The silent impact of ageist communication in long term care facilities: Elders' perspectives on quality of life and coping strategies

Communication is an essential component of any caregiving relationship. This is especially the case for institutionalized elders who need to maintain strong and empowering social bonds with caregivers. Previous studies have shown that communication can be a powerful transmitter of age-based stereotypes and as such, can lead to psychological disengagement and lowered self-esteem. In light of these results supporting the postulates of Communication Accommodation Theory, the main goal of the current study is to gain a better understanding of the role and impact of communication in the context of a caregiving relationship. Precisely, this study explored the extent to which institutionalized elders perceive daily communication with caregivers as being ageist, as well as the impact of such perceptions on quality of life in the facility and coping strategies used by elders. To do so, a total of 33 in depth and semi-structured interviews were conducted with elders living in long-term care facilities in the province of Quebec. Results of qualitative and quantitative data analyses suggest that communication with caregivers is indeed perceived as ageist by the majority of elders and that such perceptions diminish the perceived quality of life in the facility; furthermore, most elders seem to cope with ageism by accommodating caregivers, a strategy that may ironically reinforce patterns of ageist communication.     

The effects of federalism on policies for care of the aged in Canada and the United States

Debates about who should care for the elderly often center on the relative responsibilities of the state and family. In federal societies such as Canada and the United States, however, multiple governments are involved. This article compares and contrasts federalism in these two nations and its effects on the division of fiscal, administrative, and programmatic responsibilities for care of the aged between the national and regional (i.e., state, provincial) governments. Two major policy arenas, health care and social services, are examined, with particular attention focused on the roles played by the nongovernmental sector. Because most care of the aged is provided informally--a situation firmly rooted in the value systems and public policies of both nations--national and regional policies that assist family caregivers directly are examined. Policymakers at the regional level have been more active and often more innovative in constructing policies that are supportive of family caregiving, but in general, few programs of direct assistance exist in either nation and these largely depend on their geographic location. The article concludes with a discussion of the continued effects of federalism for future policies affecting care of the aged and suggests some approaches that can be undertaken to empower families in their caregiving roles.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

Engaging Experts: Expanding Participation and Enhancing Research in Chinese Eldercare Institutions

Due to the myriad factors straining China’s traditional family-based eldercare system, today unprecedented numbers of older adults are turning to institutions for caregiving needs. As researchers and policy makers organize conferences, analyze trends, and allocate resources, the subjective experiences of elders themselves are often forgotten or ignored. While providers recognize that institutionalized elders are at an increased risk for mental health issues, most cite personnel and resource shortages as insurmountable barriers to provision. Using examples from ethnographic research in Chinese eldercare institutions, this article examines the link between participation and mental health for contemporary Chinese elders and makes a case for expanding the role of elders in research in order to improve both the experience and understanding of institutional eldercare.     

Challenges for Studying Care After AFDC

Mandatory work and low wages after the end of AFDC may propel changes in the caregiving of children and dependent elders in single-mother families. This article suggests some challenges facing researchers who will examine care in single-mother families. Drawing on a qualitative study of care in the last years of welfare, and on social network analysis, it suggests how changes in resources, networks, and norms may affect practices of care and also make it difficult to discover the changes.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.     

Caregiving and long-term health care in the People's Republic of China

The growing proportion of frail elderly in the People's Republic of China has necessitated policy of the state toward their long-term care. In this decade, there has been an increase in the amount of data available on the care and needs of Chinese frail elders. This article synthesizes these data and traces the patterns of care of frail elders. It distinguishes between urban and rural patterns, and identifies the increasing role of the family and community in the caregiving of elders. State policy, evident from the data, suggests that the state's role in direct care of elders is minor but that it continues to influence and support eldercare as part of its policy of promoting the one-child per couple policy. This process can be seen in support programs for the childless elder, who symbolizes the expected condition of a large number of future elders under the one-child policy. The article identifies four factors that are influencing the changing patterns of long-term care of elders in China: (1) economic reform programs; (2) the political agenda of the Chinese Communist Party; (3) differences in urban and rural economic conditions; and (4) policy directed at long-term investment in health care technology.     

