Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

School Social Work Information Systems (SSWIS): A Relational Database for School Social Workers

SUMMARY

After a review of their information management system, the Winston-Salem/Forsyth County School Social Work Office began a process to improve data collection and information management. The result was the creation of the School Social Work Information System, a relational database designed and developed by the school social workers themselves. This article reviews the process of evaluating existing systems, developing and implementing the new system, evaluation and continued development of the new system, and implications for further social work practice. This article is intended to provide the school social worker with the necessary information to develop similar systems.     

A Knowledge Based System for Assisting in Differential Diagnosis of Chemically Dependent/Mentally Ill Patients

Summary

This paper discusses the use of Knowledge Base 2.1, a computer program that administers a response dependent, structured interview to evaluate the presence of psychiatric disorders within the chemical dependency treatment setting. The writer reviews the problems commonly encountered when conducting clinical interviews, psychometric examinations and differentially diagnosing psychiatric disorders within this special population. Knowledge Base 2.1 utilizes combined computer techniques of rule driven logic, pattern matching, and an original algorithm that accomplishes a “real time retandardization” of the complete database. With each administration, standardization is implemented in an effort to adequately consider the effects of chemical dependency on psychological test performance and normative information regarding symptoms. Knowledge Base 2.1 also functions as a research tool inasmuch as all patient responses to this structured interview are permanently stored in computer files for ongoing analysis.     

Reduction of Face‐to‐Face Contact Hours in Foundation Research Courses: Impact on Students' Knowledge Gained and Course Satisfaction

This study investigated the impact of reducing the number of face‐to‐face contact hours in a Masters of Science in Social Work (MSSW) foundation research course in an urban school of social work on students' knowledge gained and course satisfaction. A quasi‐experimental pretest/posttest comparison group design was used to test the following hypothesis: reducing the number of face‐to‐face contact hours will not negatively impact knowledge gain and course satisfaction in a foundation research course. The findings of this study suggest that reducing the number of face‐to‐face contact hours does not negatively affect student learning as both the comparison and the experimental group demonstrated an increase in foundation research knowledge. The level of course satisfaction was influenced by the number of hours completed in the program, age, and the number of hours worked in paid employment. Students who are especially vulnerable are younger students who have completed less course hours. They tend to struggle at the beginning to get used to new technology as part of their educational experience. This paper demonstrates that it is no longer ‘if’ web‐based and distance learning technologies are appropriate for social work education but rather ‘when’ and the degree to which their integration yields greatest educational value.     

Medicaid Funding for Assisted Living Care: A Five-State Examination

Medicaid waiver programs financing assisted living care are examined in five states to gain insights about program implementation, accomplishments, and challenges. Documents, augmented with stakeholder interviews, are used to describe income eligibility, options for supplementing payments to facilities, risk adjustment payment levels, and participation. Needs determination and waiver-based payments are in place. Eligibility and funding levels are complicated by room and board allocations that are linked to the federal benefit rate for Supplemental Security Income. Provider participation may be diminishing. Many recipients have to accept shared occupancy as program payments are insufficient for single units.     

Social Relationships of African American and Hispanic Older Assisted Living Residents: Exploring the Role of Race and Ethnicity

African American and Hispanic older adults are underrepresented in assisted living communities, so little is known about how they experience social relationships in these settings. The purpose of the study was to explore resident-to-resident and resident-to-staff relationships experienced and perceived by African American and Hispanic older residents in assisted living settings. In-depth interviews with 15 African American and 15 Hispanic older adults were conducted in seven assisted living communities in Central Florida. Three salient themes emerged using a grounded theory approach: formation of relationships: emotional vs. instrumental support; language as a facilitator or barrier; and avoidance of inter-racial relationships. Implications for providing culturally competent services in assisted living communities with diverse populations are discussed.     

Eight Years of Data on Residents in Small Dementia-Care Settings Suggest Functional Performance Is Maintained

Eight years of data analysis on residents’ status from three small Alzheimer care centers suggest notable stability in function. Individuals’ functional ability was best in their first year, but their year-to-year decline was mostly not significant. Cognitive abilities also were best in the resident's first year, but first-, second-, and third-year cognitive scores were not significantly different. We compared the residents’ dementia progression rate to the true rate of natural disease progression. This study, like others on small homelike settings, suggests that appropriate homelike environments maintain persons with dementia at an optimum level longer.     

An ICT-Driven Hybrid Automation System for Elderly Care Support: A Rehabilitation Facility Study Case

Abstract

The demographic statistics in developed countries suggest growth in the elderly segment of the population. At the same time, other studies forecast a shortage of nurses, increasing the pressure on hospitals to provide treatment for longer periods of time. These trends suggest a need for new ways of taking care of the elderly population that support safe, comfortable, and independent living. Meanwhile, prominent advances in information and communications technology (ICT) have enabled new systems that address various needs of the elderly. This article presents a case study of a rehabilitation facility located in Tampere, Finland, that uses an automation system in which ambient assisted living (AAL) and building automation (BA) system functionalities are combined. It details a field study summarizing the needs of the users, describes functional scenarios supported by the system, and reports the results of the first usability tests suggesting acceptance of a new technology by residents and caregivers. The unique combination of ambient assisted living and building automation offers a safer and more comfortable environment for the elderly as well as helps caregivers on-site in managing their workloads.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.