Family Influence on Caregiver Resistance,Efficacy, and Use of Services in Family Elder Care

This research investigated how resistance to use of services attributed to family members and primary caregiver self-efficacy and resistance influenced actual use of services. Data were analyzed from questionnaires completed by 224 persons engaged in informal elder care in the community. Tests of 6 hypotheses revealed that family influence on caregivers had a consistent, important influence on behavior and views of caregivers. Family resistance to use of formal services framed caregivers' feelings, preferences, and decisions ranging from their own perceived self-efficacy to actual obtainment of help outside the family. Professionals must include family members in their dialogue with primary caregivers about their plans for elder care. Suggestions for interventions to better understand family and caregiver resistance 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.     

Caregiver's Spirituality and Its Influence on Maintaining the Elderly and Disabled in a Home Environment

ABSTRACT

This study examined the role that faith-based organizations play for caregivers in maintaining the elderly and disabled in their homes. The study explored if persons who use religious beliefs and practices cope with caregiver stress better than those who do not use religious beliefs and practices. The study also explored the role of religious coping as a factor affecting decisions to institutionalize, and the role that faith-based practices and organizations play in helping caregivers maintain the elderly and disabled in their homes.     

Public Policies and Services for the Aged in Japan

No abstract available for this article.     

Services for disabled children: integrating the perspective of social workers

The paper addresses questions about the appropriate focus and direction of social work with disabled children, by triangulating parental views with those of social workers. Previous studies concerning services for disabled children have concentrated either on the views of parents or, less often, on those of service providers. This study adds to the picture by linking the two together and allowing service providers to comment on the views of service users. Parents of nine disabled children were inter-viewed following the introduction of a specialist disability team in an inner city borough, following the implementation of the Children Act 1989. The interviews took place over a 9-month period in 1995, and the comments of parents were then shared with social workers both from the borough concerned and from elsewhere. The parents' views reflect confusion about service provision, ignorance of their children's legal (as opposed to moral) rights, a preference for proactive service provision and the need for emotional as well as material support, the last framed variously as counselling, advice and someone to listen. There was little evidence that the Children Act, which could have facilitated improvements in all these areas, had made any discernible difference. Social workers' comments on these findings, with which they identified strongly, revealed a lack of confidence in their own abilities, a lack of clarity in their role and increasing disillusion with the services of their organizations. It is argued that in order to meet parents' expressed needs, service providers require a confident and fundamental shift in emphasis back to the role of social worker as provider as well as enabler.     

Civic Engagement for Nursing Home Residents: A Call for Social Work Action

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.     

Emotional Support for Health Care Professionals: A Therapeutic Role for the Hospital Ethics Committee

Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in the case presented.     

Home Care Services for Indigenous Population in Taiwan: Cultural and Socio-Structural Implications for Long-Term Care Policy

Taiwan faces the world’s top aging rate over the next 8 years, making long-term care a priority for all populations, including the 16 indigenous groups who live primarily in the mountains and have different cultural practices than mainstream Taiwanese people. To examine how home care services are coordinated, managed, and delivered to the indigenous populations, we interviewed 10 public care managers and analyzed the interview content to assess their work experiences with home care workers and indigenous users in 2016. The research revealed four findings: (1) Home care utilization patterns and attitudes were different between the rural indigenous and non-indigenous populations; (2) home care utilization was limited by cultural, economic, and language challenges; (3) home care workers faced cultural and socio-structural challenges; and (4) policy and service provisions were rigid, without the socio-structural flexibility needed to accommodate the indigenous culture. A more efficient model will require the collaboration of public care managers, home care workers, and indigenous families to create a fair-coordinated plan. As Taiwan launches the Ten-year Long-Term Care Plan 2.0, a one-stop service delivery center to integrate care options and provide services for people of indigenous backgrounds is a must.     

Assessing Statewide Need for Older Adult Health Promotion Services: The Oklahoma Experience

ABSTRACT

The growing senior population and persistent poor health status of seniors in Oklahoma compels a fresh look at what health promotion services would be well received. Surveys were distributed to a list of registered voters aged 65 and older in Oklahoma with a total of 1,248 surveys returned (19.8%). Survey items asked about interests in services, classes, and activities, plus current barriers to accessing and/or engaging in such programs. To account for survey weighting, Rao-Scott Chi-Square Tests were performed to determine differences by demographic characteristics. We identified services, classes, and activities that were (and were not) of interest to seniors in Oklahoma with legal assistance (52.1%), exercise classes (46.6%), internet classes (40.7%), and indoor exercise activities (45.5%) receiving the highest level of interest. Barriers to interest in participating in programs included not wanting to go and not knowing availability of such services. The results of this survey provide useful data on health promotion gaps for seniors, interests and barriers to engaging in such activities, and guidance for statewide program development. Future program development needs to be focused on areas of interest for older adults, including legal assistance, exercise classes, and internet classes.     

Sexual Health Services for Homeless Youth: A Qualitative Analysis of their Experiences

The sexual health problems experienced by homeless youth bring into question their use of available sexual health services. Using a qualitative typological analysis, this study aims to identify sexual health services utilization profiles for homeless youth, and to understand the role of the homeless experience on the utilization of sexual health services. Individual interviews were conducted with 33 homeless youth (17 men, 16 women) between 18 and 25?years of age. Typological analysis identified four profiles: (1) a targeted use of sexual health services to determine one’s serological status following a relational change during the homeless experience; (2) a limited use of sexual health services to manage sexual emergencies that arise during the homeless experience; (3) a regular use of sexual health services to avoid the risks associated with the homeless experience; (4) a frequent use of sexual health services to obtain support when engaging in prostitution during the homeless experience. This study shows that the precarious and unstable conditions within the homeless experience incite youth to utilize sexual health services in different ways. These findings point to the importance of rethinking sexual health services to better adapt them to the different utilization profiles of homeless youth.     

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.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Interconnections among Homelessness,Family Separation,and Mental Health: Implications for Multi-Sectoral Social Services

This qualitative study explored the interconnections among the phenomena of homelessness, family separation, and mental health and substance abuse issues within the social services, geographic, and infrastructure context of northern Ontario. In-depth semi-structured interviews were conducted with thirteen participants. Findings revealed the effects of colonization in the form of poor and overcrowded housing conditions in the northern First Nations, difficulties in obtaining affordable and suitable housing in northern towns and cities, reliance on the scarce social services for survival, and valiant attempts to cope with the cold climate of northern Ontario. All participants reported multiple and intergenerational experiences of separation from family due to involvement of child welfare system, placement in residential schools, death of family member(s), flooding, and epidemics. Participants described their lifelong struggles with mental health and substance abuse issues. All three phenomena were tied together in various configurations of causes and consequences. The implications include the need for critical examination of the historical policies and practices, early intervention for mental health and substance abuse issues, greater support for youth transitioning out of care, creation of a continuum of housing options, collaboration across multiple social services sectors, and incorporation of Indigenous worldview and practices in the mainstream services.     

Mergers and Acquisitions in the Private Sector: What Are the Lessons for Health and Social Services?

In seeking a more seamless provision of health and social care, the government is promoting the merger of the functions of primary and community health services and social services. In the private sector, mergers have been commonplace. The primary aim of this paper is to identify the key concepts and explanatory frameworks in the literature on mergers and acquisitions in the private sector that are relevant to the development of new organizational structures in health and social care. The evidence suggests that it is difficult to merge two organizations successfully. Reasons for this are explored and the implications for health and social care mergers drawn out.