Access to Services as a Civil and Social Rights Issue: The Role of Welfare Professionals in Regulating Access to and Commissioning Services for Disabled and Older People under New Labour

This paper draws up a theoretical framework of citizenship, based on Marshall's thesis, that encompasses the idea of access to welfare services (using the example of community care services for disabled and older people) as a civil and social rights issue. The authors critically examine current policy developments in the NHS and local authorities under New Labour that emphasize partnership, particularly the proposals and provisions made in 'The New NHS' and 'Partnership in Action'. Their theoretical framework is used to explore issues concerning access to and the commissioning of health and social care services under New Labour. They conclude that the role of welfare professionals, particularly GPs and social services workers, and their relationships with service users, patients, carers and their families under New Labour presents a continuing challenge to the citizenship status of disabled and older people.     

“Working with COW”: Social Work Supporting Older Women Living in the Community

ABSTRACT

Australia, like all developed Western countries, is experiencing a demographic shift resulting in an increasing proportion of the population being over the age of 65 years. Contrary to stereotypes, the vast majority of older people live independently in communities. This article explores the potential of social work practice informed by community development principles to enable socially disadvantaged older women to live in vibrant and supportive communities, in which they feel safe and are able to access the support services they need. It argues that participation in social action not only builds older women’s well-being but also enables them to become (or continue to be) agents for social change in local communities. Adopting a community-based research methodology, this article draws on a decade of community development practice with the Concerned Older Women’s (COW) Group. This data suggests that community development practice based on participation, empowerment, and social action founded on respectful relationships may accrue significant benefits to individuals and the broader community. This social work practice creates the social conditions to facilitate older women’s capacity to work collectively to achieve social change, challenging ageist stereotypes.     

Co‐producing Approaches to the Management of Dementia through Social Prescribing

A promising approach to the management of dementia is ‘social prescribing’. Social prescribing is a form of ‘co‐production’ that involves linking patients with non‐clinical activities, typically delivered by voluntary and community groups, in an effort to improve their sense of well‐being. The success of social prescribing depends upon the ability of boundary‐spanning individuals within service delivery organizations to develop referral pathways and collaborative relationships through ‘networks’. This article examines the operation of a pilot social prescribing programme in the North East of England, targeted at older people with early onset dementia and depression, at risk of social isolation. It is argued that the scheme was not sustained, in part, because the institutional logics that governed the actions of key boundary‐spanning individuals militated against the collaboration necessary to support co‐production.     

Anticipated Engagement in a Village Organization for Aging in Place

Although older adults prefer maintaining residence independently in the community as they grow older it is not always possible due to impairments, isolation, and changing health needs. Villages, an emerging consumer-directed care model providing social engagement and services, support aging in place. To be viable organizations villages must attract and enroll sufficient numbers of members. This study examined factors associated with older adults anticipated engagement as a village member. Using a cross-sectional survey design community residing older adults (N?=?193) identified predisposing, enabling, and need factors associated with anticipated engagement. Participants rated anticipated engagement between “Slightly Unlikely” and “Likely” (Mean?=?2.71, SD?=?1.31). A model including predisposing and enabling factors produced the best overall fit [?2 Log likelihood?=?246.514, χ2(8)?=?20.414, p.?=?.008] correctly classifying 61.1% of cases and explaining 13.4% of the variance according to the Nagelkerke R² statistic. Older adults who engage in preventative health behaviors may be predisposed to joining a village as well as those who are already engaging in supportive acts of neighboring. Villages might consider these factors in designing outreach and service programing. Future research should identify how factors such as income and personal health practices contribute to interest in village membership.     

