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.     

Aging and Elder Care in Japan: A Call for Empowerment-Oriented Community Development

This article provides a brief overview of the situation of the elderly and their caregivers in Japan, including demographic changes in Japan, development and changes in long-term care policy that have targeted the poorly integrated community care system, and other challenges that the elderly and family caregivers face. Policy direction designed to address these issues is increasingly targeting care by the community versus support care by society (which was initially the main strategy). The potential of empowerment-oriented community development intervention strategies to decrease the gap between available institutional and formal community-based services and the needs of the elderly and their families in their efforts to meet late life challenges is described. The need for an increased role of social workers in community development interventions is explored and strategies are suggested.     

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.     

The Supply of Foster Families for Children in Care

Correspondence to John Miles, Institute of Social and Applied Psychology, The University, Canterbury, Kent CT2 7LZ. Summary The family circumstances of 2694 foster homes in England arecompared with representative families from the 1985 GeneralHousehold Survey. Foster families typically include a womanin the 31–55 age group, live in homes with three or morebedrooms, are two parent families with one parent working full-timeand the other not, and they have older children only. The incidenceof families with these characteristics is used to develop anestimator of the relative supply position of local authorityareas for foster care, from which a number of conclusions aredrawn. Over the last thirty years some social changes have improvedthe supply, others decreased it, and on balance the nationalsupply position is little changed. Ironically, supply is bestin those areas which have the lowest need for fostering services.Ways in which local authorities can improve their supply positionare considered. The supply estimator reveals that the averageboarding out payments made by authorities show clear signs ofresponsiveness to the local supply position for foster families.     

构建老人福利机构危险管理机制——日本经验之启示

"养儿防老"是中国传统的养老模式,长期以来老人的养老主要依靠子女来解决,但是随着生活方式的改变、家庭规模的日趋小型化,老人的长期照顾问题受到了社会的广泛关注。近年来国家制定了相关的政策、制度以及服务来满足老人及其家人的需求,然而老人福利机构及所提供的照顾服务,其服务质量离人性化照顾服务仍有一段距离。就现阶段而言,老人福利机构所提供照顾服务的质与量,均有提升与改善的空间。日本是亚洲第一个施行公共性长期照顾保险的国家,其施行之初也面临着一些与我国同样的问题,为提升长期照顾机构的服务质量,日本厚生劳动省在介护保险制度施行后的2002年,就开始倡导老人福利机构应建立危险管理机制的理念,并于2006年修订老人长期照顾福利机构管理规则,规定老人福利机构应建立危险管理机制,以提升照顾服务质量。有鉴于此,本文将对日本老人长期照顾福利机构建立危险管理机制的过程、基本架构,以及相关课题做系统说明,为我国老人福利机构经营管理提供参考,也可为我国未来在探讨老人长期照顾问题之际,提供必要的配套依据。     

The residential home – what difference does it make?: Comparing the public systems of care for the elderly and disabled in two Swedish municipalities

Two municipalities in Sweden – Solna and Sigtuna – have taken part in a project (the ASIM project) aimed at developing a system for monitoring and analysing the public system of long-term care and assistance for elderly and disabled people. The two municipalities have chosen different alternatives in the question of residential homes. In Solna they have been retained and in Sigtuna they have been converted into sheltered housing. By separating the clients into different classes of dependence using the ASIM assessment, it is shown that in Solna, compared with Sigtuna, fewer of the most dependent clients are in long-term hospital care and fewer of the high-medium category are in domiciliary care. The data were used to calculate the distribution of the clients and the average dependence on the different levels of care if Solna were to apply the care pattern of Sigtuna and vice versa.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

Managing the Care Home Closure Process: Care Managers' Experiences and Views

This paper reports case study research that set out to identifywhat care managers do during independent care home closures.Little research has focused on the way in which care homes forolder people are closed in England, or what those involved thinkabout the process. This paper reports the activities and viewsof care managers directly involved in helping older people relocatefrom care homes that were closed by their owners. During suchclosures, residents and their families have no choice but tomove, usually to a deadline, and with little control over theprocess. Care managers have a responsibility to help arrangealternative care for those current residents who are publiclyfunded, and to offer information and support to those fundingtheir own care (the ‘self-funded’). Closure relatedactivities could involve considerable staff time. Care managementarrangements, including the organization of teams and provisionof needs assessments, varied across authorities. The care managersdescribed drawing on emotional counselling and inter-personalskills, as well as practitioner knowledge and experience, particularlywhen offering support and advice about finding appropriate newhomes. Tensions between aims, constraints on their actions andviews of good practice are identified.     

