Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

Toward Empowerment: ReVisioning Family Support Groups

ABSTRACT

Family support groups (FSG) have been recognized as an important and viable means for responding to the needs of family caregivers. How these groups work, however, is not well understood. The purpose of this qualitative exploratory study was to explore the impact of attending a family support group on the caregiving experience from the perspective of the family member. Personal, semi-structured interviews took place with eleven family members who had participated in at least one FSG. Data was analyzed for themes, using a constant comparative categorizing strategy. This analysis suggests that attending a FSG impacts the caregiving experience in four important ways: helping the family member to construct a self-identity as a ‘caregiver’; promoting a sense of personal competence; fostering the use of formal support groups; and creating a community context within which to experience the caregiving role. Cumulatively, these have the potential to contribute to a sense of empowerment for the family member by helping him or her to reposition the caregiving experience as more than a personal issue and promoting the emergence of a more collective voice.     

Caregiver Isolation

Abstract

Caregiving to a partner with Alzheimer's disease results in isolation, which impacts on the help/service seeking behaviors of care givers. In-depth interviews done with caregiving wives found that they experienced multiple dimensions of isolation. A tentative ecological model of the dimensions of caregiver isolation is proposed. Research participants did not engage early in supportive help because they were not aware of their isolation, did not know about available supports, and were not identified by medical or social services personnel as needing support and assistance. Social workers need to be aware of the isolating effects of caregiving and reach out to caregivers to avoid or lessen isolation in their caring role.     

Perspectives on family caregiving of people aging with intellectual disability affected by dementia: Commentary from the International Summit on Intellectual Disability and Dementia

ABSTRACT

This article, an output of the 2016 International Summit on Intellectual Disability and Dementia, examines familial caregiving situations within the context of a support-staging model for adults with intellectual disability (ID) affected by dementia. Seven narratives offer context to this support-staging model to interpret situations experienced by caregivers. The multidimensional model has two fundamental aspects: identifying the role and nature of caregiving as either primary (direct) or secondary (supportive); and defining how caregiving is influenced by stage of dementia. We propose staging can affect caregiving via different expressions: (1) the “diagnostic phase,” (2) the “explorative phase,” (3) the “adaptive phase,” and (4) the “closure phase.” The international narratives illustrate direct and indirect caregiving with commonality being extent of caregiver involvement and attention to the needs of an adult with ID. We conclude that the model is the first to empirically formalize the variability of caregiving within families of people with ID that is distinct from other caregiving groups, and that many of these caregivers have idiosyncratic needs. A support-staging model that recognizes the changing roles and demands of carers of people with ID and dementia can be useful in constructing research, defining family-based support services, and setting public policy.     

Long-Term Care of Older Adults in Malta: Influencing Factors and Their Social Impacts Amid The International Financial Crisis

ABSTRACT

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although public-private partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources.

Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on state-provided care, use of expensive private care, and waiting lists to secure services.     

Deciding to Institutionalize: Caregiving Crisis,Intergenerational Communication,and Uncertainty Management for Elders and Their Children in Shanghai

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.     

Haudenosaunee Grandmothers Caring for their Grandchildren: The Process of Assuming the Caregiving Role

The purpose of this grounded theory study was to understand the processes, motivations, and reasons for Aboriginal grandmothers assuming the full-time caregiving role for their grandchildren. Fifteen Haudenosaunee grandmothers who were from the Six Nations community participated in this study. The results indicate that a series of complex factors, circumstances, and processes contributed to them caring for their grandchildren. Of particular significance is that, prior to assuming their full-time caregiving roles, they had intermittently cared for their grandchildren as a means of preventing family breakdown. Many of them were accustomed to this type of care arrangement as over half of the grandmothers had been cared for by their grandmothers or great-mothers. Ultimately, they cared for their grandchildren as a means of “keeping the state’s hands off” their grandchildren and avoiding child welfare involvement. Furthermore, the women in this study served as important vital roles for healing in Aboriginal families and communities.     

A Survey of the Unmet Needs of Homebound Elders

Abstract

In conjunction with the 1995 White House Conference on Aging (WHCoA), the authors conducted a study of 917 homebound elders in one state in order to determine whether medications and medical care were always affordable and accessible, and how nursing home care would be paid for if needed. For more than two-fifths of the sample, paying for physicians' services and medications, as welt as locating reliable medical transportation was problematic at times. A similar proportion did not know where they would turn for assistance if family and friends were unavailable. Although Medicare only pays for up to 100 days under certain circumstances, more than half of the sample projected that Medicare would pay for nursing home care if it was needed. The authors conclude by discussing the WHCoA resolutions and resulting social policy implications.     

