Care Diamonds and Welfare Regimes in East and South-East Asian Societies: Bridging Family and Welfare Sociology

This paper tries to bridge the micro-level analyses of social networks for "care" provision which have been conducted in the field of family sociology, and the macro-level framework on welfare mix which has been developed in the area of welfare sociology, because the options for creating social networks are given to individuals by society. A group of Asian researchers including the author have conducted comparative research on social networks for childcare and elderly care in six Asian societies, namely Korea, China, Taiwan, Thailand, Singapore, and Japan. To reexamine the results, the author draws diagrams of the care diamonds in each society for each type of care (childcare or elderly care) to show the balance between four sectors (the state, market, family and relatives, and the community) which determines the pattern of welfare mix. The most prevalent pattern in Asian societies today is the pattern with a large family and relatives sector and a large market sector. We can interpret it as a familistic welfare regime combined with liberalism. However, Japan alone shows a pattern close to pure familism because the development of the market sector is restricted by immigration policies prohibiting the employment of foreign domestic workers. Unlike other Asian societies which were exposed to the global market before the family could become a closed organization and marketization of care work took place easily, in Japan, where the modern family system had been established, both socialization and marketization of care work have stagnated.     

Oral health in long-term care: The implications of organizational culture

When an investigation designed to compare extant models of delivering oral health and dental services to the institutionalized elderly revealed that structural variables explained very little of the difference between effective and ineffective programs, secondary analytic techniques were employed to consider alternative explanations. The original study was a program evaluation based on a comparative case study of 12 long-term care (LTC) facilities. Data for each case included interviews with administrators, care providers, family members, and residents, administrative documentation, and clinical measures of oral health from the residents. The secondary analysis revealed the mechanisms through which the organizational context of each facility influenced the effectiveness of the oral health services. In addition, it revealed how administrative and leadership issues influenced the quality of care.     

Family Versus Individual Therapy: Impact On Discrepancies Between Parents’ And Adolescents’ Perceptions Over Time

This study examined the degree of disagreement between runaway adolescents and their primary caretakers, defined as informant discrepancies, on their view of their family. How these discrepancies changed over time and whether family therapy or individual therapy could impact that change were also explored. The current sample (N = 179 dyads) included adolescent substance abusers residing in a runaway shelter and their primary caretakers. Adolescent gender was examined as a correlate of change, and treatment attendance was controlled. The intraclass correlation coefficient was used to measure discrepancies between the individuals within a dyad. Results showed that among those receiving family therapy, but not individual therapy, informant discrepancies decreased significantly over time. Additionally, dyads with a male adolescent showed a significantly slower rate of improvement in discrepancy scores across time compared with dyads with a female adolescent. Previous research indicates that lower levels of discrepant perceptions are associated with better individual and relationship functioning. Therefore, this study’s findings support family therapy as superior to individual therapy for addressing parent–child discrepancies––possibly through its focus on improving family communication, perspective taking, and understanding.     

New roles for families in child welfare: Strategies for expanding family involvement beyond the case level

This paper examines the strategies and approaches child welfare agencies used to integrate meaningful family involvement into their service delivery systems, under the Children's Bureau Improving Child Welfare Outcomes Through Systems of Care demonstration initiative. Through a series of retrospective interviews with child welfare agency staff, systems of care project staff, family members actively involved in implementing the systems of care initiative, and local program evaluators, researchers investigated the family involvement planning and capacity building activities of child welfare agencies during the initiative's implementation. Findings indicate that child welfare agencies' capacity building efforts primarily centered on human resource development, focusing on three areas: program staffing, family engagement, and agency buy-in. These findings illustrate the importance of developing the capacity of child welfare agency staff and family members before fully implementing family involvement programs and activities. Although more research is needed to document the impact of family involvement, the lessons learned from these grant communities' experiences provide critical information and can inform development of policies and practices to help child welfare and other child- and family-serving systems promote and implement meaningful and sustainable family involvement.     

From Caregivers to Caretakers: The Impact of Family Roles on Ethnicity Among Children of Korean and Chinese Immigrant Families

Scholars have long examined the effects of family and community on ethnicity, but they have less to say on why some children may be more receptive to the positive influences of ethnic communities than siblings within the same family. As more immigrants struggle to adapt to the needs and demands of the new global economy, many families are turning to alternative caregiving arrangements that significantly impact the long-term ethnic identities of the second generation. The article considers how adult-age children of immigrants negotiate the emotional disconnects created by these varying contexts of care depending on their individual role within the family and how it shapes their views on ethnicity and culture in their own adult lives. The study focuses in-depth on fourteen semi-structured, in-person interviews with adult-age children of Asian immigrant families in the NY-NJ metropolitan area. Depending on their social status, children of immigrants are integrated into their families: as cultural brokers expected to mediate and care for their family members, as familial dependents who rely on their parents for traditional caregiving functions, or as autonomous caretakers who grow up detached from their parents. I argue that because of their intense engagement with family, cultural brokers describe their ethnic-centered experiences as evoking feelings of reciprocated empathy, whereas on the other end, autonomous caretakers associate their parents’ ancestral culture with ethnocentric exclusion. Depending on how they are able to negotiate the cultural divide, familial dependents generally view their parents’ culture and immigrant experiences through the hierarchical lens of emulation.     

