Monitoring the Monitors: Medicaid Integration of Passive Remote Monitoring Technology

Implementation of passive remote monitoring is advancing faster than our knowledge base about appropriate and ethical use. For all the media and research attention these technologies are getting, there has been very little discussion about how they are positioned to be integrated into health plans, yet their integration is key to how they will be incorporated into social work practice. As coverage of passive remote monitoring technologies expands in Medicaid home and community-based services (HCBS), new policies that support informed decision-making, consenting processes, and regulations for ethical, appropriate use are urgently needed. Research translation often trails policy, but the rapid development and implementation of technologies that passively collect and transmit new information about older adults call for a more responsive approach. In this commentary, I describe passive remote monitoring technologies, their implementation in Medicaid HCBS, and ethical issues. I conclude with specific suggestions for policy and practice to start addressing these issues.     

An evaluation study of a dementia screening program in taiwan: an application of the theory of planned behaviors

A challenge facing dementia service providers is how to detect dementia early to facilitate timely intervention. This article reports findings of an evaluation study of a dementia-screening program in Taiwan utilizing the Theory of Planned Behaviors. We present the Short Portable Mental Status Questionnaire (SPMSQ) program rationale and examine the effects of this important health and social service intervention. Follow-up telephone interviews were completed by 108 respondents. Findings indicate that the SPMSQ program was successful in identifying suspected dementia. Results also show that the dementia-screening program contributed to an increase in medical service utilization and in unpaid informal care.     

Staff and family attitudes to fences as a means of detaining people with dementia in residential aged care settings: The tension between physical and emotional safety

This study investigates staff and family attitudes towards the use of the fences that surround many aged care facilities in Australia, in the context of indefinite detention of people with dementia. This indefinite detention has been described in a report from an Australian Senate Inquiry as “a significant problem within the aged care context”, which “is often informal, unregulated and unlawful”. Five focus groups comprising direct care workers, family members, nurse unit managers and facility managers discussed the reasons for and their attitudes towards fences. The results show a tension between the provision of physical and emotional safety. This is to say that even while it is illegal to detain people with dementia against their will, and even while participants understood the negative impact of fences on the well‐being and emotional safety of people with dementia, they accepted and supported the presence of perimeter fences because they provided the perception that fences kept people with dementia physically safe. This has implications for redressing the balance between physical and emotional safety in policy and practice.     

The Role of Empowerment in Home Care Work

ABSTRACT

The home care industry experiences similar problems with the recruitment and retention of direct care workers (DCWs) as those faced by institutions, and it is important to identify strategies to help retain and grow this important workforce. The empowerment of DCWs has been shown to be an effective strategy for increasing job satisfaction and decreasing turnover in nursing homes but has not been studied in home care. Using Kanter’s organizational theory of empowerment, including structural empowerment (structure of opportunity, access to resources, access to information, and access to support) and psychological empowerment (meaning, competence, self-determination or autonomy, and impact) this study examined whether home care workers (HCWs) feel empowered in carrying out their jobs. An exploratory, qualitative study of 12 HCWs, recruited from two states in the United States, found high levels of both structural and psychological empowerment among research participants, as well as a number of disempowering aspects of their job. Findings suggest ways to support elements of the work that HCWs find empowering and decrease elements that contribute to job dissatisfaction and turnover.     

Needs and Supports in Transitional Housing for People Living with HIV/AIDS in Ontario,Canada

ABSTRACT

There is a paucity of research on transitional housing for people living with HIV/AIDS (PHA) and even less so within the Canadian context. The present work addresses that gap and reports on the results from the Transitional Housing Study, a province wide community-based research collaboration involving PHA, service providers, and university researchers in Ontario Canada. This article answers the following research questions: What supports do residents in transitional housing for PHA access and what needs do these supports address? Developing from a thematic analysis of in-depth qualitative interviews with 25 residents in one of three transitional housing agencies in Ontario for PHA, the findings reveal that participants benefited from four key supports while in transitional housing: the provision of a safe environment, co-coordination and management of HIV (and other) drug therapies, assistance with appointments, and referrals to health and social services. Until more resources are available to increase availability of transitional housing for PHA, the nonprofit housing sector must fill the gap that exists by offering the types of supports identified in this study in order to address the needs of PHA. Future research may link these supports efficiently with concrete health improvements and permanent housing stability among PHA.     

