Current Developments in Social Care Services for Older Adults in the Czech Republic: Trends Towards Deinstitutionalization and Marketization

ABSTRACT

Deinstitutionalization and marketization of eldercare has been delayed by 20 years in the Czech Republic compared to Western Europe, and it takes place in a completely different context, characterized by the legacy of communism, a growing older population, and less generous public subsidies. This study is the first in the Czech Republic to examine how deinstitutionalization and marketization effect implementation of these principles on the availability and quality of eldercare services at regional and municipal levels. A mixed-method approach was used, combining several data sources (policy documents, administrative data, statistics, expert panel, and secondary use of qualitative data). The findings suggest that the support for and availability of home-based care has declined, despite the ever-increasing number of older adults and policy preference for deinstitutionalization. Furthermore, home-based services have failed to adjust to growing care needs of older adults (e.g., inflexible schedules, limited provision of time-demanding care, inadequate staff composition). This situation occasioned an unintended outcome: the emergence of nonregistered, semilegal, for-profit nursing homes offering low-quality care and poor working conditions, and subject to no quality control. The health and even lives of older adults are at risk if they choose such services. Research is needed to study older adult decision making and offer them tools to identify and avoid questionable services.     

Developing a Community-Based Social Service Program for the Elderly

This article describes the development and implementation of a community-based social service program for the elderly. The problems encountered as a new professional unit within the municipality are analyzed and the role of the social worker in resolving those problems is described. The local community is the primary focus of change and strategies of intervention include reaching out and involving members from all levels of the community in the social service program, from members of the client group to individuals with political influence in the governmental system. Planning considerations for social work practice are posed including the relationship of the private, nonprofit sector to the public sector, the demands for service and difficulties establishing program stability.     

Gender Identity and Social Services: Barriers to Care

ABSTRACT

Transgender people seek social services for a variety of reasons. This literature review highlights needs assessments and social science research articles (N = 30) from the last 16 years that demonstrate the many ways in which social services are further revictimizing transgender people. Studies indicate that transgender people often encounter ignorance, hostility, and transphobic environments while attempting to access social services, and these environments can dissuade transgender people from gaining needed care. Suggestions are made to address these inequalities and include simple measures that social service agencies can begin with to make their services more transinclusive. Future research should address the bias in social services more directly and also develop a clear plan of action and best practices to help agencies remove discrimination from social service settings.     

Formal Social Participation and Utilization of Community-based Services among Urban Elderly Chinese Living Alone in Shanghai,China

This research examined formal social participation among elderly Chinese adults living alone and the association between utilization of community-based services and formal social participation, which refers to participation in employment, volunteer jobs, and social groups. Using a secondary analysis on a survey data from a simple random sample of 228 adults aged 60 and older living alone in a Shanghai neighborhood, it was found that only small percentage of older adults living alone were involved in formal social participation. Hierarchical multiple regression analysis showed that use of community-based services is significantly associated with formal social participation among elderly Chinese living alone. Thus, future policies and programs should focus on strengthening community-based services for elderly Chinese, to more effectively promote and facilitate their social participation.     

俄罗斯的社会转型与社会阶层分化

20世纪80年代,俄罗斯社会开始转型,90年代以后,俄罗斯的社会阶层发生了明显的分化。本文主要从以下几个方面描述和分析俄罗斯的社会阶层分化：1、社会收入的差距（包括个人的收入差距,政府各部门之间、社会各行业之间的收入差距,俄罗斯区域间的收入差距）。2、“社会边缘群体”和“新贫困者”。“社会边缘群体”是一些不能确定自己的社会地位和群体归属的“被社会边缘化”的人群。“新贫困者”是指前苏联时期,以教授、工程师和医生等知识分子为主体的社会阶层,俄罗斯社会改革前,他们生活安逸,有很高的社会地位,而现在却生活艰难,变成了俄罗斯的穷人。3、新中产阶级。 俄罗斯在社会政治、经济转型过程中,旧的以知识分子为核心的社会中间阶层消失了,出现了新的以企业主为中心的中产阶级,俄罗斯新中产阶级的出现使俄罗斯的社会阶级结构发生了巨大的变化。     

Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People

Risk management systems and structures are developing rapidlywithin UK health and personal social services. However, therisk management strategies of organizations need to take intoaccount the conceptual frameworks used by professionals. Thisgrounded theory study used data from nineteen focus groups andnine semi-structured interviews (ninety-nine staff in total)to explore perspectives on risk and decision-making regardingthe long-term care of older people. Focus group participantsand interviewees comprised social workers, care managers, consultantgeriatricians, general medical practitioners, community nurses,occupational therapists, home care managers and hospital dischargesupport staff. Social work and health care professionals conceptualizedrisk and its management according to six paradigms that appearedto be in a state of reciprocal tension: (i) Identifying andMeeting Needs; (ii) Minimizing Situational Hazards; (iii) Protectingthis Individual and Others; (iv) Balancing Benefits and Harms;(v) Accounting for Resources and Priorities; and (vi) Warinessof Lurking Conflicts. The effective translation into practiceof risk management strategies needs to address the complex andoften contradictory issues facing health and social servicesprofessionals.     

Promoting Personalization in Social Care Services for Older People

This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.     

End-of-Life Care and Social Work Education

Summary

Social workers are major service providers to people who are facing end-of-life issues including the terminally ill and their families. Yet, exemplary models for social work education and intervention methods are limited in rural states. A statewide survey conducted in Kentucky found only two social work courses dedicated to end-of-life care currently being offered by accredited undergraduate and graduate institutions. Another statewide survey found that many hospice social workers are relatively inexperienced and have a need and desire for more education on death, dying and loss. Also, unique cultural, economic and geographic areas, such as Appalachia are enigmas when it comes to the provision of end-of-life care. This partnership provides a varied perspective on delivery of end-of-life care services with an emphasis on social work interventions and education.     

Practitioners' Documentation of Assessment and Care Planning in Social Care: The Opportunities for Organizational Learning

This paper analyses practitioners’ documentation of socialcare assessments and care plans for disabled adults of workingage. The data were collected in the course of an innovativeproject that introduced new outcome-focused documentation intoroutine social care assessment, care management and review processes.The project aimed to encourage practitioners to focus duringthese processes on the full range of outcomes that individualdisabled adults might seek to achieve; and identify the appropriateservices for realizing those outcomes. Analysis of the new documentationprovides insights into the diverse range of priorities and outcomesthat service users aspire to achieve as a result of receivingservices, and the service inputs that were agreed between practitionersand service users. However, despite the new documentation, themajority of both outcomes and services that were recorded tendedto cluster around a fairly narrow range of conventional socialcare service functions. Moreover, the emphasis of both outcomesand service inputs differed between different groups of socialcare professionals. In the context of current policies to makesocial care services more individualized and outcome-focused,each of these findings has major organizational implications.The opportunities for using routine practitioner documentationto identify areas of organizational and professional changeand learning are discussed.     

市场转型理论与社会整合

市场转型理论并没有直接言说社会整合议题,它的主题是社会与 分层。其主要的观点是,从计划再分配体制向市场体制的转型,将同时 出现产权私有化、精英权力转移和利益群体重组。因而环绕它的争论 集中在三个问题上:谁占有产权?谁控制管理?谁获得较多报酬?对 这些问题的回答直接涉及整合机制的变动问题,可以概括地说是产权 关系的整合、权力支配关系的整合和利益群体的整合(以下简称产权整 合、权力整合和利益整合)。我将着重评述关于产权整合和权力整合的     

Good Intercultural Practices in Social Services Projects

ABSTRACT

This article reflects part of the results obtained from a wider research project aimed at the elaboration of a “Map of Good Intercultural Practices” in several areas of social intervention in Andalusia, Spain. It also reports the results obtained from the analysis portion related to the participating projects within the social services. Intercultural assessment was conducted at the level of institutional intervention through a 32-item questionnaire that was sent to 139 intercultural project-leading institutions measuring intercultural sensitivity. A definition of the fundamental concepts of “interculturality” and “good practice” is given to support the foundations of “good intercultural practice” (GIP). Such definitions help in the design and validation of a GIP Scale that was used in the analysis of 60 social services projects with an intercultural component. The results obtained underline the relevance of aspects such as intercultural empathy and show significant differences between the social services and other intervention sectors. Future research is proposed that studies GIP scale in other intervention sectors such as the private and public sector. Also, the transferability of the instruments and methodology used makes it possible that the research presented in this article is conducted in other geographical areas.     