On Lok: a pioneering long-term care organization for the elderly (1971-2008)

On Lok is a pioneering nonprofit organization that has delivered services to the frail and elderly since its founding in 1971. The agency began as a grassroots effort focused on improving the health care available to older adults living independently in the community. Over its 40-year history, On Lok has evolved into a $70 million nonprofit human service organization with a national reputation for innovation as a leading provider of care to frail elderly. The agency has developed its own model of care that has been replicated in cities around the country. The history of On Lok represents the important impact that donor and community support plays in an organization's long-term success.     

Pets and Family Relationships Among Nursing Home Residents

An anthropological study of pet visiting programs to three nursing homes reveals five aspects of how elderly residents deal with their past and present ties to their families. (1) Sessions trigger childhood memories and family reminiscences associated with animals. (2) Pet loss and human loss are spoken about as interrelated experiences. (3) Animal visits highlight and help counteract the decline of domesticity that people go through in institutions. (4) Residents explore their ties to pets they have had to give up and their relationships with family members currently caring for these animals. (5) The occasional visits of people's kin during pet sessions indicates the role of animals in domestic interaction and the reaction of family members to the situation of their institutionalized relatives. These findings are compared with other studies on the ties between pets and the elderly.     

The “Costs” of informal care: an analysis of the impact of elderly care on caregivers’ subjective well-being in Japan

This paper examines the impact of providing informal care to elderly parents on caregivers’ subjective well-being using unique data from the “Preference Parameters Study” of Osaka University, a nationally representative survey conducted in Japan. The estimation results indicate heterogeneous effects: while informal elderly care does not have a significant impact on the happiness level of married caregivers regardless of whether they take care of their own parents or parents-in-law and whether or not they reside with them, it has a negative and significant impact on the happiness level of unmarried caregivers. These findings call for more attention to be paid to unmarried caregivers, who presumably receive less support from family members and tend to be more vulnerable to negative income shocks than their married counterparts.     

The changing responsibilities of the state and family toward elders in Hong Kong

With a predominantly Chinese population and a cultural tradition of respecting the old, Hong Kong has long relied on the family to support its elderly members. Economic success has, however, not spared Hong Kong from encountering the same problems as other industrial societies, such as the loosening of its traditional values. This article examines the changing responsibilities of the state and the family in Hong Kong in supporting the old, and in particular, the effectiveness of the "care in community" policy, which the Hong Kong Government has adopted since the mid-1970s. The examination concludes that the responsibility must now be shared between the state and the family.     

Caregiving and cost of health care for later life families

In the future, the number of families providing care for elderly relatives as well as the costs associated with health care will continue to increase. The caregiving triad—individual, family and government—will need to balance the resources to meet the needs of the elderly. Public policy changes can assist older persons and their families as they address caregiving in the later years.     

A review of private residential care in Hong Kong: implications for policy and practice

Hong Kong government policy encourages and facilitates families to care for their older members as long as possible by providing families and their older relatives with community support services. Residential care for the elderly is viewed as a last resort. Due to the inadequate supply of community support services, the long period of care required, and the gradual breakdown of values of filial support, families may increasingly give up their caring roles and seek residential care for their dependent elderly relatives. A shortfall in subsidized residential care may lead to needy elderly persons' being cared for in private residential facilities. The demand for private residential care is projected to increase, despite criticism about the standard of care provided. Although an Ordinance, a Regulation, and a Code of Practice for residential care homes are in place to control, monitor, and upgrade private residential care in Hong Kong, problems remain that put the elderly at risk of receiving substandard services. These include the existence of substandard private aged care homes operating either with or without a license; the provision of substandard "places" to the elderly under the government's "bought place" scheme and "enhanced bought place" scheme; ineffective inspection; a lack of grading to indicate the quality of private aged care homes; and a general neglect of the quality of care. We provide recommendations to address these concerns. This requires paying attention to both the quality of care, as well as to the physical environment of homes.     

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.     

