The Family Group Within the Nursing Home:

An ongoing monthly family group was implemented in an intermediate care facility in hopes of improving communication between staff and families of long term care residents. Other objectives of the group were to provide families with information about policies and procedures, education about the aging process, and to facilitate an informal support group network where families could share problems and concerns. The feedback and evaluation process indicated that sharing feelings of anger, quiet, frustration and other emotions helped the families deal with the responsibilities of institutionalizing a relative and helped to facilitate better communication between staff and family members.     

Comparing Families and Staff in Nursing Homes and Assisted Living: Implications for Social Work Practice

Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic. Data from 488 families and 397 staff members in 24 settings examined family involvement and family and staff burden, depressive symptoms, and perceptions; and staff absenteeism and turnover. There were few differences across setting types. Although conflict rarely occurred, there was room for improvement in family–staff relations; this area, and preparing family for their caregiving roles, are appropriate targets for social work intervention.     

‘She was like a mother and a father to me’: searching for the ideal mentor for youth in care

Recent studies of youth in out‐of‐home placements have indicated that a successful mentoring relationship in care is associated with better emotional, educational and behavioural outcomes in adulthood. The goal of this exploratory qualitative study is to describe the profile of a staff member who is able to establish a meaningful relationship with youth in care through the perspectives of 20 young adults aged 21–26 who left care in Israel. Findings revealed that the staff member who formed meaningful relationships with youth was the staff member who was available to the youth and familiar with their personal backgrounds, who was able to see them as positive and trustworthy and to provide guidance and support from a non‐judgmental approach. One of the study's conclusions is that staff members who were able to transform their connection with the youth into mentoring relationships were those who were able to make the youth feel as if they were the staff member's own children, and as a result feel cared for deeply and loved. The discussion addresses the barriers in forming a mentoring relationship with a formal professional and the ways to utilize these mentoring relationship components more effectively within the care system.     

A good death for residents of long-term care: family members speak

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistency as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

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.     

Older People's Family Contacts and Long-term Care Expenditure in OECD Countries: A Comparative Approach Using Qualitative Comparative Analysis

In recent decades there has been a suggestion that public and private long-term care (LTC) expenditure might be replacing traditional family care for older people. The decline of family contact is known to be more advanced in some OECD countries than others, with southern Europe identified as where family contact is still strong. This article explores at a country level whether there is an association between levels of expenditure on long-term care and the availability of family contacts. Qualitative Comparative Analysis is used as a comparative method, so as to use national quantitative indicators with a small sample of countries. An association between higher levels of family contact and lower levels of expenditure on LTC is suggested, but it is weakened by a number of untypical cases. Countries that defy this relationship have government care policies that seek to promote informal social care through the family contact that continues to be available. Austria, Canada, Great Britain and Japan are discussed in this context.     

Women and the Family in the British Welfare State: The Thatcher/Major Legacy

This paper reviews the moral agenda of Thatcherism, in terms of maintaining traditional family structures, family roles and family responsibilities for economic support and personal care of family members. It asks to what extent and in what ways this agenda was promoted during the eighteen years of Conservative rule; to what extent contradictory forces within Thatcherism and elsewhere undermined this agenda; and what have been the consequences for women in family and public life. The marketization of life, pursued under Thatcherism, contributed to undermining the family form which has traditionally underpinned the market. Deregulated labour markets and spreading owner-occupation in an unstable housing market have been important contributions to family breakdown, insecurity and women's access to—and need for—jobs. The idea of family responsibility was promulgated, but in practice family members have become less able to support each other.
Nevertheless, one consequence of these changes has been a stronger position for women as women by the end of this Conservative era. Access to paid work makes women less dependent within families and improves their access to public politics. Social policies geared to the Beveridge-type family had become increasingly threadbare and some changes—such as policies enabling lone mothers to do paid work—had been forced by the increasing mismatch between family realities and the Beveridge model. Many changes owed more to the women's movement than to Thatcherism, but Thatcherite policies played a (largely unintentional) part.     

