Multilevel Factors Related to Psychosocial Care Outcomes in Washington State Skilled Nursing Facilities

As the primary providers of psychosocial services in skilled nursing facilities, social services professionals report barriers interfering with their ability to meet residents' needs. This study utilizes a 3-category quality assessment framework and a cross-sectional survey design to assess factors impacting the provision of effective psychosocial services in Washington State facilities. Hierarchical linear regression results indicate that the 3-factor model explains 26.4% of the variance in psychosocial outcomes; 4 variables exert the most influence: ownership turnover, practitioner experience, practitioner role identity, and the importance of individualizing care. Findings have implications for developing necessary supports for quality psychosocial care delivery.     

Long-Term Outcome Effectiveness of a Health Promotion Program for the Elderly

A sample of long-term care facilities utilizing ombudsman services was compared to facilities not in receipt of such mediation services. Independent assessment measures were derived from State Department of Health ratings and complaint statistics for long-term care facilities. Findings revealed that ombudsman-served facilities were not appreciably different from facilities not served by ombudsmen. Facilities served by ombudsmen, however, received a relatively higher amount of complaints than did the facility group not served by ombudsmen, particularly in areas not covered by statutory abuse reporting requirements. It is suggested that nursing home patient ombudsmen call attention to aspects of quality care not currently assured by other protective mechanisms.     

Practitioners preferences of care coordination for older people: A discrete choice experiment

These findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences.

This study explored practitioner preferences about the relative value of attributes of care coordination services for older people. A Discrete Choice Experiment (DCE) survey was used to identify the views of 120 practitioners from 17 services in England in 2015. The survey design was informed by an analysis of standards of care coordination, a postal survey and a consultation with carers of older people. Results of the DCE survey were supplemented by a content analysis of qualitative comments and fieldwork notes. Most respondents were over 30 years of age, female and almost half worked part-time. Continuity of care (care provided by the same care coordinator) and the ability to access the range of services outlined in the care plan were the most important service attributes. Service setting influenced practitioner preferences. Those in specialist services for people with dementia identified the length of time a service was provided as another important attribute. The DCE methodology has provided the opportunity to systematically canvas practitioner preferences.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Gerontological social workers' perceived efficacy for influencing client outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure-process-outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R (2) = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Gerontological Social Workers' Perceived Efficacy for Influencing Client Outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure–process–outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R ² = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Investing in the relationship: practitioners’ relationships with looked‐after children and care leavers in Social Work Practices

Providing more consistent and continuous relationships for looked‐after children and care leavers is a current preoccupation in social work in light of many criticisms of the quality of such relationships. Recommendations for more direct work have spurred new models of service delivery in children's services aimed at improving individual outcomes. Independent Social Work Practices (SWPs), a new organizational model piloted in some areas of England between 2009 and 2012, were established to enable social workers and other practitioners to spend more time in direct work and thus to improve the practitioner/child/young person relationship. This paper uses findings from interviews with 169 children and young people across 11 local authorities and 5 SWPs, undertaken as part of a 3‐year national matched control evaluation of pilot SWPs, to identify key elements of good quality practitioner relationships with children or young people. Focusing on children's and young people's perspectives and experiences, the study demonstrates that more direct work and consistent relationships are valued. The paper deploys Recognition Theory to further understanding of effective practice as defined by children and young people.     

Life Prolongation Technologies in Home Care for the Frail Elderly

The imporfation of life prolongation technology from acute and chronic care institutions to the home has given rise to a range of challenges for the practitioner engaged in the delivery of gerontological home care services. The prominent programmatic and training issues are identified in an ethical context and approaches to improving home care staff practice skills are offered.     

In Their Own Words: Participants' Perceptions of the Impact of Adult Day Services

Despite the growth in the number of adult day services programs providing long-term care in the United States, researchers have struggled to consistently identify the benefits of the services to older adult participants. Instead of identifying participant outcomes driven by administrative databases, funding requirements or accreditation expectations, this study attempted to identify outcomes through the lived experiences of the older adult participants through one-on-one interviews after 3 months of attendance. The purpose of this qualitative study was to gain an understanding of the experiences of older adult participants and to build theoretical understandings that connect experiences with outcomes. Twenty-eight semistructured interviews were conducted with older adults attending 4 day health programs administered by 1 organization in a large mid-west City. Three main program experiences were identified: social connections with participants, empowering relationships with staff, and participation and enjoyment of activities and services. These experiences seemed to be associated with perceived improvements in psychosocial well-being and a perceived decrease in burden or dependence on the caregiver. The findings provide theoretical connections that are helpful for exploring the impact of adult day services based on participant perspectives. Results suggest a need for further examination of the role social workers play in supporting psychosocial services within adult day programs.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

