Implications of welfare reform on the elderly: a case study of provider, advocate, and consumer perspectives

Whereas many studies of welfare reform have focused on effects on children and families, little research has examined the implications of welfare reform for the elderly. This case study incorporates interviews with service providers for the aging, members of advocacy organizations, and two focus groups of older consumers conducted in the multi-ethnic urban community of San Francisco. Study findings suggest that welfare reform has had both direct and indirect effects on the elderly and their services in the study community. Direct effects derive primarily from changes in the welfare reform legislation that had the effect of undermining both immigrants' eligibility for and claiming of public assistance benefits. Indirect effects on older persons include increased child-care demands upon grandparents. The case study data bear on a significant policy change within the broader trend of devolution at a historical point when anti-immigrant sentiment in the United States was running high.     

Religiousness/Spirituality and Subjective Well-Being Among Rural Elderly Whites,African Americans,and Native Americans

SUMMARY

Little attention has been paid to subjective well-being among non-White elderly in rural areas where medical resources and financial support are deficient. The present study assessed a rural community sample of 215 elderly comprising 85 Caucasians, 75 African Americans, and 55 Native Americans, to examine roles of spirituality/religiousness on their subjective well-being. This study found ethnic differences in the reliance on religiosity/spirituality and a significant association between dimensions of religiousness/spirituality and subjective well-being among all ethnic rural elderly groups. The results of the study suggest that health providers, social workers, and faith communities need to provide rural elderly with religious and spiritual support in order to enhance their life satisfaction and lessen their emotional distress.     

Private Lives and Public Programs

Abstract

Major late life events, reported in the Dubbo longitudinal study of older Australians, are used to examine the interaction of private lives with public programs. First, the data indicate strong supportive effects of publicly funded income, health, and aged care programs in reducing family burdens from major life changes. In particular, financial crises were rarely mentioned, directly or indirectly, as major threats. Next, the central role of informal social support in these events is demonstrated, first, as in previous studies, family support was responsive to risky events and to aging itself. Also, in new findings, one-third of surviving elderly respondents coped with the burdens of family crises as a substantial proportion of the “major” life changes that occurred over 13 years of the study. Within the security and support provided by the Australian welfare system, and with strong social networks, families with older persons in the Dubbo study manage multiple, major life changes. With rapid population aging, the development of more, and more easily accessible, services for a growing population of older people is a priority. The critical challenge will be to harmoniously grow public financing, private funding, and informal caregiving to deal with the growing burden arising from an aging society.     

Social Work Practice with Older Soviet Immigrants

ABSTRACT

With the recent sociopolitical changes in the Former Soviet Union, significant numbers of older Soviets have arrived in the U.S. with their families. Soviet immigrants who enter the U.S. are no longer automatically considered political refugees, which has limited their entitlement to services. Recent changes in public welfare and immigration policy place the responsibility for care of elderly members solely on the family. While caring for older adults is stressful for any family, new immigrants may be especially burdened since they have limited knowledge of services, few coping resources to provide adequate care, and little experience resolving cultural conflicts with their older parent. By using a practice model designed to evaluate late-life caregiving situations, two case scenarios are presented to examine practice and service delivery issues of older Soviet immigrants and their families.     

Impacts of Welfare Reform on California Grandparents Raising Grandchildren

ABSTRACT

Debate over the potential impacts of welfare reform largely has ignored the implications of these changes for the growing number of grandparents who are raising their grandchildren. Results of a qualitative study involving 36 key informants who were intimately involved in the crafting and/or implementation of California's welfare reform plan are presented. Particular attention is focused on time limits on aid, work requirements, and sanctions regarding teenage parenthood as these may impact on grandparent caregivers and their families. Cross-cutting themes also are presented. A case is made for greatly stepping up data collection and evaluative research that may help in determining the actual impacts of the legislation on intergenerational households headed by grandparents.     

Tolerance of Elder Abuse and Attitudes Toward Third-Party Intervention Among African American,Korean American,and White Elderly

SUMMARY

Studies have found that professionals and the lay public differ consistently from one another in the ways in which they perceive elder abuse. A potential variable that may explain this observed difference is cultural norms among ethnic groups. Using 18 statements, this study examined similarities and differences among elderly from three ethnic groups in their tolerance for potential elder abuse, perceptions regarding perpetrators and the causes of elder abuse, and attitudes toward third-party intervention and reporting of elder abuse to the authorities. Results suggest that while African American and White elderly are remarkably similar in their responses to most statements, Korean American elderly differed significantly from the other two groups in their tolerance for medical mistreatment, financial exploitation and neglect, perceptions of causes, and attitudes toward reporting elder abuse. These findings have implications for understanding potential barriers to preventive outreach efforts, investigation, and intervention in cases of elder abuse in a culturally diverse community.     

Differences in Facilities' Acceptance of Patients Under Long-Term Care Insurance in Japan

Abstract

Objectives. In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI.