How do low-income older women experience living in congregate housing? A qualitative study of housing welfare intervention for older adults living alone in South Korea

The purpose of this study was to refine the understanding of the experiences of low-income older women living in congregate housing. Congregate housing refers to small-scale communal living arrangements for low-income older adults intended to reduce their social isolation and financial burden. Interviews with 12 older women and field notes were analysed using thematic analysis. Four themes were identified: (1) these older women chose congregate housing because they had no better option; (2) they gradually grew accustomed to communal living by being alert, mindful, and considerate; (3) their range of activities and interactions with the outside decreased as they aged; and (4) they came to require further care as senility progressed. Based on these findings, the meaning of housing welfare for older adults and the importance of providing additional supportive services are discussed. It is also asserted that housing welfare intervention should include protection of older adults’ housing rights.     

The nature and culture of social work with children and families in long‐term casework: Findings from a qualitative longitudinal study

Social work in the United Kingdom is preoccupied with what social workers cannot do due to having limited time to spend with service users. Yet remarkably little research has examined what social workers actually do, especially in long‐term relationships. This paper draws from an ethnographic study of two social work departments in England that spent 15 months observing practice and organizational life. Our findings show that social work some of the time has a significant amount of involvement with some service users and the dominant view that relationship‐based practice is rarely achieved is in need of some revision. However, families at one research site received a much more substantial, reliable overall service due to the additional input of family support workers and having a stable workforce who had their own desks and were co‐located with managers in small team offices. This generated a much more supportive, reflective culture for social workers and service users than at the second site, a large open plan “hot‐desking” office. Drawing on relational, systemic, and complexity theories, the paper shows how the nature of what social workers do and culture of practice are shaped by the interaction between available services, office designs, and practitioners', managers', and service users' experiences of relating together.     

Individual- and Contextual-Level Factors Affecting the Use of Social Support Services among Older Adults

ABSTRACT

By 2060, the number of Americans aged 65 and older is expected to more than double, while the number of Americans aged 85 and older is expected to nearly triple. As the nation's aging population grows, older adults will need to rely on social support services, such as transportation and housing services, in order to remain active and lead independent lives. In this study we use data collected from the elderly supplement of the Southeastern Pennsylvania Household Health Survey (SPHHS) (n = 3,042) to explore the relationship between the availability of elderly specific social service providers and utilization of social support services among older adults. We find that while the number of elderly specific social service providers can increase use of social support services among older adults, its impact is relatively minimal. We find that individual factors, instead, are stronger predictors of service use. This is a finding that should be particularly encouraging for elder care providers who may not have the resources needed to undertake large structural changes (like building new facilities). Still, future research should explore how the availability of a broader range of elderly specific social services (than explored in this study) impacts use.     

Religious congregations as social services providers for older adults

A large proportion of older adults are affiliated with congregations. The literature suggests that, in general, religious participation among the older adults enhances their quality of life and provides a network of social care. In this article, we explored the relevant literature on organized religion and social support for older adults. Based on a census study of congregations in Philadelphia (N = 1,393), we documented the following: (1) the number of congregations serving older adults, (2) the types of services provided, and (3) the number of beneficiaries. The study also identified the organizational factors that predict the provision of congregation-based services for older adults. The findings suggest that serving older adults is not a top priority for most congregations. Most senior programs are small and often informal. Approximately half (48%) of the congregations do not provide a formal social service. However, those congregations that are more likely to serve older adults have larger budgets, more members over 65-years-old, and a moderate political orientation. We recommend that congregations, social service providers, and older adults explore ways to maximize this underutilized resource of congregational services to meet the needs of the increasing number of older adults.     

Informal support and psychological well-being of older Chinese community residents

Social support is a critical factor in the well-being of older Chinese adults. Studies have found positive relationships between social support and psychological well-being. The findings, however, vary by kind of support. This article examines the relationships among objective and subjective social support from family members and close friends and three measures of psychological well-being, including loneliness, depression, and life satisfaction. The study sample consisted of 298 elderly Chinese community residents from Chongqing, China. The relationships between objective social support from family and friends and psychological well-being were, for the most part, not statistically significant. The relationships between subjective social support and well-being were fairly robust and statistically significant.     

