Settling In and Moving On: Transience and Older People in Care Homes

This paper reports on a study which examined the experiences of 46 older people who moved into nursing and residential care homes, interviewing them at four points, from before the move to up to six months afterwards. A key finding was that older people were actively involved in the process of settling into homes and forming new friendships. Participant data also indicated that these older people had often experienced many moves in recent years, as their need for care had changed, and following them through after their inclusion in the study indicated that, for some, there were more moves to come. These data place the debates about assessment, and the identified problem of "misplacement" in a different light. The problem is not simply one of improving assessment techniques so that needs and provision can be matched more accurately, but it may mean accepting that the needs of older people are likely to change over time. The question then is whether we can develop services and forms of provision which ensure that care moves to older people, rather than older people having to move to care.     

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.     

The role of social work in the ICU: reducing family distress and facilitating end-of-life decision-making

The costs associated with Intensive Care Units (ICUs) are high and at times invasive ICU care may not be beneficial, particularly for those patients admitted to ICUs who have little hope of recovery. The process of clarifying medical goals for these patients is often facilitated by addressing psychosocial factors. Social workers in the ICU are uniquely qualified to assess and address many of the complex psychosocial circumstances and can clarify potential misperceptions, enhancing communication among patients (if capacitated), their families, and the medical team members. This can not only help improve quality of life for very sick and dying patients in the ICU and their families, but may also reduce the likelihood of decision-making conflicts from arising. Further studies need to be done to investigate the effectiveness of social work interventions in reducing family distress, avoiding care that is unwanted by patients, and demonstrating cost-saving benefits.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

Treatment at the end of life

End-of-life care has gained recognition as an important interdisciplinary clinical domain during the past three decades largely because scientific and medical advances have changed the nature of dying in the US. Advances in the treatment of life-limiting ilness have typically focused on medical issues and on treating the physical symptoms that accompany the final stage of a terminal illness. However, because the lengthening life span has made more choices available at the end of life, there is also greater need for evidence-based psychosocial treatment to diminish some of the prolonged emotional, psychological treatment to diminish some of the prolonged emotional, psychological, social, and spiritual distress that accompanies dying. Both terminally ill older adults and their caregivers can be helped by interventions that address the need for information, education, preparation, communication, emotional support, and advocacy. This paper preents a review of evidence-based psychosocial treatments at the end of life for both older adults and their caregivers.     

Leisure Education

This article presents the concept of using leisure time as a potential coping resource for family caregivers of impaired older persons, that could be facilitated through a leisure education program within a caregiver support group. Included is a review of literature relevant to stresses of caregivlng, barriers to caregivers' leisure involvement, and rationale for a leisure education program within a family caregiver support group. It is suggested that leisure education programs be based on the Peterson and Gunn leisure education model which consist of four components: leisure awareness, leisure activity skills, leisure resources, and social skills. Each component is considered in relation to caregivers' situations. Reasons for caregivers' resistance to intervention and outreach techniques are also discussed.     

国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析

如何对医生的执业行为实施有效的社会控制是职业社会学的一个重要问题。本文通过对我国城市医生的执业环境与执业行为的分析,指出医生仍然依附于占据医疗服务市场垄断地位的公立医院,丧失法团自主性的他们无法与国家就收入与服务补偿进行协商。但也正是由于垄断地位,公立医院及其医生获得了对患者和医药厂商的双向支配地位,可以便利地将处方权转换为经济利益。但与此同时,医生对临床自主性的这种滥用意味着卫生行政部门的监管、职业规范内化后的自律等社会控制方式的失败。本文认为,医生这一职业群体在医疗卫生政策制定过程中的参与、逐步开放医生的执业自由以及给予非公立医疗机构平等的地位与待遇等措施会使这些问题得到改观。     

SOCIAL GROUP WORK WITH VULNERABLE OLDER PERSONS

This paper discusses the uses of social group work within the developmental model which looks at group life as a microcosm of the world. The author identifies the group as a modality for meeting differential needs of older persons. These needs are explored and some coincidence with the various stages of group development noted. The skills of the group worker are evoked on many levels-including that of making sound professional judgements regarding the appropriate use of the group for helping each individual. Groups for frail elderly persons may focus on one or more purposes.     

Postretirement work and volunteering by poverty groups informed by role theory

This study uses role theory to examine the association between postretirement work and volunteering among retirees and to determine whether this association varies across poverty status. Data came from the 2012 wave of the Health and Retirement Study (HRS). The sample was restricted to respondents of older retirees (N = 6,619). We found that postretirement work positively influenced volunteering. However, poverty can be a risk factor of volunteering among older retirees. The positive effect of post-retirement work was found to be more significant in the near-poverty group. We provide an empirical foundation to help inform volunteer programs for retirees.     

Educating Our Future Colleagues: Creating an MSW Palliative Care Practicum

As the number of older adults and those with chronic medical conditions continues to rise, the need to train social work students in palliative and end-of-life competencies becomes critical. To address this growing need, the social work team at a large urban academic medical center in the Midwest developed an MSW concentration practicum in palliative and end-of-life care. During the practicum, students receive immersive training in palliative care social work values and the skills required for these specialized assessments, interventions, and evaluations. Their training culminates in their participation on an interdisciplinary team to provide psychosocial support to patients and families receiving palliative and end-of-life care throughout the medical center. This article describes the curriculum, practice immersion, training manual, teaching modules, and structure of student supervision which is applicable to and adaptable for other palliative care social work field instructors.     