小组工作在社区长者服务中的运用--以南国颐景老年公寓为例

小组工作是社会工作的一种专业方法,它不仅是社会工作者经常运用的工作方法之一,同时还是一个重要的中介,贯通和连接着宏观社会工作和微观社会工作。运用小组工作的专业手法为社区长者开展小组工作是我们教学实践的一种新的尝试,通过小组活动和互动交流的方式,使长者放松心情,享受欢乐,体现了社区专业工学结合植根于社区的教学理念,也为小组工作服务社区长者提供了经验。     

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.     

社会转型时期的价值冲突与价值导向

当今,我国正处于社会主义市场经济转型时期。人们的价值观念发生了深刻的变化,各种价值矛盾和价值冲突以激烈的方式突出出来,现在我们面临的主要价值冲突有道德与功利、经济发展与环境建设、效率与公平的矛盾等。在现实生活中,人们的价值取向是多元的,此时,建构以马克思主义社会价值观念体系和以社会主义为基本内容的价值导向有利于我国社会的稳定和展。     

Social Work Knowledge of Community-Based Services for Older Adults: An Educational Model for Social Work Students

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.     

Compassion Fatigue and the Adult Protective Services Social Worker

Compassion fatigue is a relatively new term that describes the symptoms that are experienced by social workers and other helping professionals who work with clients experiencing trauma. This article defines the concept of compassion fatigue and relates compassion fatigue to Adult Protective Services (APS) social workers. It is proposed that APS social workers may be susceptible to the deleterious effects of compassion fatigue due to the nature of their work and environment. Suggestions for avoidance of compassion fatigue are also discussed, including self-care strategies and the need for continuing education regarding this phenomenon.     

社会转型与教育变迁

社会转型是一种必然现象。社会转型要引发其他组织机构的变迁。作为社会重要组成部分的教育,在重大的社会转型过程中受到政治、经济、文化等诸多方面的影响,尤以经济的影响为甚。从经济的视野分析教育的变迁,教育从第一部门中分离出来是社会转型的必然结果,而从第一部门中分离出来转为第二部门,然后再转为第三部门是其发展的主流,并且第三部门是教育发展的最终归宿。     

Poor Hemodialysis Outcome Identifying Social Risk Factors in Elderly and Non-elderly Patients in Singapore

Little is known about the social determinants that predispose hemodialysis patients to poor treatment outcome. Using a clinical data mining method, this study aims to identify differences in social risk factors for hospitalization between elderly and non-elderly patients. The sample consists of 100 elderly and 219 non-elderly patients who started hemodialysis at the National Kidney Foundation from October 2007 to September 2008 and were followed through up to one year of hemodialysis to examine their hospitalization status then. Bivariate analysis revealed differences in the risk profiles between the two groups. The study has implications for funding policy and also draws attention to how clinical interventions ought to be tailored between the two age groups.     

跨越与过渡:当代中国社会转型的二元特征

当代中国社会的转型在取向上具有二元特征:一是在社会制度上要跨越资本主义社会制度;二是在发展生产力的手段上又要充分利用资本主义创下的优秀遗产。邓小平对当代中国如何建设社会主义做出了卓越贡献,他提出改革是社会主义发展的直接动力,改革始终以经济体制改革为重点,并渐进式进行,等等。这些都是马恩关于"中间站"思想的中国化,具体化。     

Social Policies for the Elderly in the Republic of Korea and Japan: A Comparative Perspective*

The Republic of Korea (South Korea) and Japan are highly industrialized and modern nations which are both influenced by the Confucian tradition of respect for the elderly and family responsibility for the care of aging parents. In both countries the proportion of the elderly population is increasing. Japan, since the end of World War II, has utilized its government bureaucracy to help develop the social welfare system and to formulate social policies and programs for the elderly. Japan's tradition of samurai Confucianism is congruent with the commitment of the Japanese government to such social development as a matter of national policy. The Republic of Korea has not assigned a comprehensive planning role to its government bureaucracy. Lacking the mix of industrial/post-industrial infrastructure of Japan and not yet faced with the immediacy of a very large elderly population, the Republic of Korea's government has developed its social policies for the elderly in a more incremental manner, usually emphasizing small scale and piecemeal initiatives. With respect to social support, it has emphasized voluntary family efforts as congruent with the Korean (and Chinese) variant of Confucianism. This paper will compare and contrast these different approaches.