Willingness and availability: Explaining new attitudes toward institutional elder care among Chinese elderly parents and their adult children

This paper studies the attitudes of Chinese elderly parents and their family members toward institutional elder care. Based on a sample survey of 265 elderly residents in 67 elder home institutions and 114 family members, this study finds that elders and family members generally had high evaluations of institutions' quality in terms of facility, medical, and direct care conditions. Elders who reported improved health and emotional well-being after entering institutions gave higher ratings to those institutions' quality. Among adult children, those who had more siblings tended to rate institutions higher than those who had fewer siblings. Factors that influenced elders' willingness to stay in an institution included marital status and financial ability. Widowed elders were more willing to stay in institutions compared with married counterparts. Elders who rated service charge very high preferred to stay at home due to the high cost of institutional care. In the family relatives' sample, gender was found to be related to willingness to place elderly parents in an institution; female children were less willing to place elderly parents in the institution.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

Services to Families with Dependent Elders

This article analyzes the role of states in providing service and financial incentives for family caregivers to impaired older people. Results from a recent Massachusetts study of family relations of the elderly are reported, focusing on the role of relatives in providing care. Next, critlcal needs of family caregivers are discussed, and major service initiatives to respond to these needs are reviewed. The Massachusetts home care system is used as an example of how services that support family care can be delivered in a comprehensive fashion. Two financial incentive programs (tax incentives and direct payment of caregivers) are then presented. The article concludes with a call for experimental demonstration projects to expand knowledge in this area.     

Family members' strategies when their elderly relatives consider relocation to a residential home - Adapting, representing and avoiding

The aim of this article is to reveal how family members act, react and reason when their elderly relative considers relocation to a residential home. Since family members are usually involved in the logistics of their elderly relative's relocation, yet simultaneously expected not to influence the decision, the focus is on how family members experience participation in the relocation process in a Swedish context. 17 family members are included in 27 open, semi-structured interviews and follow-up contacts. Prominent features in the findings are firstly the family members' ambition to tone down their personal opinions, even though in their minds their personal preferences are clear, and secondly, the family members' ambivalence about continuity and change in their everyday lives. Family members are found to apply the adapting, the representing, or the avoiding strategy, indirectly also influencing their interaction with the care manager. Siblings applied the adapting strategy, spouses the representing strategy, while family members in the younger generation at times switched between the strategies.     

Does family reunification from residential care facilities serve children's best interest? A propensity-score matching approach in Ghana

The U.N. Convention on the Rights of the Child declares that children are entitled to grow up in a family environment with love, happiness and understanding. Governments and international child welfare agencies have promoted the reintegration of children currently in residential care facilities with family or other caregivers. We assess whether 157 children who spent time in a Ghanaian residential care facility but who have been reunified with their families scored differently on a battery of standardized child wellbeing measures than 204 children still living in residential care facilities using propensity score matching models. Results suggest that outcomes, including overall hope (as well as hope pathways and hope agency) and access to basic resources as measured on the Child Status Index, differ between children who were and were not reunified. These results underline the importance of supporting children's physical and psychosocial developmental needs. Children who were reunified with family members or other kin may require additional support regarding access to basic resources whereas interventions designed to increase hope in the future may benefit children in residential care. We urge a redoubling of efforts to care for children under carefully designed national schemes providing resources, trained personnel, and sustained case management.     

Accessibility and clarity of state child welfare agency mission statements

The authors reviewed 40 mission statements guiding U.S. public child welfare practice for accessibility, clarity, and values. Nine of the 40 state-administered child welfare agencies had not posted their missions on the Web as of October 2002, and 30 mission statements required a 12th-grade or college reading level for easy comprehension. The mission statements most often expressed the goals, values, and processes of safety, permanence, well-being, family preservation, cultural competence, self-sufficiency, and partnership. Mission statements can be an important tool for improving child welfare outcomes by providing direction; therefore, agency administrators should consider how clear and accessible their state agency mission statements are.     

Foster Care to Kinship Adoption: The Road Less Traveled

ABSTRACT

Although a rather extensive literature concerning informal kinship care and kinship foster care has emerged over the past 30 years, much less is known about the children and families involved in kinship adoption. This article pays particular attention to recent research that investigates placement decisions and outcomes for former foster children adopted by relatives. This review suggests conclusions similar to broader reviews, in that kinship placement tends to show some consistently favorable outcomes across a range of study populations and methods. Financial need may be the greatest concern for relatives who adopt. The Fostering Connections to Success and Increasing Adoptions Act of 2008 expands adoption subsidies and provides states with the option of providing ongoing subsidies to certain relatives who take guardianship of family members from the foster care system. However, relative caregivers often are not well informed about financial supports afforded them by federal and state policies. Specialized programs for kinship adoptive families are still limited. Much of the growth of kinship placement has been due to the absence of other placement options for many children and value-based decision making that places a premium on kinship, rather than on evidence of the advantages of kinship adoption.