Area agency on aging outreach and assistance for households with older carers of an adult with a developmental disability

A demonstration project was undertaken in the state of New York to assess how area agencies on aging (AAAs) would approach outreach and direct aid to families caring for someone with a developmental disability. It was found that AAAs organized their outreach and direct-aid efforts using three main approaches: direct operation, contract operations, and multi-organizational. They generally organized staff time so that about two days per week of effort was devoted to undertaking outreach activities, conducting community education, and providing casework and referrals for target families. Four major distinctions were identified that differentiated work with older carers of persons with a developmental disability from that with other kinds of carers: complexity of problems presented by households identified, vagaries of fiscal resources, diverse household composition, and planning for eventualities. It was concluded that targeting AAAs for outreach and providing help to these carers was effective and productive and should be replicated throughout the United States.     

Foster carer stress and satisfaction: An investigation of organisational,psychological and placement factors

The unique demands of the foster carer role are associated with high levels of self-reported stress among foster carers. The current study examines the amount of carer stress that can be attributed to certain role specific challenges and how stress from these challenges varies between carers and placements. As a secondary aim the study examines carer perceptions on current organisational support and training. Participants were sourced from a national fostering agency with branches in the local area. Carers were eligible to participate in the study if they were caring full time for at least one foster child. Eligible carers completed an identical online or paper survey including measures of general stress and parenting stress as well as study specific measures regarding satisfaction with organisational training and support. Results demonstrated that challenging behaviours are the most stressful unique role demand for foster carers and the largest predictor of carer stress levels. Overwhelmingly carers reported a desire for additional training in order to support them in their role. The results support previous research outlining the difficulties faced by foster carers and the need to improve support and training to ensure good placement outcomes including placement stability and reduced carer attrition.     

WORKING CARERS OF OLDER ADULTS

Juggling work and care presents particular challenges to carers and employers. Employers are increasingly under pressure, both from within organizations and from recent government legislation and policy, to develop family-friendly policies to support informal carers in the workplace. Yet existing ‘family-friendly’ schemes and services are still primarily designed for working parents of young children and rarely address the needs of employees who care for older or disabled adults. This paper reports on a study which investigated how working carers and managers in two public sector organizations — a Social Services Department (SSD) and a National Health Service (NHS) Trust — combined their work and caring responsibilities. A multi-method approach was adopted consisting of five phases. First, a profile of the two organizations was established, followed by a short screening questionnaire to all employees to identify who was caring for an older adult over the age of 60. Third, a lengthier postal survey was sent to the 365 carers who had indicated a willingness to participate further. In the fourth and fifth phases, carers and managers were interviewed in depth about their experiences. This paper reports briefly on the survey, but then concentrates in particular on what was said in the interviews about what helps and hinders working carers of older adults. Despite the existence of policies to support carers, our findings suggest that these were far less important than informal support from colleagues and a sympathetic manager in the workplace. Commuting distance between work, home and the older person also posed difficulties for carers, along with inflexible schedules and work overload. Employers are urged to explore these issues further if they are serious about recruiting and retaining employees, and developing the work – life balance agenda to meet the needs of those caring for older and disabled adults.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

Parenting adolescents from ethno-cultural backgrounds: A scan of community-based programs in Canada for the promotion of adolescent mental health

ObjectivesTo i) describe current community-based programs across Canada to support parents for the promotion of adolescent mental health, with special attention to ethno-cultural populations; and ii) identify needs, gaps, and opportunities for the development of a framework to support parents for the promotion of adolescent mental health.MethodsWe conducted an internet-based cross Canada scan of community-based parenting programs that promote adolescent mental health in ethno-culturally diverse populations, followed by structured phone interviews with program staff. Findings were categorized according to audience (ethnicity/culture and age group), geographical distribution and coverage, and program type. Barriers to access and outreach mentioned by interviewees were documented.ResultsWe found a total of 47 programs that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Alberta, particularly in the Greater Toronto and Vancouver Areas. Most programs consisted of psycho-educational, information-based workshops, support groups, or used innovative approaches (e.g., arts, alternative medicine, mentorship, and skillsdevelopment courses). Five programs (11%) had parent and youth components. From the perspective of service providers, cultural distrust, stigma, financial constraints and language barriers pose challenges to outreach. Program evaluations are limited and often not publicly available.ConclusionThere are gaps in geographic coverage and types of programs available to parents for the promotion of adolescent mental health in ethno-cultural communities. Inconsistent and insufficient funding [and other forms of institutional support] detract from the capacity of community-based organizations to adequately support families and conduct, publicize, and evaluate their programs.     

