Staff perceptions of staff-family interactions in nursing homes

Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study. Here, we report on 6-month case studies of two nursing homes where in-depth interviews, shadowing experiences, and direct observations were completed. Staff members from both nursing homes described staff–family interactions as difficult, problematic and time consuming, yet identified strategies that when implemented consistently, influenced the staff–family interaction positively. Findings suggest explanatory processes in staff–family interactions, while pointing toward promising interventions.     

Keeping Foster Children Connected to Their Biological Parents: The Impact of Foster Parent Training and Support

A primary goal of the foster care system is to reunite foster children with their biological parents. Keeping foster children connected to their biological parents, through visiting and other forms of contact, is essential for reunification because it helps to reestablish and maintain family ties during out-of-home placement. Parent-child contact can also increase the child's well-being while in care. Although foster parents are expected to help foster children stay connected to their biological parents, their actual involvement in this process remains problematic. This study tests the hypothesis that agencies can promote foster parent involvement in the parent-child connection by providing foster parents with specialized training and ongoing support. The findings support the notion that training and support increases the involvement of foster parents in parent-child contact.     

Child custody placement outcomes for mothers

Internationally there is a broad literature on risks for child custody placements. In contrast, very little is known about their outcomes on parents. The topic is relevant not only for parents themselves but also for children placed outside their homes, as many children keep contact with their birth parents or return to live with them. In a retrospective cohort study setting we analyze child custody placement outcomes (social assistance receipt, unemployment and work disability) for mothers whose children had been taken into custody between 1997 and 2004 in Finland. Data from a child placement register were merged with several administrative social insurance registers. Comparison groups of population mothers are included in the study. The procedure yielded an internationally unique database. According to the results of our study, mothers whose children are taken into custody are more often unemployed and in need of social assistance than mothers in the comparison group. Furthermore, they are also more often on a disability pension, due to mental health problems in particular, than mothers in general. While considering the results, we examine family policy and general welfare policy implications of support to families whose children have been taken into custody.     

Neglect of older adults in Michigan nursing homes

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.     

“Would You Do That in Your Home?” Making Nursing Homes Home-like in Culture Change Implementation

Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.     

Developing Public Information on Nursing Home Quality

The need for greater public information about nursing home quality is growing. While there are problems in using existing administrative data on nursing home quality from federal certification surveys, it is probably more feasible to use such data than to conduct direct surveys of residents and their family members and friends. Administrative records could be used to provide greater information on quality than is currently reported by the Health Care Financing Administration. These records could also be used to develop a rating system for nursing homes based upon key quality indicators and administrative sanctions. This challenge is one that should be undertaken to ensure greater access to information on quality of care in nursing homes and to stimulate efforts by nursing homes to improve quality.     

Developing public information on nursing home quality

The need for greater public information about nursing home quality is growing. While there are problems in using existing administrative data on nursing home quality from federal certification surveys, it is probably more feasible to use such data than to conduct direct surveys of residents and their family members and friends. Administrative records could be used to provide greater information on quality than is currently reported by the Health Care Financing Administration. These records could also be used to develop a rating system for nursing homes based upon key quality indicators and administrative sanctions. This challenge is one that should be undertaken to ensure greater access to information on quality of care in nursing homes and to stimulate efforts by nursing homes to improve quality.     

Mindfulness theory and professional family caregivers in long-term care facilities

This study utilized Ellen Langer's theory of mindfulness to better understand how individuals who work in nursing homes apply their professional knowledge to their personal lives within the context of nursing home family caregiving. Using a sample of 10 professional and 10 non-professional family caregivers (n = 20), qualitative and quantitative methods were used to compare levels of mindfulness and nursing home knowledge. Qualitative analysis revealed similar responses for both types of caregivers in three out of four attributes of mindfulness. This indicates that being a family caregiver of an institutionalized parent is novel for both professional and non-professional caregivers. Narrative data indicates professionals were more mindful than non-professionals when using their nursing home knowledge to approach staff in a non-confrontational manner. Professionals were also more accepting of care-related problems than non-professionals.     

Family Members' Reports of Abuse in Michigan Nursing Homes

The objective of this article is to describe abuse and neglect of adults age 65 and older in Michigan nursing homes, as reported by members of their families. Using list-assisted random-digit dialing, data on abuse and neglect for a 12-month period were collected from individuals who had a relative age 65 or older in a Michigan nursing home. Of the nursing home residents represented in this analysis, the majority were female, Caucasian, and widowed. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of these data with data from the National Ombudsman Reporting System suggests that family members constitute a sensitive source of data on abuse in nursing homes.     

Factors That Explain Marital Happiness When a Spouse Lives in a Nursing Home: Married but Living Apart

ABSTRACT

Little attention has been given to factors that affect the marital happiness of well spouses when their partners reside in nursing homes. Using two established scales, a telephone survey of 60 community dwelling individuals whose spouses were being cared for in nursing homes across Ohio was conducted. Multiple regression analysis indicated factors that contributed to the degree of happiness in the marital relationship were the amount of time married and coping techniques associated with mobilizing resources, social support, and spiritual support. These variables accounted for 35% of the variance in participants' stated degree of happiness with their marital relationship.     

