Developments in home help for elderly people in Denmark: the changing concept of home and institution

The official figures on provision of home help in Denmark are compromised in that they include figures for help delivered to people living in assisted-living dwellings, facilities that were formerly considered nursing homes. Furthermore, many municipalities have integrated home help and nursing-home care and report this as home help. This article examines the effect of these administrative arrangements on the provision of home help and the distribution of home help in terms of hours per week. There has been a polarisation in size of care packages: a smaller group of recipients composed largely of people residing in assisted-living dwellings receive larger care packages, whereas the care packages to people living in their own dwellings have decreased in size. However, a sleight of hand of definitions regarding the concept of home has made the official figures on provision of home help look even more generous than they are.     

Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

Community in a children's home

In this paper the focus is on ‘the community’ of a children's home and what it looks like from the children's point of view. The research data consist of ethnographic research material produced in conjunction with a doctoral thesis in 1996. The community was analysed in respect to four features: periodic adult relationships, alliance creation, importance of peers relationships and continuous negotiations, where children take active roles. In addition to periodic employees, the community of a children's home includes different relationships between peers and adults. The significance of the community is individually experienced. According to the field research, a children's home can offer home‐like experiences for some children and give a feeling of belonging, while there are also children for whom a sense of belonging is more complex. There is a need for a community approach in child protection and child welfare research. The studies of children's friendship and other human relationships provide adults and professionals with an understanding of the role of these relationships in the children's life and future. The studies also yield information on how these personal relationships are interpreted by young people.     

The complexities of cultural support planning for Indigenous children in and leaving out‐of‐home care: the views of service providers in Victoria,Australia

Indigenous children and young people are over‐represented at all stages of the Australian child protection system. Policy and legislative initiatives exist in the state of Victoria, Australia aiming to support the connection between Indigenous children and young people in state care and their culture and community. This exploratory research involved focus group consultations with seven child and family welfare agencies to investigate the impacts, barriers, benefits and limitations of cultural support planning for Indigenous young people in, and leaving care in, Victoria. Findings indicated that cultural planning was of value when it could be completed. However, various shortcomings of current systems were identified including limited resourcing of Aboriginal Community Controlled Organisations to generate plans and provide direct and secondary consultation services to implement plans, difficulty gathering information for plans and some Indigenous young people expressing disinterest in connecting to their culture and community. Complexities in the relationships between the Indigenous and non‐Indigenous agencies that aimed to support Indigenous young people in care were also acknowledged. Participants identified a number of strategies to improve outcomes, such as facilitating better relationships between agencies, promoting opportunities for ongoing cultural training for staff in mainstream agencies and improving the resourcing of Aboriginal Community Controlled Organisations to deliver planning and to support cultural connections.     

The Consequences of Implementing a Child Care Voucher Scheme: Evidence from Australia,the Netherlands and the USA

In the Netherlands, the USA and Australia, public funding has promoted parental choice by introducing a voucher scheme for child care, where parents are free to choose the provider. The policy experiments and the outcomes in these three countries provide useful information about the consequences of introducing a voucher scheme in the child care market. We show the voucher system can be effective in increasing demand, but there can be uneven supply responses. The structure of the voucher income scheme and quality controls affect the nature of the supply response. We argue that voucher schemes must take into account the complex nature of the child care market and the substitutability among free public care, private market care and unpaid household care. To secure quality and access, government also must play a coordinating role that vouchers alone cannot supply.     