Service Barriers of Chinese Family Caregivers in Canada

ABSTRACT

Family caregiving is a stressful process, especially when the complexity of being an immigrant or ethnic minority is added. This paper examined service barriers experienced by Chinese immigrant family caregivers in Canada and the predictors of different types of barriers. Principle component analysis was performed with the barriers reported loading onto cultural barriers, administrative problems, circumstantial challenges, perceived negative quality of services, and personal attitudes. Multiple regression analysis was used to identify the role of the culture-related factors in predicting service barriers, controlling for socio-demographic status of the caregivers'. The results show that financial factors significantly predicted the number and types of barriers reported by the caregivers. Culture-related factors were significant in predicting the total number of access barriers and the different types of barriers experienced by the family caregivers. The findings indicate the importance of culturally sensitive support for family caregivers in order to reduce the access barriers.     

An Analysis of Supervisor Support of Policies on Workplace Flexibility

ABSTRACT

Workplace flexibility policies provide workers with an opportunity to attain a healthy work–life balance. This study utilized a secondary data set of 658 supervisors from a study that was commissioned by the work–life office of a major university in the Southern United States to get a better understanding of the implementation of flexibility policies at this university. The purpose of examining this secondary data set was to determine whether supervisors who have caregiving responsibilities are more likely to be supportive of workplace flexibility policies than those with no caregiving responsibilities. The findings indicate that supervisors who have caregiving responsibilities are no more likely to be supportive of workplace flexibility than those with no caregiving responsibilities. This finding is important to those who have a vested interest in understanding factors that may promote or undermine workplace policies that have direct impact on workers and their families. Future research and recommendations for practice are made.     

Social Policy and the Politics of Hispanic Aging

Abstract

This study examines the contributing factors to job satisfaction and commitment among lower-income, older (age 55 and over), part-time employees (N = 164). Job satisfaction index (JSI) scores were relatively high for all subjects and did not differ significantly for age, gender, or Senior Community Service Employment Program (SCSEP) status. While not particularly low, white employees were significantly less satisfied with their employment experiences than Hispanic or African American workers. The scarcity of fringe benefits was the least satisfying aspect of employment. Older Hispanics, whites, and men reported less interference between job, family, and home life than African Americans and women. Multiple regression analysis revealed that race/ethnicity, skill utilization opportunities, perceived views of elders held by younger workers and supervisors, availability of fringe benefits, and suitable work days explained the majority of variance in JSI scores. Opportunities to interact with others and stay active were more important than financial supplementation in these elders' assessment of the benefits of part-time employment. Findings provide further understanding of those elders likely to be placed successfully in part-time employment.     

The Elder Latino Population in Holyoke,MA

Abstract

Holyoke's elderly Latino population's needs, as well as their patterns of service utilization, were explored through detailed interviews of 13 individual elders and a focus group of an additional 10 participants. The research uncovered a gap in the web of resources available, with some services, such as medical care, functioning well. However, there continue to be unmet needs, particularly in the areas of transportation, social and recreational activities, and sense of safety. Negative perceptions of aging and complaints of anxiety, depression, and boredom are also an area of concern.

The barriers to use of services were also explored. Recommendations for the enhanced provision and utilization of services, many suggested by the elders themselves, are offered. Implications for social work research and policy on, and practice with, Latino elders are discussed.     

Intergenerational Care Perceptions of Older Women and Middle Adolescents in a Resource-Constrained Community in South Africa

ABSTRACT

This study describes intergenerational care perceptions in a resource-challenged community. Ten women (aged 60+) and eight middle adolescents (3 boys and 5 girls) participated in the Mmogo-method®, a visual data-collection method. Textual data were analysed thematically, and visual data by applying Roos and Redelinghuys (2016) proposed steps. Both groups provided physical and instrumental care to the other. Older women cared for adolescents by teaching and disciplining them, while the adolescents cared for them by obtaining an education and by showing respect. Older women felt being cared for when adolescents helped them, obeyed and complied with instructions and discipline, while the youngsters expressed it when their basic needs were addressed and school attendance was enabled. Older women’s expressions of caring about were vague, while the younger people detected, act and elicited reactions from the elders. The adopted care approach informed care perceptions. Joint intergenerational activities are proposed to discover care currencies and contributions of generational members.     

