Labour Markets,Care Regimes and Foreign Care Worker Policies in East Asia

This article analyzes the politics of foreign care worker policies in Japan, Korea and Taiwan. In the face of socio‐demographic challenges, these countries have responded differently to the increasing demand for hiring foreign care workers, creating distinct policies with respect to the origins of the foreign care workforce, the size of the foreign care workforce in the labour market, and job specifications. In this article, I argue that the interaction of female employment patterns, the public provision (or lack) of social care, and labour market policies in the care service sector determines the diverging political pathways of foreign care worker policies in these three countries over the past two decades.     

Older Workers in Intergenerational Child Care

Thirty-four older workers in one of five intergenerational child care settings participated in a study exploring the effects of their participation in intergenerational child care programs. The purpose o the study was (1) to identify and describe a sample of older child care workers and (2) to identify characteristics of the older child care workers or the work experience which significantly impact on their lives. The older workers completed a written questionnaire, standardized life satisfaction scale, and interviews. The results suggest that participation in intergenerational child care programs supports the notion of generativity and enhances productive aging. Older workers reported increases in feeling needed, valued, and a sense of self-worth, and increased social contact. Over 90% of the older workers reported that their job expectations were met and that they felt the children had benefitted from their work. Positive changes in attitude about children's growth was positively related to the older workers' personal growth. Older workers also reported greater personal growth when they worked in excellent child care centers as compared to good or fair quality centers. Younger teachers reported positive changes in the classroom environment with the presence of older workers. These findings have implications for training older adults as child care workers and for social policy issues concerning older citizens' roles in our society.     

The Beckford Report: A Critical Appraisal

Correspondence to Nigel Parton, Department of Behavioural Sciences, The Polytechnic, Queensgate Huddersfield HDI 3DH. Summary This paper provides a critical analysis of the Beckford Reportand its implications for social work and the personal socialservices. Four interrelated themes are explored: the relationshipbetween social work practice, statutory responsibilities andthe law; the attitudes of social workers towards children andfamilies; the social work skills required; and the assumptionsthat are made about child abuse and the role of social workers.This is then related to recent research findings in the areaof policies and decision making in child care. It concludesby arguing that the report is in great danger of misdirectingour attentions from the major issues concerned with social workwith children at risk.     

Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

应对地震灾害的社会工作的方法与开发——借鉴阪神淡路大地震、中越大地震、东日本大地震的经验教训

日本3.11大地震后,各种专业组织、社会福利组织致力于灾后重建的社会工作,有力佐证了日本护理保险制度中的护理管理在震灾救援中的巨大威力。针对震灾的社会工作,需要注重以个人援助为主的护理管理,与以地域社会为主的网络相结合。在灾害社会工作的发展方向上,需要社会工作把医疗和团队结合起来,通过加深相互之间的配合,建立在灾害医疗援助小组(DMAT)或日本医师会灾害医疗团队(JMAT)进行治疗后开展生活援助的机制。在社会工作中导入与灾害医疗援助小组同样的体系,平时就要培养好应对震灾的社会工作者。注重培养社会工作者应用现存的社会资源的能力,以及动员、调动灾区以外地区的社会资源的能力。重建受灾者的社区,非常有必要保持并进一步强化以往的居民间的关系。需要建立区域综合援助中心,配有保健师、社会福利士(社会工作者)、主任护理经理。以区域综合援助中心为主来开展灾区和灾区以外地区的社会工作者互相合作的"区域综合照顾"。在生活圈里重建各种组织机构的网络,社会工作者在各自的生活圈内,以地区的需求为基础,制定解决这些需求的计划,动员灾区居民参加,力求实现正式和非正式组织、机构的组织化,并在各种组织、机构的合作下进行实施推广,为社区复苏提供援助,促进地域社会中的各种组织的网络建设,从而形成地区的组织化。     

Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

COVID‐19 and social work practice for older adults in China

After the spread of COVID‐19, the Chinese central government has issued a series of policies and regulations to guide the prevention and control of the epidemic in the elderly care industry. Social workers provided a series of services for older adults in nursing homes and in the community. All efforts made by government agencies and social workers have helped older adults go through the difficult time.     

Why Do They Leave? Factors Associated With Job Termination Among Personal Assistant Workers in Home Care

Recruiting and retaining an adequate number of personal support workers in home care is both challenging and essential to allowing elders to age in place. A mixed-method, longitudinal study examined turnover in a sample of 261 personal support workers in Maine; 70 workers (26.8%) left their employment in the first year of the study. Logistic regression analysis indicated that younger age and lack of health insurance were significant predictors of turnover. Analysis of telephone interviews revealed three overarching themes related to termination: job not worthwhile, personal reasons, and burnout. Implications of study findings for gerontological social workers are outlined.     