Challenging behaviour in out‐of‐home care: use of attachment ideas in practice

Children in out‐of‐home care that demonstrate challenging behaviour are often thought of as ‘attachment disordered’. Our understanding of what this might mean for practice is not well developed. In this study, 92 South Australian stakeholders were interviewed about how they understood extremely challenging behaviour amongst school‐age children in out‐of‐home care. Participants consistently described behaviour as arising from attachment difficulties. Despite this, there were a variety of ways that a child's attachment needs were conceptualized, which appeared to be inconsistent with contemporary attachment theory. Thematic analysis yielded four implicit views about children's attachment: attachment as capacity that is limited, attachment as skill that children can learn and transfer to other relationships, attachment as unachievable for some children and an idealized view of attachment as a close and trusting relationship. These possible misconceptions about attachment and attachment needs and their relationship to the development of challenging behaviour are discussed in terms of attachment informed research and theory. The possible implications for placement practice and policy for children in out‐of‐home care are discussed.     

The emerging role of Financial Counsellors in supporting Older Persons in financial hardship and with management of Consumer‐directed Care packages within Australia

The role of financial counsellors as providers of information, support and advocacy for those in financial difficulty is a well established mechanism in the mainstream welfare landscape in Australia. In general, the role of financial counsellors is in helping people alleviate or resolve their financial difficulties through improvement of their financial literacy. It is recognised as an important component of policy responses to assist low‐income households and individuals in financial stress. The use of financial counsellors for older persons (i.e., those aged 65+ years), however, appears to be underutilised. Financial hardship and abuse of older persons within our community are becoming key issues as the population of Australia “ages”. Existing evidence also suggests that service providers alone do not have adequate skills to address these issues. This paper firstly examines the development of financial counselling in Australia. It then examines the newly emerging role of financial counselling in supporting older persons in addressing barriers to financial literacy and then in navigating the complex landscape of aged care service provision. The current financialisation, marketisation and complexities of consumer‐directed care are identified as key contextual factors. The paper will then discuss an evaluation study of the provision of financial counselling to the older person population designed to support financial hardship and navigation of the complex aged care services system. The findings of the paper are based on an evaluation of the Financial Consumer Rights Council (FCRC), Victoria: Dignity and Debt Financial Difficulty and Getting Older initiative. This pilot initiative included older persons from both community‐based and aged care residential facilities in one regional area of Victoria. The initiative, conducted over 2016, was designed to assess the effectiveness of one‐on‐one financial counselling sessions with older persons that provided consumer advocacy and information about support services and entitlements (including hardship protections) associated with ageing. The evaluation found that the provision of financial counselling to the older person population could be a key mechanism in improving overall financial literacy, avoiding periods of financial hardship and in maintaining financial well‐being, quality of life and positive ageing. Findings also demonstrated a need for an expanded outreach financial counselling model to better service older persons in more isolated living environments and/or with mobility impairments living in the community, and the potential to situate offices of financial counsellors within medical centres (a space often visited by the ageing population), to co‐situate financial health check‐ups as an overall element of health and well‐being. As such, financial counselling was viewed as well placed to support older persons in improvement of financial literacy and in supporting navigation of the increasingly complex marketised and consumer‐directed care (CDC) landscape of aged care service provision in Australia.     

The Effects of Housing Costs on Nursing Home Diversion

Abstract

This article examines the effect of the housing market on nursing home diversion and/or transition. Prior evaluations of federally funded diversion/transition efforts indicate that lack of housing may be a significant impediment to diversion policy efforts. We test this charge by examining the transition rates in all 351 municipalities in Massachusetts, using a data set of over 15,000 individuals seeking to remain or transition home between 2010 and 2014 through Massachusetts' Options Counseling program and their relation to key indicators of housing quality and affordability, including housing burden, crowding, and incomplete kitchen and plumbing facilities. We also control for demographic indicators identified in previous findings, which are age, level of frailty, and whether seniors live alone. We do not find a significant relationship between housing affordability or quality and successful nursing home diversion. This fact suggests that consumers are not as sensitive to housing costs and conditions as previously expected. Future research should continue to investigate the economic and social conditions behind this fact in the context of home value appreciation, incidence of home ownership, and the ability of seniors to offset nursing home costs through accumulated home equity.     

Understanding the Impact of Early-Life Trauma in Nursing Home Residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.     

