Long-term care planning as a cultural system

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

Broadening Our View

Summary

The growth in child welfare caseloads and the increasing use of kinship foster care has raised new questions about effective permanency planning. The majority of children in kinship foster care are children of color and have been less likely to exit the custody of the child welfare system than children placed in traditional foster care. Permanency planning which ensures the long-term protection and well-being of children from diverse cultural backgrounds requires a broad view of family, ongoing striving for cultural competence, collaboration between the formal child welfare system and the kinship systems of children in state custody, and a long-term view of permanency planning and child-rearing that builds on the case-management capacities of kinship networks to support permanent plans, looks beyond the child's exit from state custody, and helps families and larger kinship systems make long-term plans for the protection, permanence, and well-being of children.     

Children with Special Health Care Needs

Abstract

The health care model presented in this paper is a non-linear, systems approach to service delivery. The model was a by-product of three ethnic-specific conferences that were convened to discuss strategies for improving access to care and the quality of services provided to children with special health care needs (CSHCN) from diverse cultural backgrounds. The model evolved as insights regarding the common values and norms held by parents, health care providers, and cultural representatives were shared. Content analysis was used to identify core themes identified by participants. These themes were incorporated into a model that included the following elements: community-based, culturally competent, health-oriented, resiliency-focused, and family-centered care. At the fourth Consensus Conference, selected participants from the previous ethnic specific conferences reviewed the proposed model and deemed it a vehicle for facilitating health care service utilization by culturally and linguistically diverse CSHCN and their families.     

Kinship Care: A Cultural Resource of African American and Latino Families Coping with Parental Substance Abuse

SUMMARY

This paper examines kinship care as a cultural resource used by African American and Latino families coping with substance abuse by a family member. Although there is a growing body of literature on kinship care, there are no conceptual or empirical studies that have drawn or built on cultural similarities between these two groups of ethnic minority families. A framework that prioritizes cultural assessment and relevance in using familial and cultural resources is proposed to assist practitioners confronted with the demographic realities of working with social, clinical and ethnocultural complexities when serving ethnic minority families. The framework is based on practice implications raised by recent studies on kinship care and from the perspective of pertinent cross-cultural and anthropological literature.     

Working with Leroy

Abstract

With the recent transnational turn in the humanities and social sciences, questions of translocalism have come to dominate the academic agenda. Where southern African studies has engaged with transnationalism, this has generally been pursued through the framework of the black Atlantic. This article argues that we need to supplement this perspective with a systematic engagement with the Indian Ocean. The article outlines various major historiographical traditions associated with the Indian Ocean and then seeks to draw out how these themes challenge assumptions which have been theorised on the basis of black Atlantic patterns. The paper concludes with a discussion of how a consideration of the Indian Ocean would enlarge the maps of South African literary and cultural studies.     

Voluntary work in the Norwegian long-term care sector: complementing or substituting formal services?

ABSTRACT

Across Europe, governments call for increased involvement of volunteers to shoulder some of the welfare burden. Nevertheless, there is little research into what kind of work and how much volunteers currently contribute in the long-term care services and whether this has the potential to substitute formal services. Drawing on findings from a survey of employees in Norwegian nursing homes and home care districts, we examine the nature and volume of voluntary, unpaid work in the long-term care services in Norway. Our data suggest that volunteers to a very limited degree carry out work that has traditionally been considered the formal system’s domain: personal care and practical help. Nearly all the voluntary, unpaid contributions in our data takes place within cultural, social and other activities aimed at promoting mental stimulation and well-being, indicating a classic specialisation of tasks between volunteers and professionals. However, there has been an expansion of the formal care system to include activities aimed at promoting well-being in recent decades. This may indicate that there is a certain level of task sharing between voluntary and formal care. Thus, social workers need to consider voluntary service provision when assessing the needs of clients.     

