice

Abstract

Increases in the foster child population, at a time when terminations in foster care placement have decreased along with a decline in the number of non‐related foster parents, has resulted in an increasing use of relative foster care placement. Relative care as an emerging trend in foster care placement, is not without controversy. Its merits, however, should be assessed in terms of its benefits to the children in care, the fiscal and organizational costs, and the problems it creates for the child welfare system. This paper reviews what is known about the characteristics of relative caregivers and the children in their care. Federal and state policies that affect the use of relatives as an alternative placement resource for children are described. The available data regarding the length of time in placement, number of placements, physical, mental health and educational and permanency outcomes for children placed with relatives are discussed. Implications for practice are drawn and areas for further research are suggested.     

Kinship Foster Care and Its Impact on Grandmother Caregivers

Summary

Kinship foster care programs are designed to address the needs of relatives, usually grandparents, who have taken in children who have been removed from their homes voluntarily, or following a substantiated report of neglect and/or abuse. The author reviews the history of kinship foster care nationally and examines related research. Reported are findings on a survey of kinship foster care programs nationwide and from qualitative interviews with nine grandmothers from New York City who were kinship foster care providers. Particular attention was paid in these surveys to the impact of kinship foster care on families caring for children with disabilities.     

Vietnam’s extraordinary performance in the PISA assessment: A cultural explanation of an education paradox

This paper examines the nature and drivers of Vietnam’s paradoxical performance in the Program for International Student Assessment (PISA) – consistently high student achievement despite being the poorest of all participating countries and a centralized education system. We first document ‘Vietnam advantage’ in a wide-range of supply and demand-related indicators such as school participation rate, educational inequality, inputs and expenditure in cross-country regression models. We then estimate an augmented educational production function to show that these supply and demand-side advantages don’t explain away Vietnam’s positive deviance in PISA when compared to other participating developing and developed countries. We then conduct student-level analysis to examine Vietnam’s performance in PISA 2012 in a regional context, vis-à-vis three high-spending but low-performing ASEAN member countries (Malaysia, Indonesia and Thailand) and two high performing Asian countries (South Korea and Singapore). Pooled regression estimates show that, holding differences in various indices of socioeconomic background, the gap in average student test scores between Vietnam and South Korea in Reading and Science becomes statistically insignificant. Moreover, once school-specific differences are also accounted for, Vietnamese students do just as well as Singaporean across all subjects – equalizing for existing socioeconomic differences between countries would give Vietnam an even better advantage in PISA. A similar gain in PISA scores is absent in the case of Malaysia, Indonesia and Thailand. The paper concludes by offering a cultural explanation for the significant variation in educational performance among high-spending East Asian countries.