Gerontological Social Work Student-Delivered Respite: A Community-University Partnership Pilot Program

ABSTRACT

This study describes a community-university partnership to support a gerontological social work student-delivered respite program, the Houseguest Program (Houseguest). Houseguest was designed using a community-engaged scholarship model of integrating research, teaching, and service. Houseguest was piloted with a small group of community-dwelling, coresiding dementia caregivers and care recipients. We examined caregivers’ experiences with student-delivered respite using qualitative data analysis. Thematic analysis produced 8 themes: (a) respite from full time caregiving role, (b) information on caregiving strategies, (c) no-cost supportive services, (d) opportunity for care recipients to socialize, (e) tailored activities for care recipients, (f) rapport-building between students and family dyad, (g) reciprocity between students and family dyad, and (h) program continuation. We conclude with a proposed community-engaged scholarship model for dementia caregiving. Through a community-university partnership, Houseguest reduced the impact of caregiver burden and created an opportunity for students to serve families affected by dementia through respite and tailored activities.     

Challenges and Successes in Developing an In-Home Respite Program

Demographic trends indicate that the increasing population of very frail elderly is putting enormous strains on caregiving families. Share-the-Care is an attempt by a community agency to provide in-home respite care by using trained neighborhood workers. The program is particularly unique in that it attempts to implement a business-oriented model of service due to the lack of public funds in Pennsylvania for this type of program. The authors hope this article, which describes the development of Share-the-Care, will be helpful to others who are considering offering in-home respite services.     

Strengthening kinship families: scoping the provision of respite care in Australia

Kinship care is the fastest growing form of out‐of‐home care in Australia, as it is in many other countries. The Victorian Government's response has been to establish 18 programmes across the state to provide support to kinship families. The scoping project described here, based on interviews with key programme staff, explores the experiences of the new programmes in providing support, specifically respite care, to kinship families. It has produced a picture, based on qualitative and quantitative data, of how respite care is understood, the perceived respite needs of kinship families, how services are organized and provided, identified barriers to families accessing support, the effect of respite provision and what constitutes optimal practice. The findings establish a basis for a best practice model of service provision for this increasingly significant family type.     

DIFFERENTIAL USE OF GROUPS IN MAINSTREAMING THE HANDICAPPED ELDERLY

This article describes the experience of Selfhelp Community Services in establishing a day center for the physically frail handicapped aged. Through the use of groups and other support services, a program for the isolated homebound is developed and maintained. Goals of the program include prevention of premature institutionalization, restoration of socialization skills, enhancement of individual self esteem, and respite for families. The evolution of the program from its beginning as a self standing center to its present suucture as an integrated service in a multipurpose senior center is described.     

Poetry

This paper describes the services and procedures of the Philadelphia Geriatric Center's multi-service respite service demonstration project for 305 caregivers of elderly Alzheimer's patients. Selected sections of data are reported that provide information needed by professionals for planning and delivering such services. Of all caregivers who were offered respite, 52% actually availed themselves of the services. Of those, two-thirds chose in-home services, with smaller proportions using day care and institutional respite. Reasons for such choices and for the non-use of respite, the advantages and problems of different types of respite, and implications for development of respite programs are discussed.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Barriers to Implementation of a Cooperative Model of Respite Care

This paper describes the conceptualization and field experience with a cooperative model of respite care for the frail elderly. Planning and program development were successfully completed yet implementation did not come to fruition. A survey of family caregivers, conducted to analyze obstacles to implementation, is instructive in identifying attitudinal barriers to use of a cooperative model for providing respite care for the frail elderly. The reasons for the program's failure and the lessons learned from it are examined and discussed. Implications are drawn for the planning and development of new intervention programs.     

PLANNED RESPITE CARE: HOPE FOR FAMILIES UNDER PRESSURE

Respite care — having breaks from the constant demands of parenting — has long been recognised as a crucial service for families of a child with a disability Only more recently has it been considered equally beneficial for families at risk of abusing or neglecting their children. A growing body of research demonstrates the negative impact of social and economic stress on people's capacity to raise their children effectively. The experiences of welfare workers indicate that planned respite care can be an important means of reducing stress and lessening the likelihood of child maltreatment and the possibility of children's removal to long‐term care. A case is outlined for a much more substantial investment in planned respite care as part of an integrated range of family support services.     

