“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care

Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

Multilevel Factors Related to Psychosocial Care Outcomes in Washington State Skilled Nursing Facilities

As the primary providers of psychosocial services in skilled nursing facilities, social services professionals report barriers interfering with their ability to meet residents' needs. This study utilizes a 3-category quality assessment framework and a cross-sectional survey design to assess factors impacting the provision of effective psychosocial services in Washington State facilities. Hierarchical linear regression results indicate that the 3-factor model explains 26.4% of the variance in psychosocial outcomes; 4 variables exert the most influence: ownership turnover, practitioner experience, practitioner role identity, and the importance of individualizing care. Findings have implications for developing necessary supports for quality psychosocial care delivery.     

Improving Emergency Care for the Elderly

Much has been written on the developing role for social workers in hospital emergency rooms but little has focused specifically on social work interventions with elderly emergency room patients in an urban teaching hospital. A group of fifty patients over sixty-five years of age, referred to social service for assessment and assistance with home care issues, is described. The emergency room social worker's role with these elderly patients is highlighted and three case examples are discussed. It is argued that social work interventions improve the quality of both emergency and ongoing care for this growing and often at risk population.     

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.     

Deciding to Institutionalize: Caregiving Crisis,Intergenerational Communication,and Uncertainty Management for Elders and Their Children in Shanghai

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.     

Is brief daily body–mind–spirit practice desirable for staff who provide services for elderly people? Two pilot studies with care and professional workers

A symptoms-focused approach had only limited short-term effects in addressing burnout. A new trend is toward a positive approach in fostering well-being in the workplace. The current study piloted a daily body–mind–spirit practice programme which provided a 15-minute small-group meeting with staff who provide services for elderly people, towards the end of every workday for one month at two study sites. Repeated measures of burnout, daily spiritual experience (DSE) and engagement were taken at pre-intervention, post-intervention (the intervention lasted for one month) and one month after intervention. The two groups, home help workers and professional staff respectively, showed different patterns in burnout reduction and increase of DSE.     

Effort-reward imbalance and work-home interference: a two-wave study among European male nurses

ABSTRACT

This one-year follow-up study among 1,421 male nurses from seven European countries tested the validity of the Effort-Reward Imbalance (ERI) model in predicting prospective vital exhaustion and work-home interference. We hypothesised that effort and lack of reward would have both main and interactive effects on future outcomes. Results of structural equation modelling (SEM) showed that effort was positively related to exhaustion and work-home interference, both simultaneously and over time. Lack of reward predicted increased exhaustion at follow-up, but effort-reward imbalance did not influence the outcomes. Additionally, Time 1 exhaustion predicted increased work-home interference and exhaustion at follow-up. These results do not support the ERI model, which postulates a primacy of effort-reward imbalance over main effects. Instead, the findings are in line with dual path models of job stress and work-home interference. Multi-group SEM showed partial cross-cultural metric invariance for the ERI measure of effort, but the ERI measure of rewards showed no metric measurement invariance, indicating its meaning is qualitatively different across cultures. Nevertheless, the main conclusions were markedly similar for each national sub-sample. We discuss the theoretical and practical implications of our study.     

Better know a Human Resource Development (HRD) scholar: a conversation with Robert (Bob) G. Hamlin

This article contains a conversation with Robert (Bob) G. Hamlin and is part of aseries that focuses on different human resource development (HRD) scholars. Theaim is to better understand the people behind the names we see in print and at HRD scholarly conferences. Bob is professor emeritus and chair of HRD at the University of Wolverhampton Business School, UK and a management and organization development consultant at Oaken Consultancy. Bob has spoken at many HRD conferences in Europe and the United States and was one of the founding members of the University Forum for HRD. The conversation explores Bob's career in HRD practice, research, teaching and management. Among the topics covered are the significance of practical experience and the influence it can then have on research, the power of evidence-based practice, and the need for HRD research to be seen as relevant and having utility within the world of practice.     

跨文化背景下儿向语的普遍性特征

儿向语是成人对儿童的一种简易化的特殊语言。最早是由西方中产阶级提出并运用的。对这种语言现象,目前有两种看法,一种观点认为这是一种语言句法的学习形式,另一种则认为是一种交流形式。西方心理语言学家认为儿向语在不同的语言和文化群体中有不同的表现。不同的文化背景下会形成不同的看护儿童的理念,也决定了儿向语在该文化背景下的特点。