The Transformative Potential of Social Work's Evolving Practice in Dementia Care

Social workers in diverse service systems throughout the United States encounter many opportunities for improving quality of life for people with dementia and their families. Yet practice with this population is unclearly defined and a core set of competencies for such practice does not yet exist. Instead, it is shaped by roles within aging and health systems. These roles are informed by a biomedical disease model of dementia. This article examines social work practice and its connection to evolving views on aging and senility throughout the 20th century. New directions for practice are recommended to improve services for individuals with dementia.     

Asian Pacific Islander Dementia Care Network: A Model of Care for Underserved Communities

This study presents the results of the work of the Asian Pacific Islander Dementia Care Network (APIDCN)—a collaborative model of care created to develop community capacity to deliver dementia capable services, build community awareness about Alzheimer’s disease and other dementias, and offer direct services to caregivers in the API community in Los Angeles. Through trainings, mentoring, and outreach campaigns, the APIDCN expanded the availability of culturally competent services in the API community. The knowledge that was embedded within partner organizations and in the community at large assures sustainability of the services after the project ended.     

The Contribution of Practice Skills in a Care Management Process for Family Caregivers

Practice skills are believed to improve practice, yet, little is known about the extent to which skills affect outcomes. This exploratory study examined the extent to which 3 practice skills specific to a care management context for family caregivers, including communication skills, supportive skills, and linking skills, were associated with fidelity of a care management process. Twenty-one care managers who used a single process to serve 113 family caregivers were included in the study. Bivariate correlation analysis revealed the 3 practice skills are positively associated with process fidelity. Implications for social work practice, education, and research are discussed.     

Recognizing But Not Acknowledging: On Using Research Information in Social Work with Elderly People Suffering from Dementia

The gap between theory and practice in social work continuesto be great, and research results seem to live a life of theirown, far from the field they were intended to improve. Thisarticle considers research information as a useful contributionto the practice of social work with elderly demented peopleand to qualitative methods used in the area of social scientificresearch. Arising out of a project aimed at studying the usefulnessof research information through an interactive exercise withinfocus groups, the author discusses how the results of researchcan be used to improve practice. When the researchers’theoretical- oriented perspectives meet with the practitioners’action-oriented perspectives, two different models enrich eachother in the process of developing integrated knowledge.     

Social Work and End-of-Life Care

Abstract

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

Considerations in Care for Individuals with Intellectual Disability with Advanced Dementia

Abstract

A number of physical, psychosocial, or ethical issues related to the care of the individual with advanced dementia are reviewed and related to individuals with intellectual disabilities. The sources used include the published literature and illustrations drawn from personal observations. The author notes that through anticipation and early planning, advanced directives and service planning (which looks to adaptation of services and other care management interventions), can effectively impact care at the end. Areas that need to be addressed include technical information, including a review of and, as appropriate, adaptation of general advanced dementia resources, relief, rest, support, reassurance, receipt of on-going information, participation in planning, a sense of humor, and appreciation. Also noted, are the differences experienced because of the presence of paid staff as carers and residence outside of the family home. It is concluded that, although the goals of quality care is the same for all people with advanced dementia, the process by which to reach these goals often needs further consideration and adaptation for people with intellectual disabilities.     

Examining Cost Fulfillment: Child Care Policy and Strategies

ABSTRACT

Most advanced industrialized countries have established social support to aid families in balancing productive and reproductive labor during child-bearing years. Secondary data analysis was used to examine patterns of public support for low-income working families. Key findings highlight four types of policy strategies (Conservative, Limited, Average, and Universal) suggesting differentiated social citizenship opportunities based on place of residence. This research highlights how a complex policy environment contributes to unintended consequences as the working poor are exposed to child care and employment instability. Future research should consider how the policy environment contributes to material well-being in families during the life course.     

Anxiety and Related Symptoms in Older Persons With Dementia: Directions for Practice

Anxiety disorders and related symptoms commonly occur in older people with cognitive impairment or dementia, significantly worsening functioning and reducing quality of life. This review of the literature outlines the extent of the problem, and focuses on current best practices in psychosocial interventions anxiety in persons with dementia. Discussion follows on promising nonpharmacological interventions that are recommended for further consideration and future research.     

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

ABSTRACT

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.     