Migration, ageing and mental health: an ethnographic study on perceptions of life satisfaction, anxiety and depression in older Somali men in east London

This ethnographic study was carried out in the aftermath of an epidemiological investigation, the first of its kind, on the health and social status of Somalis aged 60 years and over living in Tower Hamlets, east London. The main aims of the study are to explore views on mental health and well-being and identify sources of stress and support so as to gain greater understanding of background factors of life satisfaction and depression in 'first-generation' older Somali migrants in Tower Hamlets (males). Face-to-face interviews were conducted among 28 males in Somali with the help of a bilingual interpreter from the same age, sex and cultural background of participants. Several factors were perceived to decrease life satisfaction and increase vulnerability to depression in male Somalis, in particular low family support in the face of increasing physical disability, loneliness, inadequate access to community services and inability to return home. Social isolation, low level of control over one's life, helplessness and social degradation – ageism, perceived racial/religious discrimination and, to a lesser extent, racial harassment – were common themes identified in people who said to be depressed. Family support was the main buffer against depression; other coping resources were represented by religious practices and reliance on Somali peers. Avoidance coping seemed to encompass denial of depression in participants who had low mood. The study revealed multiple reasons for ill-being, in particular in people who had high expectations about medical and social care. Low levels of distress were found in Somalis who felt supported by their families. There is a need for social workers and other health professionals to advance discussions of mental-health issues in the community and for service providers to promote greater access to culturally relevant medical and social services for Somali elders in Tower Hamlets and strengthen their informal support networks.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.     

Life Satisfaction of Rural Migrant Workers in Urban China: The Roles of Community Service Participation and Identity Integration

Abstract

China is home to approximately 245 million rural-to-urban migrant workers. The influx of migrants into urban areas has posed various challenges for local social service systems. Recently, increasing number of community services have been developed to meet the growing service demands from the migrant population. However, whether increase in community service use results in improved wellbeing among migrant workers remains critically unexplored. As such, this study examines the role of community service use in migrant workers’ life satisfaction and the potential mediating effect of identity integration in Shenzhen, China. Bootstrapped models were adopted to examine relationship among variables. Drawing from a sample of 1,087 rural-to-urban migrant workers, we found that community service use is positively correlated with both identity integration and migrant workers’ life satisfaction. Moreover, identity integration served as a partial mediator between community service use and life satisfaction. The mediating effect of identity integration was found to increase with age. This study highlights that diverse services should be implemented to address divergent needs of migrants in different age groups. Community service can also serve as a vehicle to foster integration among migrant workers in host communities, especially for older age groups. Future studies may further investigate the relationships between community social capital, community social support, quality of community-based organization and frequency of service use so as to optimize the life satisfaction of migrant workers.     

Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC)

This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.     

What do we know about the social networks of single parents who do not use supportive services?

The role that social support and social networks play in mediating isolation and stress experienced by vulnerable families is well established. However, a major issue facing supportive human services is to find and engage families with limited social networks and link them to supports that could improve outcomes for their families. This paper reports on the results of in‐depth interviews with 20 sole parents with children aged under 5 who were not well connected to services. It documents their social networks with the use of a social network map. Using a social capital lens, the analysis attempts to differentiate the different relationships in the participants' lives. Most participants were not satisfied with their informal networks, with conflicted or ambivalent reliance on family, absence of support and community engagement and fragility of informal networks. Although this group of isolated mothers does encounter the formal service system, the opportunities to increase and strengthen their networks do not eventuate. Better understanding of the nature and extent of social networks can inform practitioners and policy‐makers of the critical factors needed to increase service use for parents with limited resources.     

A Model for Community-Based Mental Health Services for Older Adults:

The mental health needs of older adults have historically been underserved by existing mental health service delivery systems. This paper presents a model for the delivery of comprehensive mental health services to older adults in their own homes, based on sound clinical practice, and incorporating a cross-cultural perspective coupled with a strong social and community support base.     

