In Home Social Work With Abused or Neglected Elderly:

This article proposes a practical guide to both assessment and treatment of abused andlor neglected elderly receiving home health care services. Indicators of mistreatment, intervention strategies, and limitations to in-home social work are discussed. This experiential article limits its focus to those elderly recipients of home health care who are living with family.     

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.     

Group Work with Natural Parents in Permanency Planning

Group work with parents of children in foster care has good potential as a complement to casework services in permanency planning. An underused social work service in child welfare, group work has rarely been provided to natural parents. It can be utilized differentially along the foster care continuum from needs identification through aftercare to provide parents information, support and training specific to foster care. Reports of group work services for abusing parents, parents of children in residential treatment and special programs for natural parents provide relevant information for design of group work with natural parents. An example of a group of parents whose children are in foster home placement is presented. Special considerations for providing group services to natural parents are highlighted. Group work appears to have positive effects on the providing agency as well as on parent group participants. Issues regarding group work in permanency planning include the risk of its misuse through agency-imposed agendas and/or agency determined timetables for individual and group development. It will be helpful to study what group services with which parents at which points in the foster care continuum assist permanency planning efforts.     

“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.     

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.     

Caregiver involvement in behavioural health services in the context of child welfare service referrals: a qualitative study

Human service agencies serve a growing number of adults with behavioural health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioural health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioural health services. Researchers reviewed agencies' case records and conducted in‐depth interviews with 16 caregivers, 9 child welfare caseworkers and 12 behavioural health treatment counsellors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioural health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioural healthcare needs. Implications for managers and practitioners are discussed.     

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.     

Inter‐agency joint protocols for safeguarding children in social care and adult mental‐health agencies: a cross‐sectional survey of practitioner experiences

Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi‐agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross‐sectional survey of practitioner self‐reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self‐complete questionnaire administered to all professionals in adult mental‐health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter‐agency working between children's social care and adult mental‐health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter‐agency collaboration.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.     

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.     

Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.     

Improving Emergency Care for the Elderly

Much has been written on the developing role for social workers in hospital emergency rooms but little has focused specifically on social work interventions with elderly emergency room patients in an urban teaching hospital. A group of fifty patients over sixty-five years of age, referred to social service for assessment and assistance with home care issues, is described. The emergency room social worker's role with these elderly patients is highlighted and three case examples are discussed. It is argued that social work interventions improve the quality of both emergency and ongoing care for this growing and often at risk population.     

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

Working in the Social Services: Job Satisfaction, Stress and Violence

Correspondence to Professor Jan Pahl, Department of Social and Public Policy and Social Work, Darwin College, University of Kent at Canterbury, Canterbury CT2 7NY. Summary A major survey of the social services workforce (Balloch etal., forthcoming), carried out in the Research Unit at the NationalInstitute for Social Work, has produced new data about sourcesof job satisfaction and about the incidence of stress and violence.The survey took place in five different local authorities inEngland, and interviews were carried out with 1276 individuals,selected from four groups of staff: managers, social work staff,home care workers and residential staff. The results suggestedthat those who work in the statutory, social services do experiencemore stress and violence than workers in other parts of thehealth and welfare services. However, different jobs presenteddifferent hazards. In general, home care workers were the mostsatisfied with their jobs, and were also the group least likelyto be stressed or to experience violence in the course of theirwork. By contrast, residential workers, especially those withmanagement responsibilities, were most at risk of both violenceand stress. Men were more likely than women to experience violence,while other groups with a higher than average risk of stressincluded younger members of staff, and managers and social workstaff responsible for elderly people.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

The Senior Outreach Program of Park Ridge Mental Health

Abstract

Availability and accessibility of mental health services for the elderly is woefully inadequate, failing to recognize the diversity of needs in the older adult population. Stigma, confusing and exclusionary insurance regulations and restrictive mental health center policies have both limited and discouraged treatment interventions. Through innovative case finding, programming and funding arrangements, the Senior Outreach program of Park Ridge Mental Health in Rochester, New York, has proven effective in identifying and providing outreach mental health services to elderly individuals. The program utilizes a human services agency model, yet operates within a large heath care system as part of a continuum of psycho-geriatric services.     

Barriers to collaboration on behalf of children with challenging behaviours: a large qualitative study of five constituent groups

Inter‐agency collaboration is seen as an effective way to support children and families with multiple and complex needs. Children in out‐of‐home care, especially those exhibiting challenging and disruptive behaviour, often require the services of multiple agencies. Ninety‐two South Australian stakeholders experienced in supporting children in out‐of‐home care were interviewed about their experience of collaborative practice, using the specific example of supporting children with extremely challenging behaviour. Participants were teachers, foster parents, child welfare workers, child mental health professionals and residential care workers. Thematic analysis revealed several tensions inherent in such collaboration. Results are discussed in terms of their unique implications for managing challenging behaviour, and suggestions are made for improving collaborative approaches to behaviour and multi‐agency practice.     

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.     

Hospital-Based Long-Term Care Services for the Frail Elderly

This paper examines acute care hospital diversification into long-term care services for the frail elderly. The discussion focuses on five multifaceted roles played by health care social workers as hospitals develop long-term care initiatives. The need for an advocacy stance in both macro and micro aspects of care is stressed. Ethical dilemmas that arise in hospital-based systems are presented.