Social protection as a mechanism for family protection in sub‐Saharan Africa1

Mokomane Z. Social protection as a mechanism for family protection in sub‐Saharan Africa In sub‐Saharan Africa (SSA), the extended family has for generations been the basis for the sustenance of society, offering material, social, emotional and care‐giving support for its members in times of need and crisis. Over the years, however, this institution has been affected by demographic and socio‐economic transformations that have continued to take place in the region. This article illustrates how these changes have contributed to family circumstances that are characterised by economic fragility, debilitating poverty and weakened family support for household chores and care‐giving responsibilities. The article argues that the development and provision of more comprehensive social protection policies and programmes in SSA can help mitigate the impact of the changes on families and their members.     

Family Visiting with Institutionalized Mentally Impaired Aged

The nature and frequency of interaction between 43 mentally impaired aged residents in a long term care facility and their relatives was studied. It was found that in most cases the frequency of visiting remained stable over time, and in addition, the relatives combined visiting with other tasks-gift giving, assistance with grooming, etc.-on behalf of their family members. The artice includes recommendations for institutional staff help to these relatives as they cope with the continuing decline of the aged person.     

Family perspectives on the hospice experience in adult family homes

Growing numbers of terminally ill older adults receive hospice services in adult family homes (AFHs); however, little is known about the provision and receipt of end-of-life care in such environments. This article reports findings from a qualitative exploration of family members' perspectives of the hospice experience in AFHs. Analysis of data obtained during interviews of 15 residents' family members exposed significant challenges associated with transition to an AFH, highlighted the importance of AFH and hospice staff in family members' assessment of overall quality of care, and emphasized the critical nature of communication in AFH settings.     

A secure base? The adolescent–staff relationship in secure residential youth care

The client–therapist relationship is recognized as an important factor contributing to outcomes of child and youth care. Particularly in secure residential youth care, in which adolescents with mainly externalizing behaviour problems are often placed coercively, the client–staff relationship seems to be important for the achievement of positive outcomes. The present study aims to assess the client–staff relationship for a group of 135 adolescents in secure residential care and factors associated with a positive relationship. The results show that adolescents, group care workers and teachers experience a limited affective bond in their relationship 2 months after the adolescents were admitted to the secure care centre. Adolescents do tend to use care workers and teachers as a secure attachment figure, which suggests that an affective bond is no precondition for the adolescents to experience staff as a secure base. Main predictors of a good relationship are the positive treatment skills of both group care workers and teachers. These findings point to the need for training of care workers and teachers so that they are better prepared for working with these adolescents.     

The 'Consumer Principle' in the Care of Elderly People: Free Choice and Actual Choice in the German Welfare State

In the mid-1990s, together with new long-term care legislation, the German welfare state introduced care markets and consumer choice between family care and different types of formal care. However, instead of using the new option to choose publicly funded care by long-term care agencies, the majority of elderly people in need of care continued to decide in favour of care exclusively provided by family members. The article examines how the persistence of family care in spite of the new options of consumer choice can be explained, using data from representative surveys on the care of elderly people in Germany and the results of guided interviews by the authors with family members involved in care. The findings indicate that there are two main reasons. The first is that elderly people and their families orient their behaviour towards traditional care values in which the first priority is given to mutual support between spouses and generations. The second reason is that elderly people on the one hand and care agencies on the other have substantially different definitions of a good quality of care.     

Child protection in China: Changing policies and reactions from the field of social work

