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.     

FACTORS AFFECTING THE POST-HOSPITAL CARE PLANNING OF ELDERLY PATIENTS IN AN ACUTE CARE SETTING

Post hospital care decision making is an issue for a vast number of elder persons and yet has received little attention from social work professionals. This paper reviews literature regarding attitudes of professionals, family members and patients themselves toward decision making in a hospital context. Furthermore, an exploratory study involving 40 hospitalized elderly patients highlights the potential risk in limiting patient involvement and identifies implications for practice with the elderly.     

Foster Family Care for Frail Elderly

For the last 10 years, the development of cost-effective, community alternatives for chronically ill has been a serious concern of many service providers and policy-makers. The expanding of the elderly population has been well documented. In this state, projections show a need for an additional 1602 long-term care beds by the year 2000, almost double the current capacity. The state Medicaid Program is searching for ways to reduce the 50 million spent in 1982 for institutional long-term care. Already experiencing the shortage of long-term beds, hospitals have a chronic loss of revenue potential through the holding of non-acute patients in the hospital while waiting for a nursing home bed vacancy. At the 500 bed acute care hospital, 25-30 beds daily are occupied by nursing home wait-listed clients. The average wait-listed days per patient is 20.4. In September 1979, the hospital's department of social work began foster family care for elderly persons eligible for nursing home care. Foster families are extensively screened and trained for the severely dependent clients. The social worker and registered nurse team are closely involved in placements, developing and implementing an individualized written treatment plan to assure the clients quality of care. Data collected over the past three years clearly indicates that this setting provides cost-effective, quality care. Overall scoring on bathing, dressing, toileting, transfer, and continence, utilizing the KATZ Activity of Daily Living, shows that 71% of the clients improve after 3 months on placement. Although 45% of the clients are incontinent of bowel or urine at the time of placement, 33% make significant improvement to only occasional accidents. With 41% of the clients at placement requiring adaptive device and assistance for walking, 48% of the clients show functional improvements in walking. Most significant for continued survival of this type of care, the total program cost is half the cost of institutional care for these elderly clients. The paper will examine the multiple needs served through the program: the ill elderly person's need of a therapistic, caring environment; the hospital's need to curb loss of potential revenue; and the need of the Medicaid Program to contain costs. The paper also reviews client characteristics, foster family characteristics, quality assurance, and overall cost-effectiveness of the foster family model.     

Social services provided for physically abused children in Sweden: background factors and interventions

This study aims at describing and analysing what kinds of social services are provided for physically abused children in Sweden. The social services files were examined for 113 children under 15 years of age (67 boys and 46 girls) who had been reported to the police as having been physically abused by a parent or equivalent caretaker in a particular police district. The children's social services files indicated an increased risk of a parental abusive behaviour prior to the abuse incident. There had been former interventions in 81 per cent of the families and previous reports on neglect or abuse in 44 per cent of the 113 families. After the abuse incident, investiga-tions were opened in 80 per cent of the cases. The three most common interventions were placement in foster care, referrals to Child and Adolescent Psychiatric Service and Social Services support contacts. The study shows that there was a tendency towards more proactive work with injured children, children of immigrant parents and children of mentally ill parents.     

Applying critical social work in direct practice with families

This paper seeks to further discourse concerning the implications of critical social work for direct practice with families and children. It presents and discusses a hypothetical example of how a social worker in a social care agency in Israel can incorporate critical social work notions into an official social work report. The paper begins by presenting key concepts in critical social work, their manifestations in practice and their implications for official social work reports. It then presents a mock report informed by critical social work ideas and discusses its structure and contents. The mock report provides an example of how abstract notions central to critical social work can be actualized. The paper thus offers practitioners the opportunity for a richer discourse on the contribution of critical social work to direct practice with families and children.     