The impact of ethnicity on attitudes toward health care reform in New Mexico

Latinos tend to have significantly lower levels of access to general and top quality medical care than do non-Latino whites, and although disparities in access to health care have diminished for all other minority groups over time, they have widened for Latinos. Given these trends, current attempts to provide universal health care at both the national and state levels across the United States have large implications for the health status of Latinos. The objective of this analysis is to determine whether Latinos have different attitudes regarding health reform than non-Latino whites. Our data are from a statewide random digit dialing telephone survey of New Mexico residents, age 18 and older, conducted in the Fall of 2007. With a Latino population of 44% and ongoing health care reform efforts by the state legislature, New Mexico is an ideal location for this analysis. After controlling for a host of individual level factors, our findings suggest that while Latinos are less likely to identify health care as a salient state issue relative to the economy and crime, they are more likely than non-Latino whites to believe affordable health care programs are important. Finally, Latinos view employers, more than government or individuals, to be responsible for expanding health care coverage.     

Familial caregivers of older adults

Caregivers of older adults face many obstacles as they balance family, career, and caregiving demands. Caregivers are at an increased risk for burden, stress, depression, and a variety of other mental and physical health complications. It is not uncommon for caregivers to receive some form of pharmacological therapy to treat the physical and mental health changes that may occur throughout their caregiving career. However, while pharmacological forms of treatment are invaluable, medications only may not be sufficient to treat the needs of caregivers. As such, geriatric professionals also have a responsibility to intervene with caregivers through psychosocial interventions. This paper provides an overview of caring, a summary of evidence-based psychosocial interventions for family caregivers of older adults, and recommendations for future interventions.     

HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.     

As Parents Grow Older:

For those older persons with families, the family is the vital, natural support system while also being the link between the older person and formal community supports. No matter how many community services and supports are provided for older persons, these services only supplement the emotional ties and support from the families. Enhancing the family's supportive role is crucial. This paper describes a community based support group model called "As Parents Grow 0lder" as an example of a systematic, effective effort to provide services to this natural system. This model has evolved and been used with 10 different groups totalling l25 participants over the past four years.     

Substance abuse

Alcohol abuse poses special risks for increased morbidity and mortality among older adults, contributing to the heightened use of medical resources and the related increase in medical costs. Although the prevalance of alcohol use disorders in the older adults is generally less than that found in younger groups, it is expected to increase with the aging of the "baby-boom" generation. In spite of this, little attention has focused on developing, and evaluating the efficacy of, treatment programs for older adults with alcohol related disorders. This article discusses the availability of effective treatment strategies for older alcohol abusers and reviews the epidemiological and outcomes research literatures related to alcohol abuse and older adults. The few empirical studies that examine outcomes associated with the treatment of older substance abusers reveal positive outcomes, especially when "age-specific," cognitive-behavioral, and less confrontational treatment approaches are employed.     

An exploration of adopters' views regarding children's ages at the time of placement

This paper describes a project undertaken as part of a masters degree at Kingston University that looked at factors which influence adopters' decisions about the ages of children that they want to adopt. This subject is topical because currently many adoptive parents want to adopt very young children, but many of the children waiting for placements are older. Relevant literature is reviewed to place the project in context and to provide a theoretical perspective on adopters' decision-making on the preferred ages of children at the time of placement. The views of adopters and adoption social workers were sought using questionnaires and semi-structured interviews. The majority of adopters who responded wanted to adopt children who were as young as possible. Adoption social workers who responded reported difficulties finding placements for older children. Data obtained suggests that the strategies designed to encourage adopters to consider adopting older children may have limited effect. In the conclusion, tentative suggestions are made about the implications of this project for adoption practice.     

Understanding quality of service in a delayed gratification situation: The case of social security providers in Tanzania

Abstract   This article looks at five quality of service dimensions (reliability, responsiveness, assurance, empathy, and tangibility) in a delayed gratification situation in the public sector in a developing economy. Using four formal social security service providers (SSSPs) in Tanzania, it examines members' familiarity with, and expectations and perceptions about, social security services. Through focus group discussions and an adapted servqual instrument, it is found that familiarity is lowest among older members, that members expect more information about benefits, and perceive negative disconformities for cash benefits but positive disconformities for medical benefits. The findings suggest that SSSPs must continually enhance familiarity, offer proactive and repeated assurances to members, and realize improvements in the processing and adequacy of benefits.     

Impact of support groups on well-being of older women

The goal of this study was to determine whether differences in incidence of depression and level of well-being are manifested between older women, aged 60 and older, who attend either (a) a peer-run support group, (b) a staff-run support group, or (c) a comparison group (i.e., who do not attend a support group). Thirty-six women participating in peer-run and staff-run support groups and 9 women receiving nongroup support were administered the Geriatric Depression Scale and the Philadelphia Geriatric Center Morale Scale. Separate analyses of variance were employed on each scale to determine the significance of differences in scores according to facilitator type (i.e., peer-run vs. staff-run vs. comparison group). Analysis of scores on the Geriatric Depression Scale indicated significant differences between women in the peer-run groups and women in the comparison group, but no significant differences between women in the peer-run groups and women in the staff-run groups or between women in the staff-run groups and women in the comparison group. Analysis of scores on the Philadelphia Geriatric Center Morale Scale did not indicate any significant differences between women based on facilitator type. Results of this study have implications for those who run face-to-face support groups for older adults, for those who train peer group facilitators, and for community agencies that desire to initiate a support group system for their clientele.