Why do they leave? Factors associated with job termination among personal assistant workers in home care

Recruiting and retaining an adequate number of personal support workers in home care is both challenging and essential to allowing elders to age in place. A mixed-method, longitudinal study examined turnover in a sample of 261 personal support workers in Maine; 70 workers (26.8%) left their employment in the first year of the study. Logistic regression analysis indicated that younger age and lack of health insurance were significant predictors of turnover. Analysis of telephone interviews revealed three overarching themes related to termination: job not worthwhile, personal reasons, and burnout. Implications of study findings for gerontological social workers are outlined.     

Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses

ABSTRACT

Health-care workers may experience moral distress when they are unable to act as they believe is ethically appropriate in their clinical work. A social worker-facilitated protocol called Reflective Debriefing was developed and tested for alleviating moral distress through regular debriefings with nursing staff on an intensive care unit (ICU). Forty-two ICU nurses completed a Moral Distress Scale-Revised (MDS-R) at the beginning and end of a 6-month period, during which time regular debriefings were offered. The overall level of moral distress on the ICU surveyed was found to be low to moderate. The top three most frequent situations causing moral distress reported by most nurses in this study were related to the provision of nonbeneficial care in the ICU. Participants reported gaining the most benefit from feeling empowered to constructively confront other staff members about truth-telling in giving a prognosis. Nurses’ overall response to the intervention was positive, with 100% of participants requesting to continue the Reflective Debriefing sessions either on a monthly or on an as-needed basis. The response to the intervention emphasized the importance of interprofessional collaboration to successfully combat moral distress among health-care workers and may protect them from burnout, detachment, and even quitting their profession.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

Results of a nationwide hospice and palliative care social work job analysis

The role of the hospice and palliative social worker is often ambiguous and misunderstood by colleagues and fellow team members. One reason for this is the lack of identified, clearly delineated roles, skills, and tasks employed by these specialty social workers in their daily work. This article summarizes the first nationwide job analysis of hospice and palliative social workers. A contextual, cross-sectional survey design was used to identify current and relevant job tasks from practicing hospice and palliative social workers. A sample of 482 social workers representing 46 states responded to a survey that included demographic questions and ranking of 152 tasks and importance to the position. Tasks were categorized into four broad categories: assessment and reevaluation; planning and intervention; death, grief, and bereavement; and professionalism; which includes subcategories consisting of multiple tasks and skills. Respondents identified performing a psychosocial assessment from a patient/family centered care perspective, assessment of the patient’s current and desired quality of life and of coping skills as the tasks most important to their role. This outline of the role of the hospice and palliative social worker was then used in the development of an evidence-based certification exam that may be required of those who want to receive specialty certification in the field.     

Tackling Inequalities in Physical Health: A New Objective for Social Work

Correspondence to Eileen McLeod, Department of Social Policy and Social Work, University of Warwick, Coventry, CV4 7AL, UK. Summary We argue that tackling the impact of social inequality on physicalhealth should become a central objective of social work andintrinsic to the development of anti-oppressive practice. Thisis on three grounds. First, the suffering embodied in inequalityin physical health should be a cause of concern to social workers,as a pervasive social problem. Secondly, awareness of socialwork's complicity in contributing to such a problem, throughits historical role in implementing state policies, needs toinform assessment of social work outcomes. Nevertheless, thirdly,social work—not confined to health care settings—whichredresses social disadvantage and tackles its consequences forphysical well-being can contribute to greater equity in health.Indicative examples of such practice are provided in relationto health maintenance, living with ill health and terminal illness.Finally, consideration is given to the current wider politicalcontext in which social work addressing health inequalitiesis embedded and to the need for complementary organizational,professional and political initiatives to buttress its development.     

Nonpharmacological Pain Management by Ethnically Diverse Older Adults With Chronic Pain: Barriers and Facilitators

As key players in multidisciplinary health care systems, geriatric social workers must understand the dynamics of pain management among older adults with chronic pain. This study identified perceived barriers to, and facilitators for, utilizing nonpharmacological pain management through face-to-face interviews with 44 ethnically diverse community-dwelling older adults. Constant comparative analysis identified barriers not recognized in prior studies: (a) embarrassment/self-consciousness, (b) unavailability of certain treatments, and (c) lack of faith in effectiveness of nonpharmacological treatments. Most frequently reported facilitators were (a) social support, (b) positive attitude, and (c) available resources. Social workers can provide counseling to motivate older adults to exercise to manage chronic pain and refer them to exercise programs tailored for older adults. To resolve the most frequently reported barrier—transportation—social workers can link older adults with transportation services offered by senior centers or other nonprofit agencies.     