This article offers a general review of the development of national policies on child protection in China. It offers an in‐depth analysis of related legislation enacted between 2010 and 2015 that have had an impact on child protection and related historical, cultural and legal issues. Furthermore, in the study we examined the emerging role of social work in preventing and responding to child abuse and neglect in China. Major findings of the research include: (i) policies concerning child protection have been highly influenced by Confucianism and its perspective of the child as family property; (ii) child protection regulations on accident reporting, custody transfer, and surrogate care are gradually being refined and improved, although the legal system for child protection is still incomplete and needs further substantiation; and (iii) the involvement of non‐governmental organisations (NGOs) and social workers has enhanced the child protection system. Key Practitioner Message: ? Policies concerning child protection have been subject to an immense impact by Confucianism, placing strong responsibility on family members in providing childcare although the child is viewed as part of the family's property; ? After 1949, the newly founded socialist political structure began to exert a significant influence on welfare and child welfare policies. Because the Confucian perspective emphasised family and parental responsibility, government in China has traditionally not been heavily involved in policies that interfere in the internal workings of families; ? Since the shift toward an open‐door policy in 1979, child protection policies in China have begun to develop, with a child welfare network gradually spreading to cover the majority of children. Moreover, child protection is generally supported by the legal system, within which regulations on accident reporting, custody transfer and surrogate care are gradually being refined and improved. However, despite the huge progress achieved in recent years, there are significant deficits in its implementation and monitoring; ? The involvement of non‐governmental organisations (NGOs) and professional social work services has promoted a child protection system.     

The Local and the National in Community Care: Exploring Policy and Politics in Finland and Britain

International literature on community care tends to focus on the national level of welfare institutions and policies. However, community care is largely a locally tailored service and this paper makes a case for local comparisons of community care policies. Using local case studies from Finland and Britain, the paper argues that focusing on the local level contributes to the comparative study of community care in two ways. First, local comparisons highlight the often distinctively local nature of community care policies and thereby add to our understanding of community care. Second, local comparisons extend existing cross‐country explanations of community care by showing that community care is largely shaped by local politics, together with indirect structuring by national contexts. As such, the local case studies highlight the importance of the relationship between policy and politics, which has often been neglected in comparative research.     

老年人日常照料的角色介入模型

本文在总结国内外老年人照料研究的基础上,提出老年人日常照料的角色介入模型,其核心是三个规律：即（1）成本命题：一个角色介入老年人日常照料的成本越大,其介入照料的概率就越低;（2）邻近命题：与被照料者的地理和社会邻近度越高,照料角色介入的可能性就越高;（3）责任命题：对被照料者的责任感越高,照料者介入的可能性就越大。由此三个命题所延伸出的六个假设,通过多元正态概率模型对2000年“中国城乡老年人口状况一次性抽样调查”的原始数据进行分析,结果显示,多数假设得到数据的支持。这一研究结果对厘清老年人照料的社会化和家庭照料之间的关系及其理性的公共政策选择,提供了新的视角和理论依据。     

Caregiving in Transition in Southern Europe: Neither Complete Altruists nor Free-riders

In the framework of the SOCCARE Project, focusing on families dealing with a double front of care for children and frail elderly people, similarities can be found in Italy, France and Portugal beyond their different welfare regimes. The comparison of family histories and caregiving strategies, by the methodology of case‐matching, gives an interesting overview of the relationship between the debate on social care and that on the intergenerational contract. The paper aims to understand which are the available combinations of family, informal and institutional resources making a heavy burden of care “acceptable and still normal”: this focuses both typical situations of each country and common features through the countries. The results show how changes in the representations of obligation and duty in the intergenerational pact produce different outcomes and demands in welfare systems. The analysis of shifting boundaries between the public and private spheres in care provides useful policy recommendations, aimed at improving choices and “sustainable” responsibilities of individuals, families and social networks. Sustainable policies seem to be more dependent on family and structural types and resources of networks than on different welfare and services support.     

Parallel Service Delivery in Community Long-Term Care

Using data collected in a state-wide study of adult day care (ADC) in Pennsylvania and indices of technicality, routinization and service provision, this study examined the interventive relationship between ADC program staff (n = 59) and participant caregivers, (n = 67). The analysis found the relationship between formal and informal networks to be one of parallel service delivery rather than complementary roles with caregivers providing a wider range of services more frequently than program staff (t = 6.91, p < 601).     

Kin Visiting and the Biological Attachment of Long-Term Foster Children

This study examines the relationship between visiting by extended family members and biological family attachment for 92 long-term foster children. Correlation and regression analyses revealed that kin visiting has a significant association with family attachment. The effect kin visiting has on the foster children's family attachment is independent of the influences foster family attachment, parental visiting and age at placement have on the relationship. The findings highlight the importance of biological family involvement for children in placement.