Redefining Welfare: Australian Social Policy and Practice

The present paper outlines and analyzes Australia's welfare reform policies as they have been implemented over the past decade. While there have been numerous social policy initiatives over this period, welfare reform provides an interesting site for analysis and review. This suite of policies and programs is of particular importance from several standpoints. First, its target groups – those needing income security assistance, including the unemployed, people with disabilities, and single parents – are historically and traditionally of concern to social work and social welfare. Second, welfare reform policies have had significant impact on social welfare agencies, and the social workers and welfare workers employed in them. Finally, welfare reform has had a wider impact on inequality in Australia and our attitudes to those in need. This paper first provides a brief overview of the context of Australian social policy and welfare, its origins and current situation. It then outlines the key operational elements of welfare reform and how it has been implemented. The third section of the paper offers a critical analysis of these policies and programs and finally poses some questions and issues requiring further discussion and research.     

Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.     

中国特色社区老年照顾的定位及其发展策略

20世纪80年代以来,中国老龄化问题日益严峻,社区老年照顾发展起来。中国社区与西方社区不同,有自身的特点,因此在发展中存在着两个问题：一是定位问题,二是推进策略问题。在定位问题上,宜将社区老年照顾定位为家庭养老的辅助;在发展策略上。宜先行发展收费型老年服务业,然后有选择地实现低偿或无偿照顾。这两个问题的解决对于社区老年照顾事业的均衡发展具有重要意义。     

中国特色社区老年照顾的定位及其发展策略

20世纪80年代以来,中国老龄化问题日益严峻,社区老年照顾发展起来。中国社区与西方社区不同,有自身的特点,因此在发展中存在着两个问题:一是定位问题,二是推进策略问题。在定位问题上,宜将社区老年照顾定位为家庭养老的辅助;在发展策略上,宜先行发展收费型老年服务业,然后有选择地实现低偿或无偿照顾。这两个问题的解决对于社区老年照顾事业的均衡发展具有重要意义。     

Aging and Elder Care in Japan: A Call for Empowerment-Oriented Community Development

This article provides a brief overview of the situation of the elderly and their caregivers in Japan, including demographic changes in Japan, development and changes in long-term care policy that have targeted the poorly integrated community care system, and other challenges that the elderly and family caregivers face. Policy direction designed to address these issues is increasingly targeting care by the community versus support care by society (which was initially the main strategy). The potential of empowerment-oriented community development intervention strategies to decrease the gap between available institutional and formal community-based services and the needs of the elderly and their families in their efforts to meet late life challenges is described. The need for an increased role of social workers in community development interventions is explored and strategies are suggested.     

Accounting for Ethical Difficulties in Social Welfare Work: Issues, Problems and Dilemmas

This paper is a preliminary exploration of social welfare practitioners’accounts of ‘ethically difficult situations’. Itdescribes variations in the ethical vocabulary and form of theseaccounts. Analysis of practitioners’ own accounts (asopposed to ‘textbook’ cases) draws attention tothe ways they construct events, actions and qualities of characteras ethically significant and highlights the qualitative distinctivenessof ethical dilemmas, where seemingly irresolvable choices leavea residue of moral loss, regret or guilt.     

Movers and Stayers in Care Management in Adult Services

Professional biographies of care managers in the mid-ninetiesand, seven years on, their profiles and career choice are thefocus of this article. The work draws on two linked studiesbased on adult services in two social services departments.The profile of those who stayed in post and those who movedon raises issues for the social work profession, for managersand for policy makers. Those who stayed constitute an experiencedworkforce of middle-aged, predominantly female practitionerswith mixed views about the changing nature of the work. Thosewho moved include a group of females who became managers bydefault. The work raises issues concerning work pressures, genderprofiles within an ageing workforce, and succession planning.The findings link to more extensive workforce studies and contributetowards debates concerning the occupational identity and thefuture of qualified practitioners within a human services landscapewhich is constantly being reshaped within a culture of new managerialism.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

Social Work Practice to Support Survival Strategies in Sub-Saharan Africa

The high levels of absolute poverty, malnutrition and illiteracyacross the sub-Saharan region require African social workersto develop new methods of intervention which differ from thoseused in Western countries. Identifying, augmenting and enhancingthe strengths of disadvantaged people lie at the core of allsocial work practice. This paper adumbrates the range of survivalstrategies used by African households and concludes that theserequire buttressing through alternative approaches to orthodoxsocial work methods.     

Aging in Poverty: Making the Case for Comprehensive Care Management

A model for holistic care management that would enhance outcomes for economically vulnerable older adults who receive an array of disjointed services administered through the older Americans Act (OAA) and local Area Agencies on Aging (AAA) is proposed. Fragmented service delivery is typically wasteful and ineffectual, but comprehensive care management that includes an autonomous care manager, a single interagency plan of care and ongoing monitoring that is client-centered may protect those aging in poverty from negative health outcomes.