Cost-Free Resorts for the Elderly?

In an era of limited resources, Hong Kong has developed a bold, innovative and controversial program which offers virtually cost-free two-day resort vacations to all elderly Hong Kong residents. The program is designed to improve the relationships between older adults and the members of their family support systems and to provide temporary respite for caregivers. It is the only program of its kind in Asia Pacific and, perhaps, the world.     

Carer Break or Carer‐blind? Policies for Informal Carers in the UK

This article examines three policy statements on informal carers published in the UK in 1999—the National Strategy for Carers, the report of the Royal Commission on Long Term Care and the note of dissent by two members of the Royal Commission. These three documents contain two rather different approaches to policy for carers. On the one hand, the National Strategy and note of dissent emphasize respite care or short-term breaks for carers, and are concerned with sustaining the well-being of carers as well as ensuring the continuation of caring itself. The Royal Commission, on the other hand, emphasizes support for the older or disabled person who is being cared for, as a means of supporting the carer, and advocates "carer-blind" services. It is argued that this policy contains within it the potential to substitute for or replace the carer and that this represents a radical new departure for social policy for carers in the UK. The advantages and disadvantages of the two policy approaches are explored. It is argued that policies for carers should include both services specifically for carers, like breaks from caring, and services provided for the cared-for person, like domestic and personal care services. Wider issues about the proper boundary between family and state care are explored.     

Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes

The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans’ family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans’ families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans’ needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans’ end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran’s death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.     

Chinese American Family Caregivers’ Perception of Program Use and Caregiver Stress

Caregiver programs provide specialized services and resources to reduce caregiver stress and improve family quality of life and health. Although there are resources and community services available, Chinese American family caregivers’ perceptions on caregiver programs and how specific services help to viably reduce their stress has yet to be examined. An in-depth interview was conducted with four Chinese American family caregivers in exploring their caregiving experiences and program service use; two of the caregivers were spouses and two were adult children. Content analysis revealed that their value of familial piety, and their need to ameliorate caregiver stress fueled their interest in new interventions to improve their quality of life and health. Spousal caregivers and adult children caregivers disclosed different needs due to caregiving, and adult children caregivers were less resistant to new interventions. The results of this study fill the knowledge gap on Chinese American family caregivers’ perception of caregiving in a cultural context as well as their needs. Suggestions for future research are to better understand the effectiveness of the specific services within caregiver programs that are effective in reducing caregiver stress among Chinese American family caregivers.     

Working and caring for a disabled adopted child during a pandemic

Integrating work and family demands can be challenging for families caring for a child with one or more disabilities. The pandemic and its changes to work, schooling and service delivery potentially added to these challenges. This exploratory mixed methods study sought to understand how the pandemic affected adoptive parents' work–life fit and service use. A total of 200 participants responded to survey questions about parenting an adopted child with a disability prior to, and after, the onset of Covid-19. More than half of the parents (59.2%) reported that it was somewhat to very difficult to integrate both work and family demands. Parents with greater access to workplace flexibility and supportive supervisors had significantly less difficulties combining work and family. Families who reported more problems with accessing mental health services, special education and respite care reported significantly more challenges with work–family fit. Parents reported increased stress due to the pandemic changes, but many also shared positive changes such as more time for family. Online services were experienced as effective for some children and reduced time spent driving to appointments. Recommendations for workplace and social service practice and policy supporting adoptive parents of children with disabilities are discussed.     

Towards Integrated Community Care for the Frail Aged

The growing awareness of family support among the frail aged has yet to be incorporated into a clear strategy for developing comprehensive community care. A starting point is to identify the characteristics of target populations, the range of tasks associated with aged care, and the capabilities of various informal and formal providers. Fully appropriate services would take into account the availability of family support as well as the needs of older people themselves. It is suggested that services be designed to (1) supplement support from spouses; (2) periodically substitute for other co-resident carers; (3) complement assistance from nonresident family; and (4) substitute for the unavailability of family support. Community services currently provide modest supplements, principally to nonresident support, but do little to address the other contexts of care. Suggestions are made for program developments that would provide genuine alternatives to institutionalisation without devolving the social costs entirely onto families.     