‘He told me to calm down and all that’: a qualitative study of forms of social support in youth mentoring relationships

The worldwide growth in formal youth mentoring programmes over the past two decades is partly a response to the perception that young people facing adversity do not have access to supportive relationships with adults and positive role models in their communities to the degree they once had. Formal mentoring programmes facilitate the development of a friendship or ‘match’ between an older volunteer and a young person, with the objective of supporting the young persons’ personal and social development. Drawing on 66 semi‐structured interviews with young people, parents, mentors and caseworkers associated with nine youth mentoring matches in the Big Brothers Big Sisters Programme in Ireland, this paper analyses the forms of social support evident in the mentor–mentee relationships and highlights how the mentoring relationship was perceived to have impacted on the well‐being of the young people participating. The findings reflect the consensus in the mentoring literature that close, well‐established mentoring relationships have the potential to bring about meaningful change in the lives of young people.     

Loneliness in senior housing communities

There are many studies on loneliness among community-dwelling older adults; however, there is limited research examining the extent and correlates of loneliness among older adults who reside in senior housing communities. This study examines the extent and correlates of loneliness in three public senior housing communities in the St. Louis area. Data for this project was collected with survey questionnaires with a total sample size of 148 respondents. Loneliness was measured using the Hughes 3-item loneliness scale. Additionally, the questionnaire contained measures on socio-demographics, health/mental health, social engagement, and social support. Missing data for the hierarchical multivariate regression models were imputed using multiple imputation methods. Results showed approximately 30.8% of the sample was not lonely, 42.7% was moderately lonely, and 26.6% was severely lonely. In the multivariate analyses, loneliness was primarily associated with depressive symptoms. Contrary to popular opinion, our study found the prevalence of loneliness was high in senior housing communities. Nevertheless, senior housing communities could be ideal locations for reducing loneliness among older adults. Interventions should focus on concomitantly addressing both an individual’s loneliness and mental health.     

Mental Health and the Asian Communities: A Local Survey

Correspondence to Barbara Hatfield, Lecturer in Psychiatric Social work, Department of Psychiatry, 12th Floor, Mathematics Building, Manchester University, Oxford Road, Manchester M13 9PL Summary The survey of people from the Asian communities in ‘Milltown’included people who used mental health services, family membersof service users, and members of the Asian general public. Personaland social stresses of the group were explored, as were theirperceptions of the ‘causes’ of mental ill-healthand appropriate responses. Although most people saw family andsocial stress as central, a religious dimension was also prominent,in terms both of causes and treatment of mental ill-health.There was no evidence of rejection of mainstream services becauseof a choice on the part of Asian families or communities tobe self-servicing. A range of issues identified by respondentssurrounded the cultural acceptability of services in ‘Milltown’to Asian people. A lack of knowledge of service availabilitywas also apparent, with a heavy reliance upon GP services formental health care in the community. The findings of the surveyare compared with similar studies, where available, which focuson indigenous white British service users. Some findings arecommon; other issues are specific to this Asian group.     

Depression and social networks in community dwelling elders: a descriptive study

Social isolation and inadequate social support have been identified as correlates of depression in older adults, although the relationship between depression and social isolation is not entirely understood (Dorfman et al., 1995). This study was conducted to describe the social networks of depressed older adults living in the community and to compare the social networks of depressed and nondepressed individuals, thus adding to the body of knowledge regarding social networks, older adults, and depression. The sample consisted of 91 respondents aged 65 and older who were randomly selected using the voter registry. About 27% (25) respondents reported significant levels of depressive symptomology as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). All respondents completed semistructured interviews that included questions about social contacts with family and others during the prior week. All participants reported social contact with family and friends during this period. In this sample, depressed elders were not socially isolated. They were more likely to report contacts with friends than those who were not depressed, and equally likely to report involvement in volunteer activities. Their likelihood of seeking social support was also comparable. Results emphasize the importance of peer relationships and suggest that, in some groups of older adults, social isolation may not be a hallmark of depressive symptoms.