Women Caring for Our Aging in Place Seniors Will Lose Out because of U.S. Immigration Policies

Most older people experiencing chronic health problems, physical disabilities, and memory losses are still able to age in place in their own homes. However, they often need help from others to enjoy healthy, active, and independent lives. They turn mostly to family members, mainly women and usually their daughters, daughters-in-law or wives. But caring for frail elders has become more demanding and complex, and these family members often feel physically and emotionally overwhelmed and burnt out. They concede that they cannot do it alone. Others find it more difficult to hold full-or even part-time jobs. Hiring home (direct) care workers to assist their loved ones can be an effective solution to ease their caregiving responsibilities. However, these personal care aides, home health aides, and nursing assistants are already in short supply. Moreover, going forward the aging of the baby boomer population will result in an even greater demand for their services even as these jobs are often unattractive to American-born workers and turnover is high. This country’s immigration policies will make it even more difficult for women caring for older persons to hire these workers. Over 25 percent of home care workers are low-skilled immigrants or foreign-born. However, the Trump administration’s policies reduce the number of immigrants entering the U.S. and specifically choke off the various pathways that enable low-skilled persons to be hirable in the home care sector. Female caregivers seeking relief from their caregiving responsibilities will lose out unless we remove these immigration barriers.     

Does Increased Use of Generic Medicines by Elders in Belgium Help to Contain Escalating Health Care Budgets?

This study explored the use of generic medicines among elders in Belgium. The generic market share by volume for elders in 2010 was 23.1%, while this was 23.7% for the total Belgian population in 2009. Pharmaceutical expenditure in Belgium was €649.74 per capita for elders in 2010. Calculations of possible savings through an increased use of generic medicines showed that these savings were rather limited (4.48% when the generic market share by volume increased to 95%). The full potential of generic medicines in the elder population has not yet been realized in Belgium, due to the limited use of generic medicines and their relatively high prices. The Belgian government should implement additional incentives for physicians, pharmacists, and patients to increase the use of generics and combine these with policies to lower prices of generic medicines and policies to decrease the volume of medicines used by elders and rationalize the prescribing of medicines for elders.     

Informal Caregiving and the Politics of Policy Drift in the United States

Informal caregivers play an increasingly important role in caring for aging Americans. Yet existing social policies that could support informal caregiving have experienced “policy drift,” a failure to adapt to social risks that develop after policies are initially enacted. This article examines policy makers’ success at updating seven major policies to address caregiver needs. It draws on an original data set of legislation in this area introduced between 1991 and 2006 (n = 96). Findings indicate that drift is more likely when policy updates are costly, lack support from members of majority parties in the House and Senate, and fail to generate bipartisan support.     

Maximizing Content on Elders with Dementia While Teaching Multicultural Diversity

This article focuses on African American, American Indian/Native American, Asian/Pacific Islander American, and Hispanic/Latino American elders and caregivers who are affected by Alzheimer's disease and other types of dementia. Three specific areas are considered for each of these ethno-cultural groups: (a) diverse perceptions of Alzheimer's disease and other types of dementia; (b) barriers to service utilization; and (c) caregiving responsibilities. Finally, suggestions are offered for the use of this information in the classroom, which may better prepare future practitioners for competent practice with minority elders with Alzheimer's disease and other forms of dementia.     

Housing Preferences of Vulnerable Elders in Suburbia

This article explores whether well and vulnerable elders residing in the suburbs differ in terms of: their level of satisfaction with their current living arrangement; their perception that they face a move within the next two years; and their level of interest in a series of different housing options. Our data support theoretical models that pose that diminished economic, physical, and social resources "push" vulnerable elders towards relocation. The data revealed that while the majority of well and vulnerable elders expressed high levels of satisfaction with their current homes, the vulnerable elders were significantly more likely to feel they faced an upcoming move. Housing options of interest to these vulnerable elders and implications for community planners are also addressed.     

When caregivers are in need of care: African-American caregivers' preferences for their own later life care

To “care for one's own” is a cultural expectation within a larger ethic of care in the African-American community. Applied to caregiving of aging elders, this ethic of care emphasizes the importance of providing in-home family care rather than opting for out-of-home placement. This study explores why a subset of African-American caregivers prefer or are open to out-of-home placement over in-home family care if they are no longer able to care for themselves. In-depth interviews with 24 family caregivers are analyzed. Three themes emerged including the desire to “spare our children” the burden associated with caregiving, viewing the next generation of potential caregivers as unequipped for the task, and having no one left to provide care for them.     

