Social Workers' Responses to Incontinence,Confusion and Mobility Impairments in Frail Elderly Clients

Social workers in home health care agencies are frequently involved in decisions concerning the independent living of their frail elderly clients. This study analyzes social workers' responses to elderly clients with three health problems that are relatively common among the elderly: urinary incontinence, confusion, and mobility impairments. Responses to clients with incontinence differ from responses to confused or mobility-impaired clients primarily in the specificity of attributions of cause of the problem and in evaluative responses toward the client. The findings are discussed in terms of the potential role of social work as an agent for change in both popular understandings of incontinence in later life and in the delivery of health care to the incontinent elderly.     

国内城市居家养老的研究综述

通过综合分析近十年来居家养老相关文献,本文总结出目前有关研究成果主要体现在产生根源、内涵界定、实施现状、问题及对策上,而其中对于居家养老内涵界定存在分歧,需要从重新明确养老模式的划分标准上来统一认识,对于居家养老方式的研究应跳出社区服务这个范围,认识到居家养老是作为家庭、社区、国家养老制度三者形成的合力,注重从整体上进行较为系统和全面的研究。     

国内城市居家养老的研究综述

通过综合分析近十年来居家养老相关文献,本文总结出目前有关研究成果主要体现在产生根源、内涵界定、实施现状、问题及对策上,而其中对于居家养老内涵界定存在分歧,需要从重新明确养老模式的划分标准上来统一认识,对于居家养老方式的研究应跳出社区服务这个范围,认识到居家养老是作为家庭、社区、国家养老制度三者形成的合力,注重从整体上进行较为系统和全面的研究。     

Moving toward Medicare home health coverage for persons with Alzheimer's disease

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

The Relationship Between Homebound Older People and Their Home Care Workers,or "The Pas de Deux" of Home Care

The multiple components in the provision of home care services, as distinct from home health care, are examined in this paper. Specifically addressed are the unique aspects of the setting, the particular characteristics of the elderly in need of care, the challenges to the care provider, and the dynamics of the relationship between the recipient and provider of care. Data were obtained from a sample (n = 200) of inner-city hospital clinic patients, aged 65+, of which 34% (n = 68) were home care clients. Practitioners can best design successful home care programs if consideration is given not only to a person's physical needs but also to their individual characteristics and those of the home care provider.     

Quality of care: relationship between the perceptions of elderly home care users and their caregivers

The aim was to study the relationship between elderly home care users', and their caregivers', perceptions of the quality of care. The sample consisted of 151 matched elderly home care user-caregiver pairs in a Swedish municipality. The elderly home care users were interviewed and their caregivers filled in questionnaires using an established, theory-based instrument. Results showed that the elderly home care users evaluated most care components more favourably than their caregivers. On ratings of the various care components' subjective importance to the caretaker, the caregivers consistently scored higher than the elderly home care users. Within the subset of elderly home care users who received help at least twice a day, there were greater similarities between caregivers and caretakers. The results are related to comparable research and discussed in terms of caregivers' needs to legitimize their professional identity and actions.     

The Role of Family Care and Living Arrangements in Acute Care Discharge Recommendations

This study examined placement recommendations of elderly acute care patients who are identified by hospital discharge planners as vulnerable to institutionalization. The purpose of the research was to determine the role of available family care and living arrangements prior to hospitalization in the placement recommendations made by discharge planners. Results indicated that elderly who lived with family compared to those who lived alone were in poorer mental, physical and functional health but had considerably more available family care and fewer service needs that could not be met in the community. Additionally, available family care was found to be significantly related to nursing home recommendations, even with living arrangements controlled. Analysis of placement recommendations by prior living arrangements indicated that family care may be especially important in mitigating the consequences of deficient activity of daily living skills and mental complications. Implications of this research to the role of family care in placement decisions are discussed.     

Moving Toward Medicare Home Health Coverage for Persons with Alzheimer's Disease

ABSTRACT

Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified.     

Caregiver Support Groups: Finding Common Ground

SUMMARY

Members of caregiver support groups for the elderly have much in common but also bring to the group different experiences and attitudes. This article explores how group workers knowledgeable about significant caregiver differences and their effects on the group can enrich the group experience for all members. The four caregiver issues examined are: (1) past history between the caregiver and care recipient, (2) ability of caregiver to privately pay for home care, (3) views on long-term care placement in a nursing home, and (4) stage of disease or level of care needed by care recipient. Essential beliefs regarding the value of differences described by Northen and Kurland provide a framework for the group worker.     

Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

Integrating Mental Health Parity for Homebound Older Adults Under the Medicare Home Health Care Benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

A PROBLEM SOLVING MODEL FOR IN-SERVICE TRAINING

With the increasing use of nursing homes to care for the frail elderly and the recruitment of poorly trained staff, in-service training has become a crucial need. This article presents a problem solving model for in-service training that the social worker can use to increase the effectiveness of staff in dealing with nursing home residents and their families.     

昆明市空巢老人健康与照顾需求的评估

“空巢”是中国科技与社会发展、独生子女政策落实的必然。日益增长的“空巢老人”为国家福利、代际和谐和社区照顾带来了严峻挑战。本文从社会保障的视角,采用健康自测量表（SRHMS）,从生理、心理和社会健康的维度,对昆明市10所养老机构和18个社区的289位空巢老人和212名非空巢老人进行了比较分析,发现空巢老人社会健康与心理支持令人担忧。文章就构建“空巢老人”长期照顾网络作了讨论和建议。     

Policy Foundations for Case Management:

The Federal Council on the Aging is now developing a national policy for providing home care for the "frail elderly." Case management is specified as the primary delivery mechanism. This article recommends areas, not now included in the policy considerations, that must be examined before case management goals can be achieved.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

Friendship Across the Life Cycle

Abstract

Using a group work model, this article discusses a short term group for older women developed to explore the importance of friendship in late life. In collaboration with group leaders, group members determined weekly topics that explored the significance of friendship through the life cycle. Social work group practice that focuses on the meaning and development of friendship for and with older women is presented as an effective therapeutic intervention for practitioners in settings such as community mental health clinics, senior centers, elderly housing, home care agencies and nursing homes.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.