The Heterogeneity of Socially Isolated Older Adults: A Social Isolation Typology

Recent statistics show a growing number of older adults who are living alone and are socially isolated. It is against this background that, in recent years, many interventions have been developed to address social isolation among the elderly. Evaluative studies show that most interventions are hardly effective, though. An important reason for this is the heterogeneity of the socially isolated. This article offers insight into this heterogeneity by presenting a typology with different profiles of socially isolated older adults and the intervention implications of this typology. The typology is derived from an extensive qualitative study on socially isolated elderly individuals in the Netherlands. The typology imposes some degree of order to a diversity of circumstances, ambitions, and possibilities of the socially isolated elderly, thereby deepening the understanding of the heterogeneity of this population. The definition of social isolation used in this study starts from a societal angle of incidence, namely the current policy context of Western European welfare states, in which governments emphasize the importance of independence and self-reliance of their citizens. Developed from that perspective, the typology provides a theoretical basis for applying interventions aimed at increasing self-reliance of social isolated elderly. This perspective on social isolation also has consequences for the way in which the effectiveness of interventions to alleviate social isolation is assessed.     

The Olmstead decision and the journey toward integration:the evolution of social work responses

The Olmstead decision declared unnecessary institutionalization as discrimination and triggered an expansion of community-based care for all people with disabilities including the elderly, thus accelerating integration. Setting a context for Olmstead and related social work interventions, this paper describes the evolution of definitions of disability and examines how social work has responded to the development of critical social policies aimed at increasing community integration.     

Elder Abuse in Turkey and Associated Risk Factors

Abstract

Elder abuse is one of the most important problems encountered by the elderly. Health, economical and psychological dimensions of the experience of aging also pose risk for elder abuse. This study aims to determine the abuse to which elder people are exposed based upon their own evaluations and to investigate the risk factors associated with elder abuse. This is a cross-sectional study among quantitative designs. Population of the study comprises 309 outpatient elders over the age of 65 referring to Ayd?n Do?an Geriatrics Clinic of Ankara University, Turkey. Collected data were analyzed by chi-square test and logistic regression. In total, 70.9% of the elderly participating in this study experienced abuse more than once. Majority of the participants were victims of emotional abuse (64.1%), followed by neglect and abandonment (26.9%) and economic abuse (12.6%). There was significant relation between sex, marital status, health status of the elderly and being abused (p?p?相似文献   

Deciding to Use the Emergency Room: A Qualitative Survey of Older Veterans

Increasing use in the past decade has created pressure for hospital emergency rooms (ERs). Healthcare provided through an ER is expensive and is not designed to meet the complex needs of an older, chronically-ill population. ER visits are presented as the outcome of a decision-making process. Thirty veterans who had visited the ER in the previous year were asked about their decisions to use the ER. Their responses reflected four distinct approaches to ER use, which are characterized by frequency (frequent/infrequent) and risk for social isolation (low/high). Appropriate interventions by social work personnel might reduce inappropriate use of the ER and enhance the care of this vulnerable population.     

Deciding to use the emergency room: a qualitative survey of older veterans

Increasing use in the past decade has created pressure for hospital emergency rooms (ERs). Healthcare provided through an ER is expensive and is not designed to meet the complex needs of an older, chronically-ill population. ER visits are presented as the outcome of a decision-making process. Thirty veterans who had visited the ER in the previous year were asked about their decisions to use the ER. Their responses reflected four distinct approaches to ER use, which are characterized by frequency (frequent/infrequent) and risk for social isolation (low/high). Appropriate interventions by social work personnel might reduce inappropriate use of the ER and enhance the care of this vulnerable population.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.     

SOCIAL INTERACTION AND MORALE OF SPANISH-SPEAKING RURAL AND URBAN ELDERLY

Considered in this survey study is the social interaction of rural and urban Spanish elderly with their kin in a northern New Mexico county. Generally rural elderly were visited significantly more than their urban counterparts. Implications about the modernization of the Mexican-American family are drawn.     