市场化、社会转型与城市郊区农村老人的“轮养”——来自子女口述史的分析

通过对河北省保定市郊区农村的深入访谈和问卷调查，本文研究了有两个以上已婚儿子的老年夫妻去世前的生活状况。研究发现，儿子成年之后的独立门户，是这类老年夫妇“宁巢”的前提，而“空巢”又是“轮养”契约得以建立的条件。市场化、社会结构转型、儿媳妇在家庭决策中作用的增强等，使老年人失去了家庭决策权。故“轮养”在生命过程中，实际是被安排的结果，而不是老年父母自己的选择。     

Behavioural and emotional problems of children by type of out-of-home care in Croatia

The aim of this article is to compare the kinds of behavioural and emotional problems of youth in relation to type of out-of-home placement in Croatia. Children living in children's homes manifest significantly more behavioural and emotional problems than other groups of children in out-of-home care or children living in their primary families. Children living in foster families or in family-type homes integrated in the community do not differ from a comparative group of children living in primary families. Regardless of differences among sub-samples regarding behavioural and emotional problems, the current problems of individual children in all groups of children in out-of-home placement were connected more to currently experienced stressors than to unfavourable circumstances before their removal. This indicates that there are benefits to be gained by improving services in the children's present care environment.     

Educational attainment and employment of young adults ageing out of care: A registry study based on the Finnish birth cohort 1987

Adolescents growing up outside their birth homes are at major risk for multiple adversities in early adulthood, including low education and unemployment. The transition from out-of-home placement to independent living overlaps with the transition from school to work and higher education. However, the support during this critical phase is often inadequate. Adolescents ageing out of care are also more likely to have faced adversities in their birth families. Yet, the interplay between different risk factors and having aged out of care has gained little attention. This study aimed to assess known risk factors for low education and unstable employment and their interaction with ageing out of care, controlling for birth-home-related adversities. We assessed this topic using logistic and linear regression modelling based on the Finnish birth cohort 1987 (n = 59 476) registry. Our analysis showed that obtaining upper secondary and higher education was much less likely among those ageing out of care, and they had spent 52–80 fewer days annually in employment after graduation. Few interactions with other risk factors were, however, found. Efforts are needed to prevent inequalities in education and employment for those ageing out of care in the transition phase from school to work.     

Social Support and Government Policy on Services for the Elderly

Government policy on services for the elderly is to increase the provision of care in the community. This paper examines this policy in relation to informal help received from relatives and friends.
Drawing on the results of a pilot study of 92 people over the age of 75, registered in a group general practice, data are presented on the balance between informal and formal help over a group of activities of daily livhg. The main informal helpers are described with the range of activities for which people in the study were receiving assistance.
Community services are, at present, limited in the help they can provide for people in their own homes. If policies of community care are to be successful, then they must take into account the strengths and weaknesses of informal support. Using the data presented, suggestions are made a bout improvements in services including task specific services not currently provided and the definition of groups at risk of their social support breaking down.     

What can agencies do to increase foster carer satisfaction?

Stable, long‐term foster care homes are critical to ensuring a safe and nurturing childhood for many children worldwide. Greater foster carer satisfaction is associated with increased carer retention and is therefore critical in securing such stable homes for children. The purpose of this study is to determine which factors associated with foster care agencies contribute to higher levels of foster carer satisfaction. Results from a longitudinal study of 137 foster carers indicate that perceived adequacy of agency support, preplacement training, money to cover placement expenses, and a good match between the carer and the child are predictive of higher foster carer satisfaction. A mediation model further points to the provision of preplacement training as key to ensuring higher levels of satisfaction. Results offer new insights into factors related to foster carer retention and provide guidance to foster care agencies about actions that they can take to maximize the retention of foster carers.     