Suicide among elderly white men: development of a profile.

1. Older white men have the highest suicide rate in the nation; a linear increase of suicide occurs with each passing year of chronological age. 2. Elderly who attempt suicide are more likely to communicate their intentions less frequently and to use violent and lethal means. 3. Chronic sleep problems, pain, degenerative illness, or clinical depression may be experienced by older white men at suicidal risk; somatic complaints including imaginary symptoms can mask depression. 4. Educational programs, outreach mental health programs, and enhanced consultation/coordination improve case findings and early intervention. Holistic nursing care, including pain alleviation, depression assessment, and simple comfort measures, are imperative in suicide prevention in the elderly.     

Social and Health Factors Affecting Community Service Use by Vulnerable Older People

Abstract

This article reports on Outcomes for older people with complex or chronic care needs, a study undertaken by the Brotherhood of St Laurence and La Trobe University, examining older Victorians’ use of community services following Aged Care Assessment Service (ACAS) recommendations that they remain living at home. The paper reports on interviews with older people and carers undertaken at three-monthly intervals, over 12 months. This paper contributes to understanding the factors that impede or facilitate uptake of community aged care services that are critical to meeting the needs of older people and their carers. The study found that among other factors social isolation, high carer burden, and the older person reporting low mood were important barriers to service uptake. Cost, waiting lists, and service satisfaction were also identified in qualitative data as influencing factors. The study concludes there is a need for better means of identifying and supporting older people and carers at risk to improve community service uptake.     

AsianWORKs

ABSTRACT

Achieving economic self-sufficiency through employment is the ultimate goal of recent changes to the welfare program. The Asian American and Pacific Islander (AAPI) population is most vulnerable to failing in this goal because of language difficulty, low education levels and lack of job skills in the labor market. Many AAPI immigrants, and Southeast Asian Americans in particular, suffer from adjustment and mental health problems due to their experiences as refugees. These are but a few of the obstacles for AAPI welfare recipients to become self-sufficient, making them one of the most “hard-to-serve” populations. The goal of self-sufficiency through employment can be reached if culturally appropriate and adequate support services are provided to meet the unique needs of the population. Few programs, however, are targeted at AAPIs. Using key-informant interviews and the case material review method, this article highlights the difficulties of AAPI welfare recipients and describes a unique program serving the Southeast Asian American, particularly the Cambodian, population. The article focuses on the program components of outreach and engagement, day socialization and job readiness, and family support services, and it discusses improvement to service access and lessons learned for the practice of cultural competence.     

Caring at a distance: Learning and practice issues

Emphasis on support for informal carers focuses on those who provide, in the words of the Carers (Recognition and Services) Act 1995, 'substantial' and 'regular' care. Following research and policy, professional education has also developed interest in those who live with the people they support, such as co-resident spouses and children of all ages. This article considers those who probably do not define themselves as carers and are usually referred to as 'relatives' or 'family', living at a distance from an older relative. It explores their possible need for support as well as the form and level of their involvement in relation to care managed services. It describes key areas or events to draw out practice issues and concludes with a discussion of the extent to which care management can work with such relatives. In many ways caring at a distance forces an examination of what is meant by 'care' and who can legitimately claim this as an emotion or status. The rationale for such interest is therefore three-fold. If social workers and social work educators restrict the meaning and their definitions of carers to those who provide 'hands on' services, as part of the care package, they risk alienating relatives from the learning experience of students. In doing so they may neglect these highly valued supports of older people and may leave relatives distressed and disempowered by anxiety over their contract with social work agencies.     

To work or to care? Working women's decision-making

Recent changes in older people's public care services in Nordic countries in particular in Finland and Sweden are based on implicit expectations that family members will increase their involvement in care. In Nordic countries, the care of small children has been acknowledged to be a social matter that concerns gender equality and the work life participation of both men and women, while the situation of working carers of older people is much less acknowledged. This study addressed the question of how Finnish working women who give care to their older parents argue for and against their decisions of working and caring and the meaning of work and care in these decisions. Majority of the interviewees emphasised the importance of work and refuted the idea of leaving work for care. The decision not to leave work for care was justified with worker identity, commitment to work, having no innate skills to be a carer, availability of support services and other carers and financial necessity. On the other hand, a few interviewees brought forward their willingness to leave work which was justified by constructing care as meaningful and valuable activity as opposed to meaningless paid employment, and with the intensification of work, and with ageing. Lengthy argumentation and several discursive tools indicate that women anticipated moral blame for the decision of giving work primacy over care, but also for leaving work. Thus, working carers balance between contrasting expectations to care and to work.     