ELDERLY HUSBANDS CARING AT HOME FOR WIVES DIAGNOSED WITH ALZHEIMER'S DISEASE: ARE MALE CAREGIVERS REALLY DIFFERENT?

In Australia, there is a dearth of literature available on men as principal carers despite reports which show that in the 60 + age group, looking after a sick spouse becomes the major form of caregiving and men as carers predominate (ABS, 1993). The paper reports findings from a study of 26 aged husbands who cared at home for their cognitively impaired wives. In‐depth interviews collected quantitative and qualitative data about men's caregiving experiences. Findings challenge the literature about the role gender plays in evoking care and service responses. Results show how men demonstrated a strong injunction to care, performed intimate personal care tasks competently, received limited government support and derived some satisfaction from the caregiving role. Despite similarities between male and female caregivers being noted, some gender differences in the way in which men approached the care role are described. The need for community care policies to be more sensitive to the gendered context of elderly care provision is discussed.     

Unexpected Caregiving in Later Life: Illuminating the Narratives of Resilience of Grandmothers and Relative Caregivers through Photovoice Methodology

ABSTRACT

This research study implements photovoice methodology with unexpected caregivers to illuminate the lived experiences of female grandparents and relative caregivers who are raising young children in the later stages of their life. As they enter older adulthood, grandmothers are increasingly finding themselves taking care of their children’s children for various reasons, including, but not limited to, their adult child’s incarceration, mental health issues, drug and alcohol addiction, or child abuse or neglect. Informed by various feminist theoretical lenses, we use photovoice methodology to highlight the narratives of resilience and explore the ways in which grandmothers re-conceptualize their roles and identity as an unexpected caregiver and the sources of strength and resilience that inform the ways in which they navigate the various circumstances in their lives.     

Grandchildren Caring for Grandparents: Modeling the Complexity of Family Caregiving

ABSTRACT

This study focuses on grandchildren (Generation 3 or G3) caring for grandparents (Generation 1 or G1) and uses agent-based modeling to conceptualize and test a model of two factors—capability and motivation—that may affect a G3's decision to provide care for a G1. We tested our conceptual model and found that the simulated proportion of G3 caregivers has concurrent validity with existing empirical data. In experiments conducted with the validated model, we investigated universal- and targeted-policy changes (tax credit for caregivers) and found that although the universal-policy change increased G3 caregiving overall, a policy change targeting low- and middle-income caregivers was even more successful.     

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.     

Quality of Life among Compound Caregivers and Noncompound Caregivers of Adults with Autism

ABSTRACT

Children diagnosed with autism spectrum disorder (ASD) are reaching adulthood and require some form of lifelong care. Many parents continue caring for their adult children with ASD for as long as physically possible. As parents age, many also may provide care for another loved one, such a spouse or parent. This study compares compound (those providing care for multiple loved ones) and noncompound parental caregivers (those providing care solely for an adult child with ASD) on six dimensions of quality of life (enjoys life, life is meaningful, ability to concentrate, accepts bodily appearance, satisfied with self, and frequency of negative feelings). Specifically, this study determined the extent to which compound and noncompound caregivers’ quality of life differed. The present study included 320 parents (age 50 or older) of adult children (18 or older) diagnosed with ASD who completed a web-based survey. T-tests for independent samples compared the six dimensions and overall quality of life between compound and noncompound caregivers. Results indicated that compound caregivers were less able to concentrate and had fewer negative feelings than noncompound caregivers. Further research is needed to determine the effects of caregiving on the multidimensional aspects of quality of life.     

1995 World Summit for Social Development and the Elderly

Abstract

INTRODUCTION TO PUBLIC POLICY: AN AGING PERSPECTIVE. David K. Brown. University Press of America, 1997, ISBN0-7618-0414-5. Reviewed by M. Joanna Mellon

LONG-TERM CARE FOR THE RURAL ELDERLY. Edited by Graham D. Rowles, Joyce B. Beaulieu, and Wayne W. Myers. New York: Springer Publishing Company, Inc., 1996, 201 pp. Reviewed by Linda J. Redford