Methods. We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions.

Results. We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor.

Discussion. In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.     

Constructing deservingness: federal welfare reform,supplemental security income,and elderly immigrants

On August 22, 1996, President Clinton signed the welfare reform law that ended eligibility for all immigrants to federal means tested entitlements. Poor elderly immigrants on Supplemental Security Income were specifically targeted. This article documents how the print media responded to these policy changes. The following are the major research questions: (1) How were older immigrants on Supplemental Security Income portrayed in the print media before and after federal welfare reform? (2) Who was involved in the print media coverage of older immigrants on Supplemental Security Income before and after federal welfare reform? (3) What types of statements were made by those involved in the print media coverage of older immigrants on Supplemental Security Income, before and after federal welfare reform? The approach used was an in-depth content analysis of newspaper articles from major U.S. newspapers. The findings demonstrate that older immigrants were constructed as "undeserving" in news articles prior to the passage of the federal welfare reform bill. However, after the passage of the federal welfare reform bill the coverage of older immigrants on Supplemental Security Income started to change, and older immigrants were portrayed as "deserving." In advancing aging policy for poor, vulnerable elderly, such as elderly immigrants, advocates, health and social service providers can play an influential role in bringing their voices to the print media.     

Psychological Distress in Older Portuguese Gay and Bisexual Men: The Mediating Role of LGBT Community Connectedness

Abstract

Objectives: Examining Psychological Distress (PD) among older Portuguese gay and bisexual men (GBM), and the mediator role of LGBT community connectedness (LGBTCC) of minority stress variables on PD. Methods: We performed a mediation analysis with LGBTCC as mediator between minority stress variables and PD with a sample of 110 elderly GBM. Results: We found moderate PD levels; LGBTCC was a significant mediator between concealment of sexual orientation and PD, but not between internalized stigma and expectations of rejection and PD. Conclusions: More attention is needed to Older Portuguese GBM’s mental health. LGBTCC is an important ameliorating factor for older GBM.     

After the Bubble Bursts

Abstract

The late 1990s was a period of robust economic growth in America, and welfare reform resulted in a historically unprecedented drop in the welfare rolls. From 2001 to 2003, the economy slumped, however, leaving the policy community to speculate how this would impact welfare reform efforts. In this study, the authors constructed a logistic regression model to determine the extent to which economic climate and other factors influenced the employment status of Georgia's TANF population. The study's findings indicated that ownership of an operational vehicle predicted employment, while economic climate and the other tested variables played a negligible role.     

Young Children's Perception of the Elderly

Abstract

Young children's perceptions of the elderly were examined using Child-Adolescent Facts on Aging Quiz in order to assess what relationships exist between perception and contact with the elderly, gender, and age. Comparisons were also made between the findings in this study and a previous one in the United States of America. One hundred and twenty respondents comprising fifty males and seventy females from two primary schools answered the questionnaire. The mean age of the respondents was 10.6 years and about 63% had at least a living grandparent. The results revealed that the mean percentage error was 47%. Item 6-“most older workers do not work as well as younger workers” had the highest error rate of 83% while item 4-“old people are not as strong as younger people” had the lowest error rate of 16%. All the three variables were found not to have any influence on the respondent's perception of the elderly. Some similarities and differences in perception of the elderly were found in the Nigerian and American samples. The implications of these findings are discussed and further areas of research suggested.     

Recent Developments in Welfare to Work in Hong Kong

Summary

The Asian financial crisis (1997) has created a social care crisis resulting in rising unemployment, poverty, income inequalities and homelessness. Although faced with dwindling public finances, the Hong Kong Special Administrative Region (SAR) government had been compelled to tackle these problems. However, it has been attracted to the neo-liberal recipe: changing the subvention system to a block grant, curbing social spending, and tightening eligibility for social assistance. Notably, the introduction of the Intensive Employment Assistance Projects (IEAPs), which are the first welfare to work programs in East Asia, has become a major policy tool. This paper reports on a study of the impact of the projects, one of the key pillars for welfare to work programs. The IEAPs were found to have brought about positive changes in welfare clients' motivation to work and sense of self-reliance. Social workers from both traditional and progressive NGOs have etched, in various ways, their place in the welfare to work programs and contributed to the debate on welfare reform in Hong Kong.     

Managing Out

ABSTRACT

With the advent of welfare reform and managed care, the nature of managerial practice has increasingly shifted from a primary focus on internal operations to a more external, community focus which involves actively monitoring and managing the boundary between the external environment and internal organizational arrangements. This article explores the boundary spanning aspects of community practice, the related theories of inter-organizational relations, and the process of “managing out” by those in top management and middle management positions in human service organizations.     

