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

Abstract

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

Mom and Pop Versus the Big Boys: Adult Family Homes as Providers of Medicaid-Funded Residential Care

This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

Transitions of Youth in Mental Health Residential Care to Less Restrictive Settings: The Role of Strengths and Gender

ABSTRACT

Changes in youth's behavioral/psychosocial functioning has been found to play an important role in the transitions from mental health residential care to less restrictive settings, and this functioning differs significantly by gender. However, there has been little attention paid to the roles played by psychosocial strength and gender in transitions out of residential care. The current study examined gender differences in the role of strengths in transitions to less restrictive settings using data on 675 youth's admission and discharge records collected from Illinois Residential Treatment Outcome System during 2005–2007 (Mean age = 15 years, SD = 2.0; 57.5% = boys). The results of multivariate logistic regression model indicated that positive recreational activities and lack of chronic illness were related to a higher likelihood of transitions to less restrictive settings among girls, while appropriate sexual development, psychological strengths, and strong spiritual/religious strengths were related to the transitions among boys. This study demonstrates the potential importance of youth strengths in the provision of mental health services and suggests a need to develop models of outcomes that take gender into account. Additional research based on multiple informants including youth self-report is needed to understand the role of gender in transitions out of residential care.     

Evaluating Group Work within a Summer Camp Intervention for Children and Adolescents with Asthma

Findings suggest that residential camps and group work within camps are highly valued by children and their parents. Children predominantly valued recreational and educational aspects of camp programming whereas parents emphasized appreciation for the safety that a condition-specific camp can offer a child with illness. Within the camp program, group work and peer support were integrally provided along with clinical monitoring and health teaching. A psychoeducational approach was implemented in which group participants engaged in sessions addressing self-care strategies and constructive ways to integrate childhood asthma in daily life. Participants identified the residential camp setting as a promising environment for group work among children and adolescents with asthma. Implications and recommendations are discussed.     

英国居住区文化景观内涵

英国居住区文化景观建设的发展过程充分展示了英国居住区文化景观的特征.英国居住区文化景观建设是由主体使用者介入、建造、实施与反馈的过程,本质是通过附加使用者的劳动和智慧,从而促进居住区文化景观的形成和发展.这样的形成过程有利于保护传统文化资源,增强社会凝聚力.英国居住区文化景观的建设成果具有传统意义、现实意义和社会意义,对我国居住区景观建设提供了良好的借鉴作用.     

城市居住空间分异的动力机制研究——从城市空间资源使用谈起

从城市空间资源使用的角度,提出个体在居住空间选择中的“主动分异”和“被动分异”,是从微观角度对居住空间研究中的宏观视角进行的有益补充。居住空间的“主动分异”和“被动分异”不仅是与个人社会经济地位相关的空间选择结果,同时影响着居民对城市空间资源相对平等的使用,并进而影响社会群体差异的“再生产”和固化。     

Collaboration between service users and professionals: Legitimate decisions in child protection – a Norwegian model

The aim of this study is to examine the conditions for achieving free and open communication in collaboration. The context is child protection where ‘the best interest of the child’ is at stake. First, a theoretical standard based on free and open communication and equal partnership (deliberation) is presented. Secondly, an explorative analysis is undertaken of the collaboration process between professionals and service users in two review groups regarding two young people, Jane and Tom, both of whom appear to have psychosocial problems living in residential care. Thirdly, on the basis of this analysis, recommendations on how to improve collaboration in review groups are made. The findings show that collaboration has several functions: formal decision‐making, legitimate decision‐making and learning. There is a need to clarify the purpose of collaboration and strengthen structural arrangements as well as develop guidelines for handling challenges at different levels.     

Models of 'ordinary' and 'special' daily living: matching residential care to the mental-health needs of looked after children

This paper proposes a set of distinctions between ‘ordinary’ and ‘special’ modes of everyday living in residential settings for young people in the ‘looked after’ system. The paper begins by reviewing both quantitative and qualitative evidence on the mental‐health needs of the young people, arguing that there is evidence of very high levels of mental distress and disturbance within this group, and that this distress is often undiagnosed and untreated both by psychiatric professionals and within the residential care system itself. There follows a commentary on the tacit assumptions underpinning much residential practice, especially the emphasis in some policy and legal documentation on the young people’s need for ‘ordinary’ everyday experience. The concept of the ‘ordinary’ is problematized, and it is argued that while young people do need to be supported towards mainstream ‘ordinary’ everyday living, they also need specialized everyday care in which their emotional and psychological needs can be recognized and responded to. Four models of ‘special everyday living’ are proposed, based upon existing literature on residential practice, and it is argued that residential care programmes should be based upon a mix of these special and ordinary provisions if the young people’s emotional needs are to be met.     

创造舒适、温馨、健康的居住环境--对家居环境设计方向的探索

家居环境的设计应树立"以人为本"的设计理念,体现不同家庭的个性需求,走出繁琐和过度装饰的误区,转向对居住空间基本功能的发挥、使用者身心环境质量的提高及人的舒适度等方面的关注,倡导"绿色设计",使居住环境舒适、温馨、健康。