Kinship Foster Care and Its Impact on Grandmother Caregivers

Summary

Kinship foster care programs are designed to address the needs of relatives, usually grandparents, who have taken in children who have been removed from their homes voluntarily, or following a substantiated report of neglect and/or abuse. The author reviews the history of kinship foster care nationally and examines related research. Reported are findings on a survey of kinship foster care programs nationwide and from qualitative interviews with nine grandmothers from New York City who were kinship foster care providers. Particular attention was paid in these surveys to the impact of kinship foster care on families caring for children with disabilities.     

The 'Consumer Principle' in the Care of Elderly People: Free Choice and Actual Choice in the German Welfare State

In the mid-1990s, together with new long-term care legislation, the German welfare state introduced care markets and consumer choice between family care and different types of formal care. However, instead of using the new option to choose publicly funded care by long-term care agencies, the majority of elderly people in need of care continued to decide in favour of care exclusively provided by family members. The article examines how the persistence of family care in spite of the new options of consumer choice can be explained, using data from representative surveys on the care of elderly people in Germany and the results of guided interviews by the authors with family members involved in care. The findings indicate that there are two main reasons. The first is that elderly people and their families orient their behaviour towards traditional care values in which the first priority is given to mutual support between spouses and generations. The second reason is that elderly people on the one hand and care agencies on the other have substantially different definitions of a good quality of care.     

Short Term Care for the Elderly in Residential Homes: A Research Note

Please address requests for reprints to Dr. D. Boldy, Division of Health Sciences, Centre for Advanced Studies, Western Australian Institute of Technology, Kent Street, Bentley WA 6102, Australia. Summary Short term care for the elderly has expanded rapidly in thelast five years. The study evaluates short stay care in fourresidential homes using interviews with 42 clients, their main‘carers’, officers-in-charge of the homes and socialworkers. Whilst the service worked reasonably smoothly and provideda break for family carers there remains further potential forimproving the quality of service in the context of a full rangeof services for elderly people.     

The Application of Family Systems Theory to Geriatric Hospital Social Work

Integrating and applying Family Systems Theory principles into the assessment and treatment process of families of hospitalized high risk elderly is an area that has received little attention in health care literature. The multigenerational approach is a model that can be used as a clinical framework for guiding the social workers in developing intervention strategies when working with hospitalized high risk elderly and their families. This approach can be extended to clinical assessment techniques and psychosocial rationales for discharge planning. Three case examples are presented to illustrate how Family Systems Theory can be integrated into social work practice resulting in effective interventions for hospitalized high risk elderly and their families.     

我国养老机构的地位、性质及运行方式研究

本文从当前养老机构存在的问题入手,通过对服务对象(老人)入住机构的原因和需要的论述,阐明了直接的服务提供主体(养老机构)的地位是长期照顾服务连续体的一个环节,在社会服务体系中发挥托底作用,应该保证较高的服务质量;养老机构在福利社会化的政策背景下兼具福利性和"准市场"性;在运行方式上应该实现各个福利提供主体之间的协调等观点。并通过总结发达国家和地区的相关经验,提出应该明确政府、行业协会、养老机构、市场几个方面的角色地位,协调好相互之间的关系,并注意发展长期性服务项目,进行科学的规划,发展适度普惠型的福利政策等建议。     

Current Realities

This article reports survey data from nursing home professional social workers on their practice circumstances, prior education and training, and current training needs. This data supports the growing body of evidence that a significant portion of social work practitioners are unlikely to have received the depth of information and the specialized skills required to work with the aged and their families during their formal education. Assuming limited personnel and time, and the responsibility of many different persons for psychosocial care -the practice reality in nursing homes today-- this data can guide education and training efforts.