Self-Sufficiency and Sobriety

Abstract

Substance abuse presents formidable challenges to a welfare reform that has employment as its primary goal. This study reviews the literature on substance abuse and women and reports what substance-abusing women on welfare perceive as unmet needs and barriers to their recovery and ability to join the workforce.     

Correlates of Depression Among the Soviet Jewish Immigrant Elderly

ABSTRACT

This exploratory study examined the prevalence rates of depressive symptoms among the elderly Soviet Jewish immigrants living in Southern California. Structured interviews were conducted with a sample of 50 self-identified Jewish elderly immigrants from the former Soviet Union, assessing their level of depression, health status, primary need areas, and family support. According to the results, 72% of the respondents reported mild to severe levels of depression. Age and satisfaction with the family assistance turned out to be significantly correlated with the level of depression among this group. Implications for human services practice with vulnerable older immigrant populations are discussed.     

The Role of Non-Governmental Organizations for the Welfare of the Elderly

Summary

Since there has been a gradual increase in the population aged 60 and older, a developing country like India is unable to cope with the needs and problems of its aged populations. While the government continues its efforts to introduce programs for the elderly, the nongovernmental organizations (NGOs) have played a key role in bringing to the forefront the socioeconomic and health problems of older people in the society at large. This paper looks at the role of the NGOs through their various welfare activities and beneficial programs in carving out a place for the elderly in India. The work of HelpAge India is highlighted to examine how voluntary organizations have worked in the field of aging in India and made an impact on the lives of the senior citizens, especially those below the poverty line who are economically and socially deprived.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

The Savings Approach to Financing Long-Term Care in Singapore

Summary

Singapore is grappling with provision of services for the current generation of older people at the same time as building the foundation for the coming generations of elderly. In this article, I analyze four sets of factors that are shaping long-term care policy and financing in ways that are almost unique to Singapore. First, current developments can only be understood in the context of the Central Provident Fund (CPF) that was established by the Government of Singapore in the 1950s to ensure that the working population saved for retirement; the Medisave and related schemes for financing health care were subsequently developed alongside the CPF. Most recently, the existing funding arrangements have been extended to some long-term care services, and options for further extensions are under consideration. Second, the government's philosophy of maintaining the primacy of family support for the elderly has been expressed through a number of initiatives that provide financial and other incentives to families, combined with an emphasis on community care. The third factor is the relationship between government and the voluntary welfare organizations that are the major providers of institutional and community services. Finally, a series of government-sponsored reviews and advisory councils have provided for widespread consultation on policy options. These developments are directed to achieving a multi-pillar approach in which intergenerational transfers through taxation will be limited, and the role of individual savings and insurance will be increased.     

Measures of Restoration in Geriatric Care Residences

Abstract

In this paper, we have studied how elderly people's frame of mind influences their response to experiencing nature, measured in terms of blood pressure, pulse rate, concentration and results from protocols. Two theories concerning the importance of psychological balance have been put forward earlier by Lawton and Kiiller, both of whom maintain that the surrounding everyday environment is one of the keys to a harmonious existence. We present findings supporting the theory that the positive experience of natural surroundings per se has a balancing and healing effect.

We have found that the people most affected by their surroundings are those with the greatest psycho-physiological imbalance. When the balance tilts, the balancing effect of the green experience can restore the individual to a state of better harmony. Time spent in the outdoors is, thus, especially important for individuals who easily lose their equilibrium or find it difficult to make compensatory changes to restore harmony on their own.

The research project is an intervention study in which fifteen elderly individuals living at a home for very old people participated. Their power of concentration, blood pressure and heart rate were measured before and after an hour of rest in a garden and in an indoor setting, respectively. Seven elderly people were randomly chosen to have their first series of tests in a garden, while eight elderly people had their first series of tests indoors. The results indicate that power of concentration increases for very old people after a visit in a garden outside the geriatric home in which they live, as compared to resting indoors in their favorite room.

The results did not show any effects on blood pressure or heart rate.

However, when we compared these results with the background variables, we found interesting correlations. Background variables included how often they took part in social activities, showed helpfulness toward other residents in group activities and tolerance/critique of other residents. After a factor analysis, the background variables formed three distinct factors, one of which showed significant correlation with blood pressure and heart rate: the factor psycho-physiological balance, with the variables “degree of tolerance,” “degree of helpfulness” and “frequency of hospital visits.” Elderly people with low psycho-physiological balance, that is, who had low tolerance of other residents, were not helpful in group activities and had a high frequency of hospital visits, were most affected by a stay in a garden, as could be measured in changes in heart rate and blood pressure. The results may be interpreted as showing that a garden can restore an elderly person with low psycho-physiological balance to a state of better harmony.

The present study show, first, that an outdoor visit is important for recovery from stress and fatigue and, second, that the improvement is especially significant for the most susceptible. Thus, it is of particular importance that weak groups, such as elderly in great need of care, have access to an outdoor space. Such groups are likely to include many people who are in psycho-physiological imbalance.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.