Understanding the experience of moving a loved one to a long-term care facility:family members' perspectives

This project was designed to develop an understanding of family members' experiences of moving a loved one to a long-term care facility and to identify ways in which facilities might help ease this process. Twenty-one semi-structured interviews were conducted with family members who had recently moved a relative into one of three long-term care facilities in Southern Ontario, Canada. Several factors appeared to contribute to the overall experience of the move to long-term care and either served to impede or facilitate a positive transition for families. These factors included: the experience during the waiting process, preparation for the move, ease of the actual move, control over decisions, communication throughout the process, support from others, and family and resident perceptions and attitudes towards the move. Easing the difficult aspects of moving a loved one to a long-term care setting can be facilitated with better preparation and support from facilities and community services.     

Reviewing the latest national policies and services for people with severe mental health disorders in government-funded institutions in Vietnam,and policy recommendations for service improvements

The aim of this paper is to provide the international community with a broad and updated picture of key policies and services for people with severe mental health disorders in Vietnam. In particular, the paper (1) reviews the most important national policies governing care for people with mental health disorders, (2) reviews the status of free-of-charge care provided to people with severe mental health disorders in a network of government-funded facilities across the nation and (3) discusses the future policy directions of Vietnam regarding people with mental health disorders.     

Caring and the generation of social capital: Two models for a positive relationship

Johansson S, Leonard R, Noonan K. Caring and the generation of social capital: two models for a positive relationship When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used for care work. When there is inadequate funding of aged care services by the state, then social capital may be seen as a substitute for economic and human capital. Caring, therefore, is seen as a drain on capital. However, this does not have to be the case. Aged care services, if thoughtfully designed, can not only consume social capital, but also generate it. Two models of elder care, one Swedish and one Australian, have been identified which specifically address the generation of social capital. In each case, the services and facilities have been developed by third‐sector organisations with a strong community development focus, often in the face of resistance from state‐run or medically oriented services.     

Considerations in Care for Individuals with Intellectual Disability with Advanced Dementia

Abstract

A number of physical, psychosocial, or ethical issues related to the care of the individual with advanced dementia are reviewed and related to individuals with intellectual disabilities. The sources used include the published literature and illustrations drawn from personal observations. The author notes that through anticipation and early planning, advanced directives and service planning (which looks to adaptation of services and other care management interventions), can effectively impact care at the end. Areas that need to be addressed include technical information, including a review of and, as appropriate, adaptation of general advanced dementia resources, relief, rest, support, reassurance, receipt of on-going information, participation in planning, a sense of humor, and appreciation. Also noted, are the differences experienced because of the presence of paid staff as carers and residence outside of the family home. It is concluded that, although the goals of quality care is the same for all people with advanced dementia, the process by which to reach these goals often needs further consideration and adaptation for people with intellectual disabilities.     

ANCILLARY AND SPECIALIST HEALTH SERVICES: THE RELATIONSHIP BETWEEN INCOME,USER RATES AND EQUITY OF ACCESS

Australia's public health system currently provides substantial funding to, amongst its other objectives, ensure access to hospital, medical and pharmaceutical services by all families irrespective of income (McClelland, 1991, p. 6). However most ancillary services are not similarly subsidised and there is some evidence that income presents a barrier to the use of these services. There is also evidence that low income might also reduce access to specialist medical practitioner services which, while funded through Medicare, are less likely to be bulk billed than general practitioner services, and which therefore attract higher out-of pocket costs. In this study, the 1989–90 National Health Survey is used to examine whether there are indicators that low income reduces access to a range of ancillary services such as physiotherapy, optician services, chiropractic and dental services and to specialist medical practitioner services.     

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.     

Psychosocial Care in Nursing Homes in the Era of the MDS 3.0: Perspectives of the Experts

Meeting psychosocial needs of nursing home residents is increasingly regarded as a critical component of care, and the nationally-mandated nursing home care screening instrument— the Minimum Data Set (MDS) 3.0—was modified and implemented in 2010 to promote better assessment of psychosocial needs and health. Recognizing the importance of psychosocial well-being among nursing home residents, and the promise of MDS 3.0 for improving psychosocial care, this article reports recommendations derived from a conference of stakeholders representing diverse disciplines and organizations regarding next steps following MDS 3.0 screening. Results relate to seven areas of psychosocial care and address cross-cutting recommendations to improve psychosocial care.