Cultural Identity and Place in Adult Korean-American Intercountry Adoptees

ABSTRACT

This study explores the interrelationship between cultural identity and place in the lives of adult Korean adoptees living primarily in the Twin Cities area of Minnesota. Using life histories derived through multiple semi-structured interviews, a web of related themes emerged which reveal the interplay between ethnicity, identity, gender, and place. From childhood to adulthood, most Korean adoptees followed a similar developmental trajectory of denial, self-awareness, and emerging cultural consciousness about their Korean heritage, particularly upon their departure from their adoptive homes after high school. These journeys were mediated and nuanced by environmental factors including -but not limited to -places adoptees lived or visited in Korea, the U.S. or elsewhere abroad. This study highlights the limitations of previous studies that focused only on adoptive parents or adoptees as children, an approach which loses the life course perspective of inter-country adoptees' search for identity, belonging, and a sense of home.     

Future Planning and Financial Education Needs for Asset Building Among Persons with Multiple Sclerosis in Rural Areas

Abstract

This paper presents findings from a study of individuals with multiple sclerosis examining their planning and preparation activities for their future independent living and long-term care needs. Data collected from a representative sample of National Multiple Sclerosis Society members in the greater metropolitan St. Louis and eastern Illinois area indicate significant differences in income, assets, education, health and functional limitation status between individuals living in rural versus urban areas. Additionally, findings show respondents with greater levels of education and assets, and those living in urban areas, are more likely to have saved for retirement, made legal preparations, or engaged in planning activities for future needs. Recommendations for asset building programs include incorporating education and training on planning for independent living and long-term care into financial planning curriculum, particularly for people with multiple sclerosis living in rural areas.     

Meaning as outcome: Understanding the complexity of decision-making around residential placement in aged care

Abstract

Changes in aged care and health policy have introduced an increasingly complex assessment, resource option, and economic and regulatory context for decision-making regarding relocation to residential care. This paper reports on a study exploring residential placement from the perspective of spouses who place a long-term partner in an aged care facility. It highlights the importance of understanding the meaning of such decision-making for the spouse who remains at home and explores the ways in which the placement is constructed as either a continuation of, or a refusal to, care for a long-term partner. The paper draws out the implications for social work practice and identifies the challenge to merge knowledge of resource packages, care options and financial arrangements with a concern with the processes of decision-making and the emotional and symbolic aspects of such decisions.     

The Bloom Is on the Rose

Summary

This paper argues for the value of an adult developmental perspective in work with lesbian couples. Focusing on midlife, case examples illustrate issues and situations that create strength and satisfaction, as well as those that create stress and disappointment. Key themes include expansiveness and generativity, differentiation, awareness of past and future, reorganizing priorities, finitude, caregiving stress, infidelity, midlife crisis, self-growth, and the different impact of homophobia on three cohorts of midlife lesbians. Implications for therapeutic intervention are described, with particular emphasis on case formulation and treatment planning that explicitly provides couples with an understanding of the sociohistorical and adult developmental context in which their difficulties arise.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

Listening to Lesbian Couples

Abstract

Lesbian couples experience many strengths in relationship. This qualitative analysis focused on the communication competence of 10 long-term lesbian couples (dyads) together for 10 years or longer. They were interviewed jointly in two semi-structured interviews, methodologically using a combination of ethnography and phenomenology from a feminist perspective. The couples described a communication process that constructed and conveyed meaning. These dyads managed conflicts by avoiding contemptuous language and through negotiating skills. Additionally, they maintained an empathic attunement to each other by attending to nonverbals and respecting differences. This article explores these themes and provides implications for professionals working with all couples.     