Experiencing Older Age in Korea and Australia The Role of Social Policies

This comparative study explores attitudes toward and experiences of ageing of 60 Koreans, aged between 55 and 65 years, residing in two countries: Korea and Australia. It examines similarities and differences in their perceptions of old age in the distinctive social welfare environments in which they live. It draws attention to the importance of social policies in affecting how people anticipate and experience old age.     

Psychosocial Care in Nursing Homes in the Era of the MDS 3.0: Perspectives of the Experts

Meeting psychosocial needs of nursing home residents is increasingly regarded as a critical component of care, and the nationally-mandated nursing home care screening instrument— the Minimum Data Set (MDS) 3.0—was modified and implemented in 2010 to promote better assessment of psychosocial needs and health. Recognizing the importance of psychosocial well-being among nursing home residents, and the promise of MDS 3.0 for improving psychosocial care, this article reports recommendations derived from a conference of stakeholders representing diverse disciplines and organizations regarding next steps following MDS 3.0 screening. Results relate to seven areas of psychosocial care and address cross-cutting recommendations to improve psychosocial care.     

Improving primary level home and community care services for older people: The case of Hong Kong

The aims of this study were to assess the impairment levels of users and waitlisted applicants for Hong Kong's Integrated Home Care Services (Ordinary Cases) (IHCS [OC]), reveal their possible hidden needs and potential demand for higher level services, assess their unmet needs for IHCS (OC) and explore whether not using IHCS (OC) was associated with any deterioration in impairment. In all, 567 respondents were clinically assessed twice, over a 6‐month interval, by the Minimal Data Set Home Care questionnaire. The results showed that some moderately or severely impaired respondents had only limited access to higher level services. Some respondents with either no impairment or only low‐level impairment had applied for higher level services. Most waitlisted applicants had not received any IHCS (OC), even after 6 months of waiting. Using IHCS (OC) or not had no significant impact on the deterioration in impairment. Several ways of improving home and community care services are discussed.     

The residential home – what difference does it make?: Comparing the public systems of care for the elderly and disabled in two Swedish municipalities

Two municipalities in Sweden – Solna and Sigtuna – have taken part in a project (the ASIM project) aimed at developing a system for monitoring and analysing the public system of long-term care and assistance for elderly and disabled people. The two municipalities have chosen different alternatives in the question of residential homes. In Solna they have been retained and in Sigtuna they have been converted into sheltered housing. By separating the clients into different classes of dependence using the ASIM assessment, it is shown that in Solna, compared with Sigtuna, fewer of the most dependent clients are in long-term hospital care and fewer of the high-medium category are in domiciliary care. The data were used to calculate the distribution of the clients and the average dependence on the different levels of care if Solna were to apply the care pattern of Sigtuna and vice versa.     

The future of adult safeguarding in Australia

Significant reforms to Australia's adult safeguarding laws and practices are in the process of occurring in the context of increasingly market‐oriented social care provision and rising human rights consciousness. Recent safeguarding developments have included federal regulatory reforms concerning disability and aged care service provision, together with significant reform activity stemming from a national inquiry into elder abuse. Despite this national activity, adult safeguarding continues largely to be an arena of state and territory responsibility. This article examines recent reform developments and asks how safeguarding laws and practices can be reformed to take account of increased federal involvement in social care regulation and the more market‐oriented ways in which social care is being provided. The article argues that while state and territory safeguarding laws and practices are unlikely to become uniform, 10 principles ought to guide continued adult safeguarding reform. These principles seek to balance respect for the autonomy of individuals with society's obligation to support those in need.     

Human Trafficking in Australia: The Challenge of Responding to Suspicious Activities

This paper relates to the Australian government's community awareness campaign, as part of the Action Plan to Eradicate Trafficking in Persons, which was announced in October 2003 in response to evidence of human trafficking in Australia. The authors explore the challenges that are likely to be encountered during the implementation of the campaign using empirical data from two Victorian studies, the first of which explored community awareness of trafficking and the second of which examined Victoria Police and local government's responses to trafficking. We conclude that there are significant barriers to both the community and authorities identifying suspicious activities and acting on reports by community. In addition, institution challenges faced by Victoria police and local government in dealing with referred information appropriately will jeopardise the success of the initiative.     