Community-Based Participatory Research (CBPR) needs assessment of parenting support programs for fathers

This study reports the results of a Community-Based Participatory Research (CBPR) needs assessment of programs, services, and support systems for fathers in the City of Detroit, Michigan. The goal of this needs assessment was to assess the availability of parenting support services to men through multiple perspectives. To enact a CBPR approach, the research team collected qualitative data through interviews with service providers and community dialogues with fathers and consulted a community advisory board for further guidance on the research efforts. The research team engaged in member checking to improve the accuracy and credibility of study findings. Results indicated that both service providers and fathers agreed that very few parenting support services are available to fathers, particularly young African American fathers, and they also largely agreed in establishing priorities to address community fathers' parenting needs. Practice implications include the need for greater collaboration across service sectors and for greater outreach, possibly through technology, to young fathers.     

A Hitchhiker's Guide to caring for an older person before and during coronavirus‐19

Coronavirus‐19 (COVID‐19) has reconfigured working lives with astonishing velocity. Older people have suffered the worst effects of the pandemic, with governments marginalizing or overlooking their needs. Women perform the majority of care for older people, often compromising their working lives and health. Yet in academic articles their voices are often filtered or aggregated in quantitative studies. Based on a weave of personal experiences and secondary research, the article traces a path through UK forms of care and shows how the inadequate response to COVID‐19 stemmed from existing policies embedded in health and social care. COVID‐19 has severed important informal care work, rendering the vulnerable yet more exposed and carers anxious and bereft. Longitudinal research capturing the trajectory of care from the perspective of older people and their carers would lead to improved support hence gender equality.     

Evidence-Based Programs for Older Adults: A Disconnect Between U.S. National Strategy and Local Senior Center Implementation

While U.S. national policies have been developed to support evidence-based (EB) lifestyle programs for older adults, there has been limited research to determine the extent to which these programs actually reach local communities. This study sought to identify factors that impact the implementation of EB physical activity, nutrition, and chronic disease management programs at regional (Area Agencies on Aging [AAAs]) and community levels (senior Centers [SCs]). Interviews were conducted with directors of four AAAs and 12 SCs to understand their perspectives on EB program implementation. Narratives revealed differences between AAAs and SCs regarding knowledge about EB programs and reasons to promote and adopt these programs. The only agreement occurred when discussing concerns about funding and program inflexibility. Substantial gaps exist between how EB lifestyle programs are promoted and implemented at the regional and community levels.     

The Longevity of Community Aging Initiatives: A Framework for Describing NORC Programs’ Sustainability Goals and Strategies

Naturally Occurring Retirement Community Supportive Services programs (NORC programs) aim to bring together stakeholders within a local area with a large number of older adults (e.g., a neighborhood or apartment building) to facilitate activities and services that promote aging in place. Despite enthusiasm for these programs, there is ongoing concern regarding their long-term sustainability, especially as federal funding to support NORC programs nationally has dwindled in recent years. This exploratory study aimed to develop a framework to describe NORC programs’ sustainability goals and strategies. As part of a statewide study in New Jersey, this study drew on data from semi-structured in-depth interviews with staff of 10 lead organizations that represented 15 NORC programs. Using a grounded theory analytic approach, findings revealed three types of sustainability goals: continuing the program indefinitely within the lead agency (described by eight organizations); integrating the program functions across other organizations (described by one organization); and defining the program as a finite project (described by one organization). Lead organizations implemented and developed their programs in ways that reflected their goals. This framework can be used to guide efforts to maintain, expand, and evaluate NORC programs and related community aging initiatives.     

Elder Abuse and Barriers to Help Seeking in Chennai,India: A Qualitative Study

This qualitative study attempts to understand why older persons abused by their family members in India do not seek help. In-depth interviews over three visits were conducted with six adults aged 65 years and above who had been physically abused by their sons/daughters-in-law. The interviews were transcribed and themes identified using a thematic analysis method. The barriers preventing a person from seeking help were service-related (accessibility, lack of trust); religious (Karma); family (deleterious effects on family, family members’ responses to help seeking); and individual (socioeconomic dependency, self-blame). The unique findings that surfaced were fear of losing one's identity by losing one's family, attributing abuse to past sins, and concern over not attaining salvation if one's sons did not perform funeral rites. The authors propose a checklist to explore and assess the barriers to seeking help. Recommendations for geroprofessionals in overcoming barriers include implementing outreach programs and changing the misconceptions regarding Karma.     

