ADULT DAY CARE CLIENTS

Discriminant function analyses were used to examine the daily functioning levels of three populations of elderly: Senior citizen center participants, adult day care clients and nursing home patients. The analyses revealed that the adult day care program was serving a distinct population of elderly who have unique needs. The Level of Care Rating Scale, developed to assess functioning and used to distinguish among populations, is also a valid means of identifying and monitoring high risk individuals in the two more independent populations. Further research in the form of a controlled study is recommended to ascertain the overall impact of adult day care in delaying or preventing institutionalization.     

The Probable Impact of Proposed Legislative and Budgetary Changes on the Lives of the Elderly and Their Families

The decade of the 1980s is characterized by economic uncertainty and political ambiguity regarding the direction of American public policy for the elderly. The purpose of this paper is to: (1) review demographic trends that particularly affect older adults; (2) summarize theReagan Administration's proposed cutbacks in programs and policies for the elderly; and (3) address the effects of these cuts on older individuals as well as on family systems across generations. It is our contention that the proposed budget cuts will seriously reduce a number of federal programs which have been developed to meet the needs of older adults. The impact of these cuts will be felt by all of the elderly and to a considerable extent, their families. However, the effects will be most severe for people who have poverty or near-poverty incomes, single women, and the "frail" elderly. The discussion suggests that these proposed budget cuts seem to reflect a lack of appreciation and recognition of both needs of the older individuals and those of their families. In addition, suggestions for program and policy directions, as well as further research are addressed.     

The Transformative Potential of Social Work's Evolving Practice in Dementia Care

Social workers in diverse service systems throughout the United States encounter many opportunities for improving quality of life for people with dementia and their families. Yet practice with this population is unclearly defined and a core set of competencies for such practice does not yet exist. Instead, it is shaped by roles within aging and health systems. These roles are informed by a biomedical disease model of dementia. This article examines social work practice and its connection to evolving views on aging and senility throughout the 20th century. New directions for practice are recommended to improve services for individuals with dementia.     

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.     

Service Arrangements Preferred by Minority Elderly:

Better programs for minority elderly and higher utilization of them will be achieved if decision-makers avoid providing services that run counter to the cultural preferences of the recipients. This study begins to explore the common patterns among minority elderly relative to whom they prefer to seek out for assistance in selected times of need.     

The Utilization of Social Services by the Mexican-American Elderly

One of the knowledge gaps in empirical research on utilization of service is that little attention has been given to testing causal models of use among the various ethnic elderly groups. The purpose of this study is to analyze the pattern of determinants of social service use among the Mexican-American elderly. A causal model of social service use was tested using a subsample of data obtained from a national needs assessment interview of 1,805 randomly selected noninstitutionalized elderly Hispanics. The findings, indicate that knowledge of social services, need for social services, perceived health status and income have direct effects on the use of social services. The major findings are discussed in relationship to past empirical research.     

Elderly Consumers and Social Care Policy

The development of social care policy for elderly Australians is proceeding with little regard for the preferences and perspectives as expressed by the elderly themselves. The likely consequence is a continuation of policies based largely on other people's assumptions about what elderly people actually need and the extension of service categories into which many elderly people do not easily fit. Discussions with 71 elderly consumers during 1983 in Queensland established that they have input to make into policy and service delivery issues such as the provision of information on services, the determination of needs, the extension of choices between alternative services and choice of appropriate service providers. Social care policy should not continue to develop around singular and untested assumptions concerning what elderly people need and prefer.     

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.     

The “Socialization of Elderly Hospitalization” in China: Development,Problems, and Solutions

ABSTRACT

Objectives to analyze the development of the elderly patients with chronic diseases and to make some suggestions for the elderly social hospitalization. Methods By using yearbook data and theoretical analyses, the paper respectively presents the problems and furthermore solutions of China's elderly services. Results The elderly patients with chronic illnesses have formed a new group, and the phenomenon of “socialization of elderly hospitalization” has become a major social risk. Discussions China needs to promote the idea of “long-term care” in elderly social security, establishing long-term care insurance and fostering a private, professional elderly service system.     

Unmet Home Care Service Needs of Rural Older Adults With Alzheimer's Disease: A Perspective of Informal Caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

Services Provided by Elderly Volunteers

As the number of elderly persons increases, the social service needs of older Americans will grow too. To provide a variety of services, many social service agencies across the nation are helping the elderly organize to help themselves. This paper represents the second of a series of research reports derived from a federally funded research project to investigate the types of services that trained elderly volunteers provide to other elderly persons in the community. This paper presents a multivariate analysis of elderly volunteers who go beyond providing socializing and reassuring services and provide instrumental services. The independant variables are developed to capture the level of the physical and mental strengths of elderly volunteers. Theses strengths are psychological functioning, perceived health, psychological adjustment, and social resources. In addition, program-participation factors, such as the duration of participation in the volunteer project and the number of persons served, as well as variables related to demographic and educational backgrounds, are included in the analysis as controls. The major findings from this study are the following: (1) Among the independant variables, perceived health is a statistically significant predictor of a volunteer's becoming a provider of instrumental services; (2) The volunteer's level of education and the number of elderly persons served are also statistically significant predictors. One the whole, however, elderly volunteers perfer socialization and reasurance over instrumental services when they try to help other elderly persons.     