Responding to the 2015 CMS Proposed Rule Changes for LTC Facilities: A Call to Redouble Efforts to Prepare Students and Practitioners for Nursing Homes

In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

Deregulation,workplace, and women: Nurses in private health care in India

The paper examines the growth of private health care in India in the context of its regulatory provisions and questions the work and employment conditions of female care workers (nurses) employed there. Nurses constitute 80% of the total workers in each nursing home/hospital. In the wake of increased demand for private health care since mid‐1990s, insertion of technology and investment is inducing transformation of nursing homes into multi‐ and super‐speciality hospitals resulting in changes in work organization of nurses. This has led to demand for larger numbers of workers. Employers gain by the segmentation in the nursing labor market, paying low wages. Workers face widespread social discrimination, long working hours, and high work intensity. The deplorable situation of a significant section of workers employed in this sector indicates state failure to control the private health sector. Lack of effective standards of work impacts nature of work of the workforce employed in various levels in the healthcare system.     

Social support and stress of kin caregivers of orphaned children in Addis Ababa,Ethiopia: Implications for practice and policy

Using a mixed methods research design, this study analysed available social supports and stressors among 127 kin caregivers who were caring for HIV‐ and AIDS‐affected orphans and vulnerable children in Addis Ababa, Ethiopia. The conceptual framework of the study was social support viewed as a buffer. Kin caregivers’ scores indicate a low level of social support and a high level of stress. The amount of support caregivers received from formal sources is considered inadequate, irregular and inconsistent. Kin caregivers’ stress is situational and largely related to poverty, especially food insecurity. Social service providers should consider programmes that strengthen support to help kin caregivers deal with major stressors. Policy makers should ensure that both specific child and caregiver supportive policies and related programmes respond to the overwhelming numbers of orphans and vulnerable children in Ethiopia through explicitly acknowledging the significant role of kinship care.     

“Build a friendship with them”: The discourse of “at‐risk” as a barrier to relationship building between young people who trade sex and social workers

Young people in statutory care and protection interact with social workers, who hold potential to provide a supportive adult role in their lives. Many however, run away at an early age and end up on the street trading sex for money or other favours. There is potential to improve outcomes for young people in care if the relationship between young people and their social workers is better addressed. This paper uses data from a qualitative study of 14 young people who traded sex and who had experienced interactions with social workers. A thematic analysis identified three themes: the rigidity of social work practice; contesting the family situation; and resisting the at‐risk label. We argue that to have any impact on outcomes for young people in care, social workers need to prioritise relationship‐building above the need to conform to organizational protocols and guidelines. Such guidelines assist the social worker in assessing whether family situations pose high risk for a young person, but the “at‐risk” label is contested by young people, which results in a lack of trust and a barrier to relationship building.     

Would Palliative Care Patients Benefit from Social Workers' Retaining the Traditional 'Casework' Role rather than Working as Care Managers? A Prospective Serial Qualitative Interview Study

Social workers have made a significant contribution to the developmentand delivery of palliative care. Both palliative care and socialwork are rapidly evolving but, given their changing contextsand increasing workloads, can they sustain compatibility? Advancesin treatment of life-threatening illness mean that people livelonger in a period of palliative care. Social work has undergoneradical change in the wake of the 1990 NHS and Community CareAct and subsequent local-authority modernizations, with socialworkers now given the role of care managers, rather than themore traditional ‘casework’ or therapeutic role.This paper aims to explore the current and potential role ofthe social worker in palliative care for people with cancerand other prolonged life-threatening illness. It draws uponevidence from a prospective qualitative, patient-centred researchstudy, which detailed the experiences of forty people with lungcancer and advanced cardiac failure, and their personal andprofessional carers (Murray et al., 2002). A total of two hundredand nineteen qualitative interviews were carried out. We found that social workers were conspicuous by their absencefrom the lives of these forty vulnerable adults, who were livingand dying in the community with many unmet needs which, potentially,could be met by social-work input. The study highlights sixareas of concern in which social-work assessment and interventioncould have impacted on dying patients’ quality of lifeand that of their carers: loss and dependency, family-centredissues, carers’ needs, practical tasks, emotional andspiritual struggles, and finally, support needs of staff. Theseareas are outlined to explore the territory which a social workermight inhabit if resources and policies permitted.