Making a connection: school engagement of young people in care

Intervention to improve educational attainment for children in out‐of‐home care is increasingly being recognized as important for their well‐being and future opportunities. This paper reports on a mixed method study of the school engagement or connectedness of young people in care. The study comprised a survey of 202 young people in care in Queensland, Australia, and a matched comparison group of young people not in care, plus interviews with a subset of 65 young people in care who were surveyed. Both the school environment and the perceived levels of support influenced school engagement, with those who were assisted by carers and caseworkers more likely to be positively connected with school. These young people perceived education as a pathway to achieving work and life goals. The findings suggest that active and focused attention on young people's school engagement should be part of case planning and monitoring as it offers an additional strategy for improving their educational experience.     

Preparedness within the municipal social services in Sweden: planning for the home help service organization for elderly people in war and crisis from two organizational perspectives

A study aiming at presenting the effects of increases in work strain during war and crisis on the home help service organization within the social service sector in Stockholm was carried out in 1991. This has given rise to a discussion about achieving the goals for the organization in war and crisis. Organizations are supposed to encompass qualities that allow them to achieve operative goals even if operative conditions are changed. The principle underlying preparedness planning is the maintenance of peace-time functions in organizations during war and crisis, although such functions may be restricted. Changes influencing preparedness planning within the social service organization include ongoing organizational restructuring in terms of decentralization and increases in private enterprising within the municipal social service sector. Two factors of decisive importance to organizational appropriateness are information generation and information processing. The results from the study show deficiencies within the organization's ability to generate and process information between different organizational levels about demands put on the organization in situations of war and crisis.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

Assessing Statewide Need for Older Adult Health Promotion Services: The Oklahoma Experience

ABSTRACT

The growing senior population and persistent poor health status of seniors in Oklahoma compels a fresh look at what health promotion services would be well received. Surveys were distributed to a list of registered voters aged 65 and older in Oklahoma with a total of 1,248 surveys returned (19.8%). Survey items asked about interests in services, classes, and activities, plus current barriers to accessing and/or engaging in such programs. To account for survey weighting, Rao-Scott Chi-Square Tests were performed to determine differences by demographic characteristics. We identified services, classes, and activities that were (and were not) of interest to seniors in Oklahoma with legal assistance (52.1%), exercise classes (46.6%), internet classes (40.7%), and indoor exercise activities (45.5%) receiving the highest level of interest. Barriers to interest in participating in programs included not wanting to go and not knowing availability of such services. The results of this survey provide useful data on health promotion gaps for seniors, interests and barriers to engaging in such activities, and guidance for statewide program development. Future program development needs to be focused on areas of interest for older adults, including legal assistance, exercise classes, and internet classes.     

Family Caregiving and the Site of Care: Four Narratives About End-of-Life Care for Individuals with Dementia

Little is known about end-of-life care for individuals with Alzheimer’s disease and other dementias. Four case studies are presented, using data collected by qualitative interviews conducted with family caregivers who were closely involved with end-of-life care for relatives with dementia. The case studies are formatted in two pairs, with one reflecting two deaths occurring at home and the other pair representing two deaths in the nursing home. The cases reveal a range of end-of-life experiences, suggesting that there is not just one “good” path. The extent of care needed, the responsiveness of the individual, the health of the caregiver(s), and the residence and support situations, can all intersect in a variety of ways that make no one scenario the answer for all. Although most people say they would prefer to die at home, in some situations the nursing home can be a satisfactory choice, particularly if hospice is involved. These narrative case studies give the reader insight into the variety of the end-of-life experiences and suggest the environment should be considered as part of the care provision.     