Ethnic Variations in Dementia Caregiving Experiences

Abstract

The proportion of minority elders with dementia in the United States is projected to rise substantially. This study elicited perceptions of the caregiving experience from informal caregivers of persons with dementia, across different ethnicities. Six focus groups with 47 dementia caregivers of African-American, Chinese-American, Euro-American, and Hispanic-American ethnicities were conducted. Caregiving roles, concern about the person with dementia, and unmet information and resource needs were expressed similarly. However, perspectives differed across ethnic groups on stigma surrounding dementia, benefits of caregiving, spirituality/religion to ease caregiving burden, and language barriers and discrimination. Findings suggest that interventions to reduce disparities in dementia care quality need to address ethnic variations in caregiving experiences.     

Zoning,Accessory Dwelling Units,and Family Caregiving

Abstract

This article explores the relationship between zoning regulations and co-residential family caregiving in the United States. It first provides an overview of U.S. housing policies, especially zoning. We then describe major changes in family structure and composition in the United States with their implications for caregiving and discuss how multigenerational housing options, particularly accessory dwelling units (ADUs) in single-family homes, can help support family caregiving. After an overview of zoning policies and actions that inhibit ADU production, we document current trends, incorporating information from a small non-random study of ADU activity we conducted in 2004. Finally, we present recommendations for promoting more multigenerational housing as a supplement to other family support programs (e.g., dependent care assistance, family caregiver payments) and as a source of affordable, supportive housing for those families choosing co-residence as their eldercare solution.     

BEYOND THE BIBLE AND THE CROSS: A SOCIAL AND CULTURAL ANALYSIS OF CHINESE ELDERS' PARTICIPATION IN CHRISTIAN CONGREGATIONS IN THE UNITED STATES

Mainland Chinese elders constitute a unique group in popular Christian participation and conversion. This work aims to explore the social contexts and cultural facets of Mainland Chinese elders' Christian practice in the United States. Based on face-to-face, in-depth interviews with 20 Mainland Chinese elders as well as participant observation at selected congregational settings, this study suggests that the existing theories on aging and religion as well as religious practice among immigrants are inadequate to explain Chinese elderly immigrants' participation in Christian congregations in the U.S. Instead, social isolation and lack of social support system resulting from immigration and aging process serve as the major drive for the elders to pursue social and cultural recognition from Chinese Christian gatherings. Besides religious services, social service functions of churches and opportunities for fellowship are other factors that explain Chinese elders' church involvement. In conclusion, we argue that social and cultural services are needed to particularly assist Chinese seniors to adjust and adapt to their elderly lives in the host country.     

Intercultural policies and the contradictory views of teachers: the Roma in Catalonian schools

In this article, we examine the contradictions and lack of consistency between various levels of discourse relating to Roma educational policies. Policy-makers have claimed that political interventions would positively impact the progress of Roma. However, the results have been mixed. We argue here that teachers need to re-evaluate their roles as politically aware and culturally informed agents in order to guarantee social justice to a historically disadvantaged ethnic minority. Based on ethnographical fieldwork carried out over a two-year period with Spanish Roma children, both in schools and in their families, this study shows how intercultural policies have failed to impact the educational realities of Roma children.     

Injustice in family care of the Chinese elderly in Hong Kong

With increasing longevity, family care of the Chinese elderly in Hong Kong is evolving as a "caring trap" for female caregivers, especially unmarried daughters. Despite this, as Hong Kong is still a patriarchal Chinese society, most of the major decisions affecting the destiny of frail elders are made by sons or other male members of the family. The unequal gender roles, obligations, and division of caregiving responsibilities within the Chinese family and their effects on the caring relationship are discussed. Implications of this injustice based on gender regarding family care of the elderly and the possibility of its elimination are examined.     

Elder Abuse:

Elder abuse in Québec has been defined as a social problem since the late 70s. Many changes in policies, social practices, and laws are proposed as scientific knowledge is still growing. Using research methodology in criminology, elder abuse is defined and the impact of violence and neglect towards elders in the community, family and nursing home settings investigated. This paper critically examines the current knowledge gained through research on elder abuse in Québec and offers suggestions for future progress on this issue.