Placement type matters: Placement experiences in relation to justice system involvement among child welfare-involved youth and young adults

Out-of-home placement in the child welfare system is related to justice system involvement. Yet, few studies address the similarities and differences of child welfare placement types in relation to justice system involvement within the same sample of youth, which can provide a more nuanced understanding of the relationship between the two. Utilizing a sample of child welfare youth with substantial out-of-home placements (N = 794), we investigate trajectory group experiences on each of three child welfare placement types, and cross-tabulate each with justice system trajectory groups to examine subgroups. The five-group model fits best for foster homes and group homes; four groups for residential facilities. Relationships between justice system groups and placement types were significant. Youth with chronic justice system involvement had more experiences in group homes and residential facilities; youth with less justice system contact tended to have foster home experiences. Implications for policy and practice are presented.     

Family involvement in the institutional eldercare context. Towards a new understanding

This article focuses on family involvement and its various patterns and expressions in the context of end-of-life care in a nursing home. Based on analyses from an ethnographic study carried out at a nursing home ward, the aim is to describe and analyze the conditions of aging and dying for the old residents, as well as effects on their visiting families and relatives. As in similar research findings, it became clear from the study that families continue to visit and contribute to the care of the old resident throughout the years, from the time of placement to their demise, but that this involvement might vary both in content and in extent. However, it was found that families' involvement (as well as their changing relationships and roles) is particularly shaped by the very process of dying and lingering aura of death on the ward. The analysis presented in the article evinces the difficult — and in many ways impossible — role of the family in the institutional end-of-life setting, and discloses the various patterns and manifestations of family involvement in this environment. Different meanings and implications of family involvement are discussed and highlighted.     

The Influence of the Extended Family on the Involvement of Nonresident African American Fathers

This study investigates the extent to which the extended family provides support to African American nonresident fathers and its influence on their involvement with their children. The data for this study were collected from 278 African American nonresident fathers as a part of the Fragile Families and Child Wellbeing Study. The findings revealed that increased support from the child's paternal extended family was associated with higher levels of father involvement. However, increased support from the child's maternal extended family was associated with lower levels of father involvement. Implications for social work practice are included.     

The Power of Older Women and Men in Egyptian and Tunisian Families

We adapt resource theory to compare involvement in family decisions by older women and men in the more patriarchal setting of Egypt and the more egalitarian setting of Tunisia. Data from the World Health Organization Collaborative Study on Social and Health Aspects of Aging are analyzed. In Egypt, women participate less often than men in most decisions, whereas participation is more gender equitable in Tunisia. Increasing age and declining health are negatively associated with participation in daily and life course decisions, particularly for Egyptian women. Although women participate less often than men in life course decisions in Egypt, involvement is more frequent among widows and those owning their homes. Future research should examine the relationship of resources, support, and the family power of older adults across normative contexts.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Indebted Relationships: Child Support Arrears and Nonresident Fathers' Involvement With Children

Low‐income, nonresident fathers owe a disproportionate amount of child support arrears, creating potential challenges for these fathers and their family relationships. This article uses mediation analysis to provide new evidence about how and why child support debt is related to paternal involvement using information from 1,017 nonresident fathers in the Fragile Families Study. Results show that child support arrears are associated with nonresident fathers having significantly less contact with children, being less engaged with them in daily activities, and providing less frequent in‐kind support 9 years after the birth. This negative association between child support debt and father involvement is most strongly and consistently mediated by the quality of the relationship between the biological parents. Although child support policies are designed to facilitate fathers' economic and emotional support, these results suggest that the accruement of child support debt may serve as an important barrier to father involvement.     

Why nonprofit nursing homes pay higher nurses' salaries

It is generally agreed that nonprofit nursing homes pay higher wages to their employees, hire more staff per patient, and are thus more costly than for-profit nursing homes. We attempt to show that higher costs in nonprofit nursing homes are related to higher quality of care in these homes. Using the 1985 National Nursing Home Survey, we show that nurses in nonprofit nursing homes have different characteristics than nurses in for-profit homes and that these differences in characteristics account for the differences in wages, a finding consistent with our hypothesis concerning quality differences between types of homes.     

Chapter 2 Residents in Assisted Living Facilities and Visitation Patterns

Abstract

Resident visitation patterns within an assisted living facility provide insight into a resident's life satisfaction. This study investigated residents' perceptions of family and friend visitation. Thirty assisted living residents from Oklahoma participated in a comprehensive interview that included demographics, life satisfaction, visitation frequency, and perceptions of visitation patterns. A majority of the respondents (90%) perceived family and friend visitation as “important” to “very important” in their life. Visitation allows residents to reminisce with family members and friends, to fulfill the need to have outside contact, and to be reassured that they have not been forgotten. Results indicate residents do desire continued relationships with family and friends through visitation. Facilities should encourage activities involving outside members of a resident's support network and be aware of residents less visited, developing programs creating social contact and involvement.     

Examining outpatient health care utilization among adults with severe or profound intellectual disabilities living in an urban setting: a brief snap shot

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors and health statuses were similar regardless of living situation, except for age and the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.