At the intersection of marketisation,diversity and migration: reshaping the provision of paid family eldercare in Sweden?

This article explores how paid family eldercare in Sweden is reshaped at the intersection of marketisation, accommodation to ethnic diversity and globalisation of international migration. Using a mixed-methods case study approach, the paper examines how implementation of customer choice in publicly funded homecare services to older adults in the city of Stockholm interacts with paid family care. The results show that some private homecare companies employ family caregivers as a business strategy; moreover, that the majority of employed family caregivers are foreign-born women coming primarily from non-European countries. The findings point towards gains but also risks for all parties involved. Though the family caregiver is ensured an income, the employment is generally associated with low wages and weak social security. In addition, employed family carers often lack formal training, which affects documentation procedures and monitoring of the daily care work. It is therefore difficult to evaluate the quality of care services performed by employed family carers. The results indicate a need for policy-makers to reconsider how customer choice in eldercare interacts with paid family care. Otherwise, unintended consequences may result in negative effects for integration as well as social work practice with foreign-born older adults.     

Family carers' views of services for people with learning disabilities from Black and minority ethnic groups: a qualitative study of 30 families in a south London borough

In 2001, the UK Government identified the widespread neglect of the needs of people with learning disabilities from Black and minority ethnic communities. In this qualitative study informal interviews were held with 30 family carers of adults with learning disabilities from Black and minority ethnic communities. Their views were sought regarding services received and services needed, and cultural or communication barriers faced in accessing appropriate services. The study showed that although carers were largely satisfied with services actually received, service provision was highly inadequate and ineffective. Even very elderly and ill carers and those caring for people with severe disabilities received little support. Social worker support was negligible, and future planning rare. It is clear that the needs of carers from Black and minority ethnic communities are not being met. The situation would be considerably eased by adequate social worker support. Stereotypes of supportive family networks, (especially regarding south Asian families) proved to be unfounded.     

Carer Participation: Training for People With Intellectual Disabilities in a Chinese Society

People with intellectual disabilities require training to improve independence, and carers are important partners in the process. Studies show that carers are able to motivate family members with intellectual disabilities to participate in training. In addition, family members may serve as cotrainers. To increase carers' participation, it is necessary to empower them with training techniques and develop strategies to relieve their stress. This article aims to explore the effects of carer support to enhance training quality of daily living skills for their family member with intellectual disabilities, through the use of care case studies, in the context of families living in Hong Kong. A model of multiple case studies is adopted. Three cases are analyzed to illustrate various modes of carer participation.     

Assessing Public Support for State Government Social Welfare Expenditures

Abstract

This study compared two different approaches to assessing the level of public support for social welfare spending at the state government level. The first approach focuses on the degree to which the public supports state government's involvement in public welfare spending. The second approach identifies the importance the public places on social welfare spending when compared to other possible functions of state government. Using Alabama data, the paper examined changes in general and comparative public support for state budget expenditures from 1980 to 2000 in Alabama. In addition, we examined the effectiveness of sociodemographic and attitudinal characteristics of respondents as predictors of both general and comparative support for three social welfare functions of state government. Support for “benefits for poor people” grew both generally and comparatively in the 20-year period; support for programs for older people remained steady; and support for mental health services declined. Sociodemographic predictors of general and comparative sup port were generally consistent with a self-interest model     

The use of key indicators as a foundation for knowledge management: the experiences of Monterey County's Social and Employment Services Department

While effective knowledge management practices are commonly sought by organizations, facilitating the use and ongoing engagement in these practices can be challenging. To this end, one agency developed a strategy for institutionalizing their knowledge management functions by appointing a team responsible for monitoring and implementing knowledge management functions, and creating a report for use as a tool by departments agency-wide. Aimed at increasing transparency both within the agency and with the surrounding community, the report provides an overview of individual departments' programs, goals, recent caseload trends, and latest achievements. The report is made available online and accessible by the general public. This case study describes the development of this team and report, as well as lessons learned and future knowledge management goals for the agency.