Organization and Delivery of Long-Term Care in Singapore

Summary

This paper focuses on the Singaporean model of long-term care for older people. With only about 2% of the older population living in institutions, the mainstay of long-term care is community care. The reader is provided an overview of the Singaporean services, including case management, followed by a discussion of the current issues and future challenges. In keeping with the prospect of a rapidly aging population profile, the Singapore government plays a leading role in framing policy and planning for future needs of this sector of the population.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Perspectives of Young People in Care About their School-to-Work Transition

Abstract

Achieving in education and employment has long-term effects on quality of life. With below-average levels of educational attainment, many young people in care are ill-equipped for the transition from school to further education and work. This paper presents findings from a qualitative study that explored the school to work transition experiences of young people currently or previously in care, and their ideas about future employment. A range of personal and contextual factors that influence study and work goals were identified. Young people spoke about the importance of personal confidence and determination, supportive relationships, someone to believe in them and encourage them, opportunities to pursue their goals, avenues to gain information about how to get desired jobs, positive school experiences, and the need for stability in their lives. The study suggests widening the agenda for case planning, transition from care and after-care support, to include career planning and vocational assistance.     

Global Aging and Intergenerational Equity

ABSTRACT

The traditional way of caring for frail elders in long-term care facilities is based in the medical model. This type of care focuses primarily on the biological needs of individual elders. A new paradigm for these care facilities is seen in the idea of culture change. This paradigm implicitly has within it elements of compassion emphasized in the teachings of world religions. The focus of this article is on the thoughts of Hesston College students in a World Religions class who spent two hours a week during the spring term 2003 interacting with frail elders in a long-term care facility. These intergenerational interactions are analyzed from the perspective of six world religions. The article concludes with reference to culture change and intergenerational relationships as related to practitioners, policy makers, and researchers.     

Changing Needs and Changing Service Delivery for Long-Term Care in Hong Kong

Summary

Both the need for and delivery of long-term care in Hong Kong are shaped by the interaction of the traditional and modern. Rapid social change is affecting traditional family structures and roles in care of the elderly, resulting in increased demand for formal care, which to date has been provided mainly by way of residential care. This growth of demand will escalate with rapid population aging in coming decades. In response to this burgeoning demand, current planning is seeking to reshape the established service system and tackle problems in service delivery in ways that will address the bias towards residential care and improve quality of care.     

Exploring Policy and Financing Options for Long-Term Care in Taiwan

Summary

Policy and financing arrangements for long-term care are important themes in each country and/or region, and Taiwan, with its unique historic and politico-economic background, can be regarded as a bridge between well-developed and under-developed countries. Policy formulation about long-term care in Taiwan involves several agencies in the government, including Ministry of Health, Interior Affairs, Education, Insurance Bureau, and Economic Council, and formulation of policy objectives has progressed considerably in the last five years. Financing arrangements are less well-developed because the National Health Insurance Program began only in 1995, and most long-term care is not yet covered. As demand for long-term care exceeds supply, and this gap will grow in future, current resource allocation measures are concerned to facilitate the expansion of community care rather than allowing institutional care to absorb more resources. Developing future financing options is now a central task for policymaking, and government must continue to take a leading role in consolidating financing and integrating the service systems.     

Cooking up: Intestinal economies and the aesthetics of specular orality

ABSTRACT

This paper aims to make a psychoanalytical contribution to a cultural studies understanding of the logics — and fantasies — of commmodity consumption in the visual culture of late capitalism. Taking up the metaphor of the gut as a discriminating organ and of cooking as a textual production, we examine the relations between oral and ocular consumption, and between aliment and excrement, as expressed in two films from the 1980s which are centred around themes of food and money. Adrian Lynne's 9½ Weeks and Peter Greenaway's The Cook, The Thief, His Wife and her Lover employ quite different aesthetics and display contrasting inflections of what we call ‘the edible complex’. The first fantasizes wealth as enabling an unstructured excess of consumption that can only end in exhaustion; the second reaffirms the structured distinctions associated with ‘quality’ in a class-divided society where wealth alone does not secure status or legitimacy. From a feminist perspective, the male characters in each text are interesting examples of masculinities not organized around the phallus, but around anal and oral eroticisms and a more primitive oral morality.     

Home Is Where the Help Is

Abstract

Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skævinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.