Assessment of a Brief CES-D Measure for Depression in Homebound Medically Ill Older Adults

Black elderly individuals represent one of the most disadvantaged groups in the United States in terms of income levels, health problems, and access to supportive services. This paper describes four major factors to be considered by social service providers to focus their programs toward needs of the black elderly population in their local communities. A research project designed to examine the social service needs and service utilization of the black elderly in a Midwestern community indicated that the following factons hould be considered if effective service programs are to be implemented: (1) Negotiation Initiative, (2) Responsible Research, (3) Symbolism, (4) Modeling.     

Alzheimer's Aggression: Influences on Caregiver Coping and Resilience

This study assessed impact of Alzheimer's patients' aggressive behavior (AD aggression) on caregiver coping strategies (task-, emotion-, and avoidance-focused) and caregiver resilience, and examined whether coping strategy moderated the AD aggression–caregiver resilience relationship. Informal caregivers across Louisiana (N?=?419) completed surveys with measures of demographics, AD aggression, caregiver coping strategies, and caregiver resilience. Task-focused coping positively related to resilience. Aggression negatively predicted caregiver resilience. Emotion- and avoidance-focused coping strategies separately interacted with aggression and increased its negative relationship to caregiver resilience. Task-focused coping showed no moderation. Implications for social work professionals are discussed.     

Alcohol and the Elderly:

This paper provides an overview of what is currently known about elderly alcohol use and abuse. It identifies areas of social work practice that need to be improved to meet the needs of elderly problem drinkers, and makes recommendations regarding identification, treatment, and coordination of services for this population.     

社会福利机构中社会工作介入老人发展性需求探究——以上海市第一社会福利院为例

本文在调查上海市第一社会福利院老人需求状况基础上,发现了老人各项发展性需求,机构中的社会工作部在老人各项发展性需求上,做出针对性的工作。调查结果发现,社会工作介入老人发展性需求有一定的成效,上海市第一社会福利院老人的需求获得较好的满足,最后提出机构社会工作在老人需求满足方面的若干建议。     

社会福利机构中社会工作介入老人发展性需求探究——以上海市第一社会福利院为例

本文在调查上海市第一社会福利院老人需求状况基础上,发现了老人各项发展性需求,机构中的社会工作部在老人各项发展性需求上,做出针对性的工作。调查结果发现,社会工作介入老人发展性需求有一定的成效,上海市第一社会福利院老人的需求获得较好的满足,最后提出机构社会工作在老人需求满足方面的若干建议。     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

More than therapy: The link between adverse childhood experiences,social support,and therapeutic services

Adverse childhood experiences (ACEs) have a cumulative effect on physical, emotional, and social well‐being throughout the life course. ACEs also impact parenting practices, which may contribute to intergenerational cycles of trauma. Access to child mental health services and caregiver social support are two protective factors that may reduce the burden of ACEs. To advance understanding of the relationships between caregiver social support and child mental health services among caregivers with ACEs, we interviewed 13 caregivers of young children receiving outpatient mental health services. Thematic analysis revealed the integral role of therapeutic providers in the social support circles of caregivers with high ACE scores. Caregivers frequently named therapeutic providers as the first point of contact in a problem situation. Implications for social work research, clinical practice, and advocacy are discussed.     

Working Together Apart

In this paper we report upon the development and operation of a “street-level” response to the problems of interprofessional joint working in providing appropriate care for elderly people living in one Scottish city. The “exchange system”, as it was known in the locale, was a mechanism for co-ordinating the movement of elderly people between the geriatric, psychiatric, and residential services within the city in response to changes in the needs of the individual elderly person, and the needs of service providers. The importance of the scheme stemmed from the fact that it was not imposed on professionals' work, but rather that it developed out of that work. By focusing on the operation of interprofessional joint working at the street level we draw attention to those complexities involved in such work which are often overlooked in the broad policy statements on joint working which have emerged from government departments, and health and social services agencies. Policy makers and analysts alike have largely ignored the meaning and consequences of joint working at the level of professionals' actual work, and it is this lacuna in the literature that the paper seeks to address. The paper concludes with an appeal to researchers and practitioners to describe any such schemes of whatever nature operating in their own locales. In so doing a corpus of knowledge looking critically at the experience of interservice and interprofessional collaboration at the street level may emerge which would inform broad policy statements.