The Value of Pets in Geriatric Practice

Abstract

A program designed to help elderly pet owners is succeeding in areas unrelated to pet care. The relationships that seniors establish with the coordinating social worker and participating volunteer create opportunities in other areas. The program establishes a social work connection which can be tapped in an emergency and enhances socialization through volunteer visits. Program participation may also reduce the severity of housing problems and provide a chance to discuss end-of-life issues. Implications for policy and practice are discussed, including the importance of acknowledging the central role of a pet in the lives of many elderly people.     

Double jeopardy: the link between child abuse and maternal depression in child and family social work

The link between child care and mental health problems in social work clients has begun to attract some attention. Despite some review articles, research is, as yet, at a very early stage of development. Maternal depression and child care problems in particular appear likely to be closely associated. This paper focuses on the link between maternal depression and the most severe of child care problems: child abuse. The paper shows a significant relationship between maternal depression and child abuse. It explores this relationship by distinguishing three groups: families where no abuse had occurred (non abuse families), families where abuse had occurred but where the mother was not depressed (non depressed-abuse group) and families where both child abuse and maternal depression were present (depressed-abuse group). The depressed-abuse group are shown to be considerably worse off than both the other groups for a range of measures, including indices of deprivation and range and severity of social problems. The depressed-abuse group were also more chronic users of services and consumed far more resources than the other two groups. Remarkably, there were few differences between the non abuse group and the non depressed abuse group in nature and severity of problems and intervention. Depression in mothers, then, provides the major distinction between families where abuse was an issue compared with families where abuse was not present. Such families are characterized not simply by maternal depression and child abuse, but frequently by abuse of the mother herself, who is often socially isolated. These findings are of major importance for child care practice, indicating that working with the mother's depression and the social conditions that provide its backdrop, are a major aspect of social work practice.     

The Application of Family Systems Theory to Geriatric Hospital Social Work

Integrating and applying Family Systems Theory principles into the assessment and treatment process of families of hospitalized high risk elderly is an area that has received little attention in health care literature. The multigenerational approach is a model that can be used as a clinical framework for guiding the social workers in developing intervention strategies when working with hospitalized high risk elderly and their families. This approach can be extended to clinical assessment techniques and psychosocial rationales for discharge planning. Three case examples are presented to illustrate how Family Systems Theory can be integrated into social work practice resulting in effective interventions for hospitalized high risk elderly and their families.     

An Exploratory Study of Social Work with Older Persons in Cuba

Abstract

Assuring a satisfactory quality of life for Cuba's large and fast growing older population is a national challenge. Social work plays an important part in addressing this challenge through its role in Cuba's National Program for the Care of Older Persons. This article explores the role of social work in Cuba's programs for the elderly and its implications for social work practice in the US. The information was obtained from 25 qualitative interviews with policy makers, social work practitioners, and community members in Havana, Cuba in 2003. The community oriented and interdisciplinary nature of Cuban social work with older persons distinguishes it from social work in the US and has implications for social work in this country. Despite the differences between Cuba and the US, the Cuban social work model provides important insights for social work in this country.     

A New Look at Home Care and the Hospital Social Worker

Clinical, administrative and social action reasons for expanding social work services in hospital based home care programs are persuasive. Hospital departments of social work should consider carefully how they may expand services in home care and coordinate and integrate such activities with social work and discharge planning processes occurring throughout the hospital. It is necessary for social work leadership to be present on professional advisory, quality assurance and similar committees and to use these committees as arenas for expanding the social work role in home care.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.     

The Perception of Organizational Issues of Social Work Practitioners in Saudi Hospitals

ABSTRACT

Health care has evolved rapidly in Saudi Arabia, based upon a Western model of service that incorporates multidisciplinary professional teams. Social work practice forms part of patient care. This study explores how Saudi social workers perceive their role and how they describe their practice within the hospital context. A quantitative methodology was employed using a self-administered questionnaire. Analysis revealed that 219 social workers perceived formidable limitations to their daily work practice. The study identified factors relating to the hospital's organizational circumstances where a) organizational structural aspects, b) organizational resources, and c) hospital management and interprofessional teamwork impacted best practice. Future research and recommendations for further study are outlined.