A Multilevel Analysis of Aggressive Behaviors Among Nursing Home Residents

Individual and organizational characteristics associated with aggressive behavior among nursing home residents were examined among a sample of 5,494 residents from 23 facilities using the Minimum Data Set 2.0 and the Organizational Social Context scale. On admission, some individual level variables (age, sex, depression, activities of daily life [ADL] impairments, and cognitive impairments) and no organizational level variables were associated with aggressive behaviors. Over time, aggressive behaviors were linked with some individual characteristics (age, sex, and ADL impairments) and several organizational level variables (stressful climates, less rigid cultures, more resistant cultures, geographic location, facility size and staffing patterns). Findings suggest multi-faceted change strategies are needed.     

The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Return of the Nanny: Public Policy towards In‐home Childcare in the UK,Canada and Australia

Research on early childhood education and care (ECEC) policy focuses overwhelmingly on formal, centre‐based provision and, to a lesser extent, on family day care (or childminding) provided in the homes of registered carers. Comparatively little research addresses the policy treatment of care provided in the child's home by nannies and au pairs. This article examines the position of in‐home childcare in Australia, the UK and Canada, and the varied nature and extent of public funding and regulation. Introducing a new dimension into comparative studies of ECEC, it also explores how shifts in migration policy in each country have intersected with ECEC funding and regulation to reshape the recruitment and employment of in‐home child carers. Australia, the UK and Canada are all liberal, market‐oriented countries, but there is considerable diversity in the way governments support and regulate in‐home childcare, their rationales for so doing, and in the connections between childcare and migration. We argue that connecting the analysis of in‐home childcare to migration policies raises new questions about the classification and comparison of ECEC policies.     

Experienced support from family,school and friends among students in out‐of‐home care in a school‐based community survey

Youth in out‐of‐home care have elevated risks for adverse events and detrimental circumstances possibly affecting their development. Responses from 311 students in out‐of‐home care (OHC) were compared with peers living in birth parent care (BPC) and in single birth parent care (sBPC) in a regional school survey, directed to students in compulsory school eighth year and upper secondary school second year. Results indicate OHC students to experience less satisfaction with friends, leisure time, and families. They state less trust in support from friends and families but a more similar level to teachers, counsellors or nurses. OHC students also express being more exposed to abusive experiences online and perceive less sense of security at home and in school. We conclude that welfare institutions need to recognize the components in building trust and safety for students in OHC and that school and other professional institutions have an important role in serve resilience and promote well‐being for children in OHC.     

Preparedness of representatives for people with dementia in a self-directed program

ABSTRACT

Representatives enact their role as decision-making partners across the intersection of participant direction (PD) and dementia care. Self-rated preparedness for key dimensions of the role endorsed by a panel of experts in PD and dementia was assessed by telephone survey of 30 representatives of persons with dementia in a PD program. The sample (daughters 60%; Black 50%; rural 70%) was diverse in length of time in the role and additional responsibilities. They represented participants with moderate to advanced dementia and ≥ two additional chronic illnesses. Overall preparedness scores were in the pretty well to very well prepared range, with variation across dimensions and between individuals. Preparedness varied according to what has to be done day-to-day in dynamic or unpredictable situations, gauging decisional capacity, anticipating changing needs, ensuring safety, supporting a dementia-capable care team and negotiation. Stress was related to having a safety net of capable back-up supports and dementia care literacy. Areas of strength, individual variation and particular challenges along the trajectory of representing can guide development of support counselor interventions to provide representatives with tailored training and resources as they enable the benefits of PD for persons with dementia.