The Experience of Respite

Abstract

Interviews were conducted with 228 African American and white caregivers seeking respite care. The two groups were compared in terms of their own functioning, that of their relative and their needs for assistance at the time of their requests for respite. After six months of use, a comparison of the effects of the program on the two groups was made. The findings indicate that although patients were comparable at the time of application, white caregivers were more anxious, depressed, felt less competent, and experienced less gain that the African-American group. Needs for assistance and the effects of the program on the two groups also varied.     

Short breaks for families caring for a disabled child with complex health needs

Data from two research studies concerned with disabled children who have complex health needs were analysed in relation to families' experiences of accessing short breaks (respite) services. Many families experience serious problems finding suitable services which can cater for both their child's complex health needs and their own need for significant levels of support. This paper highlights which services families were using and the difficulties of obtaining a coherent and consistent package of support. Regulatory concerns relating to the piece-meal provision of services and use of children's hospices are raised along with recommendations for improving policy and practice.     

Closing the gap? The effectiveness of referred access family support services

This paper presents findings from a study of the effectiveness of family support services provided through two family centres run by a voluntary agency in partnership with a South Wales local authority. It evaluates the effectiveness of family support services by looking at both the family views and a number of measurable outcomes in terms of reported changes in family functioning and the well‐being of children and parents. Interventions were monitored over 6 months using a pre‐test post‐test non‐equivalent groups design, incorporating quantitative and qualitative methods. Child well‐being, family functioning and some aspects of parental well‐being (related directly to the child) did improve over the intervention period for family support service users. This improvement resulted in the family support service users ‘closing the gap’ with non‐service users (comparison group), to such an extent on some measures, as to be statistically significant. The qualitative evidence confirmed these improvements. The only area that did not improve, according to the quantitative findings, was that of parental well‐being (not related directly to the child). This includes important factors around social support networks, such as parental confidence, social interaction and social contact. The reasons for lack of improvement in these areas are discussed, emphasizing the importance of monitoring the impact of using the service and incorporating a focus on the quality of the nature of the relationship between the worker and the service user.     

Mapping the journey: outcome‐focused practice and the role of interim outcomes in family support services

Longitudinal costly evaluations will always be important in order to understand the factors that impact on child, family and community well‐being over the long and medium term. However, in a policy era that accords major importance to the achievement of outcomes, e.g. payment by results, ‘outcome theology’ can pose threats to service access and professional morale in family support. It is essential therefore, to ascertain the short‐term outcomes of services in order to capture the trajectory of progress by families under stress. This paper critiques the concept of ‘the outcome’. It traces the development of this trend in policy and describes an alternative but complementary approach, which is based on capturing interim outcomes in family support services.     

Patterns of program development in family planning

The author urges the contribution of the field of social work to the development of family planning services. She believes that the new legislation will make it clear that Congress wants family planning services to be developed and wants Federal funds used to help with this development. Social services to pregnant women may well be the best source of highlighting the potential significance of family planning services as a vehicle for social work intervention. This intervention must involve participation in the planning of programs from the earliest possible stage to include the total design of the service. Constant attention to the social problems which interfere with effective use of family planning services, and the indications for social service intervention is needed. Ideally, family planning services should be a part of the maternal and child health programs.     

A qualitative exploration of reentry service needs: The case of fathers returning from prison

The challenge of community and family reentry after a parent's release from prison remains an under‐addressed area of collateral damage stemming from high rates of U.S. incarceration. Many fathers released from prison return to living with family, and later attribute family connections and parent–child contact as key factors in their postrelease success. However, reentry planning is hampered by a dearth of research on family‐focused reentry services, and consequently, often omits attention to resuming family and parenting roles. To address this gap, we conducted 38 semi‐structured interviews with 19 previously incarcerated fathers, 9 co‐parenting mothers, and 10 relatives to explore service needs of fathers during reentry. Findings suggest programs not only should be multimodal, emphasizing family connections complemented by socioeconomic, self‐care, and social support services, but also should be accessible and relatable, offered within the community, and engaging for fathers and family members. Findings reinforce the importance of self‐determination and human agency while underscoring the multiple challenges fathers face upon reentry. By including the voices of those most affected by incarceration, this study advances knowledge to shape reentry programs and policies, contributes to efforts addressing criminal justice inequities, and promotes well‐being among formerly incarcerated parents and their families.