Developments in home help for elderly people in Denmark: the changing concept of home and institution

The official figures on provision of home help in Denmark are compromised in that they include figures for help delivered to people living in assisted-living dwellings, facilities that were formerly considered nursing homes. Furthermore, many municipalities have integrated home help and nursing-home care and report this as home help. This article examines the effect of these administrative arrangements on the provision of home help and the distribution of home help in terms of hours per week. There has been a polarisation in size of care packages: a smaller group of recipients composed largely of people residing in assisted-living dwellings receive larger care packages, whereas the care packages to people living in their own dwellings have decreased in size. However, a sleight of hand of definitions regarding the concept of home has made the official figures on provision of home help look even more generous than they are.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

Improving primary level home and community care services for older people: The case of Hong Kong

The aims of this study were to assess the impairment levels of users and waitlisted applicants for Hong Kong's Integrated Home Care Services (Ordinary Cases) (IHCS [OC]), reveal their possible hidden needs and potential demand for higher level services, assess their unmet needs for IHCS (OC) and explore whether not using IHCS (OC) was associated with any deterioration in impairment. In all, 567 respondents were clinically assessed twice, over a 6‐month interval, by the Minimal Data Set Home Care questionnaire. The results showed that some moderately or severely impaired respondents had only limited access to higher level services. Some respondents with either no impairment or only low‐level impairment had applied for higher level services. Most waitlisted applicants had not received any IHCS (OC), even after 6 months of waiting. Using IHCS (OC) or not had no significant impact on the deterioration in impairment. Several ways of improving home and community care services are discussed.     

Shared decision‐making: a voice for the Lakota people

Child welfare has long been a concern for American Indians, so much so that Congress passed the Indian Child Welfare Act (ICWA) in 1978. The ICWA was intended to address was the large number of children placed out of home as a result of abuse and/or neglect, and the corresponding lack of tribal and community input regarding their removal and placement. This paper focuses on one group of American Indian people, the Lakota, whose children are overrepresented in the child welfare system. As a promising practice, shared decision‐making will be offered as a culturally appropriate model to build dialogue and cooperation between social workers and their Lakota clients. Shared decision‐making holds promise to help address the important social justice issues identified by Congress and by the Lakota people in the 1970s and which remain largely unresolved some 40 years later.     

To be or to be trained to be: On emerging and diverging ideological traditions in organizing day care activities for people with severe mental disorders in Sweden

Organized activities for people with severe mental disorders have until recently been the societal task of one human service organization, the medical speciality of psychiatry. With former psychiatric impatients moving out into the local community and with heavier dependence on outpatient polyclinic care, the situation is slowly changing. Day care activities for people with severe mental disorder are organized with an increasing involvement of the social services. The aim of this article is, using data from a national survey carried out in 1991 in Sweden, to describe and categorize how day care units interpret their task. Results show that claims-making activities still adhere largely to a therapeutic paradigm in spite of the outspoken social character of the work of organizing everyday life activities.     

Families of adult people with disability: Their experience in the use of services run by social cooperatives in Italy

Social cooperation has historically played a pivotal role in developing socio‐educational services for people with disability, thereby contributing to counteracting the social isolation often associated with this condition. Using a mixed‐method methodology, this study maps the diversity of perspectives on how the use of disability‐related services run by social cooperatives impacts on and becomes meaningful to family life. One hundred twenty‐nine interviews with family members of adults with different kinds of disability were studied using emotional textual analysis. It provides a multi‐dimensional model to read and map the multiplicity of emotional meanings related to disability and the use of services, shedding light on key diversities in how family members emotionally make sense of care and support. The results reveal the importance of supporting family‐carers on two main issues: accessing a less passive representation of their relative with disability; and being able to test and acknowledge limits without succumbing to a sense of powerlessness.