End of Life,Chronic Illness,and Trans-Identities

In this study, the experiences and needs of a sample of 1,963 current, global, English-speaking, transgender-identified adults responding to the Transgender MetLife Survey (TMLS) as related to a number of later-life and end-of-life (EOL) preparations and concerns were examined. EOL concerns are integrated with concerns and challenges around chronic illness and disability. Overall, this population was significantly ill-prepared for the major legalities and events that occur in the later to EOL time periods. The population was found to harbor significant fears around the future. Drawing on the author's decades of survey research in transgender aging and case data along with current scientific and online literature, illustrative quotations and case examples are provided.     

Gender Stereotypes and the Reshaping of Stigma in Rehabilitative Eldercare

Rehabilitation policies are becoming increasingly popular in eldercare as a means to ensure dignity and reduce costs. This paper examines the implications of rehabilitation within Danish homecare work, a type of work that is often stigmatized due to its associations with low‐status ‘dirty’ body work in old people's homes. The paper combines two research traditions: studies of dirty work and studies of body work. It draws on observations and focus groups in Denmark to explore how the introduction of rehabilitation changes the work of care workers, and how such changes are associated with a potential reshaping of stigma. In contrast to previous research, this paper shows that although rehabilitation was partly introduced to reduce stigma of this type of work, the practice of rehabilitation paradoxically reinforces the stigma that it attempts to manage. Thus, the analysis helps to improve our understanding of the ambiguous and varying ways rehabilitative eldercare reshapes and reinforces stigma and gender stereotypes among women who do ‘dirty’ body work.     

The cost of caregiving: wage loss among caregivers of elderly and disabled adults and children with special needs

Sixty-one percent of the adults caring for elderly and disabled family members and 53% of parents of children with special needs are employed. Yet studies examining the experience of employed caregivers of children with special needs and elderly or disabled adult family members have not examined the impact on earnings or the workplace policies that might help reduce the conflicts between work and caregiving. This study begins to fill this gap using data from a nationally representative US survey of American adults. We find that employees who live with a child with a health problem are 48% more likely to have lost wages. Each adult with health issues that an employee is responsible for raises the chances of wage loss by 29%. At the same time, access to paid leave for family health needs reduces the likelihood of wage loss by 30%, and having a supportive supervisor reduces the odds of experiencing wage loss by 37%. Implications for employers and US policy-makers are discussed.     

Associations of eldercare and competing demands with health and work outcomes among manufacturing workers

Employees juggling eldercare and work report work–family conflicts and poor health-related outcomes, but little is known about eldercare demands (ECDs) in the context of competing demands in the manufacturing workforce. This study determines how ECDs vary by age, gender, income, and job category, and how ECDs and competing demands are associated with health-related and work-related outcomes, among manufacturing workers. Employees from six manufacturing companies completed questionnaires. ECDs were defined as providing assistance to an adult aged 65 and older due to disability or chronic illness; those with ECDs were asked how many care-hours per week and whether assistance included personal care. Workers over age 45 were more likely than younger workers to report ECDs. After adjusting for competing demands and socio-demographic characteristics, ECDs were associated with greater depressive symptoms and family-to-work conflict (FWC), providing 5 or more hours of eldercare weekly was associated with greater depressive symptoms, and providing personal care was associated with greater FWC.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

Abstract

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.     

Families,Work, and an Aging Population

Abstract

This article examines the intersection of family caregiving, work, and long-term care. Supporting families who provide care in order to minimize negative work effects while enhancing the acceptability of care options is of common concern to employers, state and federal policymakers, and the homecare professionals in the community-based care system. The contribution of families to the long-term care system, how employer policies have developed, how the public policy agenda has addressed family caregiving, and the importance of a more effective partnership on the state level are discussed.     

Professionalized through audit? Care workers and the new audit regime in Sweden

The professionalization of social care workers is a policy goal in many welfare states. At the same time, professionalization risks being undermined by enhanced audit. The objective of this article is to analyze whether the audit processes adopted in Swedish eldercare and childcare support or undermine the professionalization of the occupations working there, i.e., nurses, nursing assistants, preschool teachers, and preschool assistants. In particular, we investigate whether the three main forms of audit—standard‐setting, inspections, and quality measurements—support or undermine the occupations’ ability to achieve professional closure and enhance their external and internal autonomy. The findings suggest that audit processes in eldercare risk undermining professionalization, while in childcare the pattern is reversed: audit appears supportive of professionalization, at least for preschool teachers. This finding suggests that audit processes do not have to be detrimental to professionalization.     

From the state to the family or to the market? Consequences of reduced residential eldercare in Sweden

This article analyses the changing roles of the state, family and market in providing care for older people in Sweden, in relation to Scandinavian welfare ideals of universalism and de‐familisation. Since 2000 every fourth residential care bed has disappeared and the increase in homecare services has not compensated for the decline. Instead family care (defined here as help from adult children and other non‐cohabiting family or friends) has increased in all social groups: help by daughters mainly among older people with shorter education and help by sons among those highly educated. Use of privately purchased services has also increased but continues to play a marginal role. Family care remains more common among older people with less education whereas privately purchased services are more common among those with higher education. This dualisation of care challenges universalism, and working‐class daughters continue to be most affected by eldercare cutbacks.     

Making sense of reablement within different institutional contexts. Collaborative service ideals in Norwegian and Danish home care

With population ageing, many countries are setting up reablement—short-term rehabilitative eldercare interventions—aimed at helping older adults to regain independence and thereby curb their need for long-term care. Reablement is premised on a citizen-centred and collaborative service ideal intended to challenge the fragmented thinking associated with professionalism and a dispersed service delivery field. Drawing on contextualist sensemaking theory and cross-national qualitative case study data, we explore how historical and institutional conditions influence the way reablement is made sense of on the ground. In Danish settings, characterised by legal regulations and institutional arrangements rooted in previous New Public Management reforms, new service ideals were constrained by vertical levers of control. The Norwegian bureau–professional settings opened up for user involvement but also gave rise to tensions between reablement teams working to prevent ill health and agencies expected to respond to the urgent needs of the frailest elderly.     

Eldercare Service Redesign in Finland: Deinstitutionalization of Long-Term Care

ABSTRACT

Deinstitutionalization is an important trend in the redesign of long-term eldercare in Finland. It refers to a process where traditional institutional care is partly replaced by home care services and the creation of homelike housing units. The first part of this article provides an overview of eldercare service redesign by using national statistics. The second part consists of qualitative analysis of the deinstitutionalization of eldercare. The data consist of 27 interviews conducted among municipal care administrators and is analyzed using thematic and discourse analysis. Main findings show a deep policy change taking place in eldercare deinstitutionalization discourse lying at its center. A distinction between explicit and implicit deinstitutionalization discourse is made. The former clearly states that institutional care needs to be cut back making it possible for all older people to live at home or in homelike housing facilities. Implicit deinstitutionalization discourse is underpinned by comments of a different type, more critical and problem-centered. Within intensive service housing, for instance, fee policy is reformed. The main results include the observation that explicit deinstitutionalization discourse is in line with the national policy aims of putting home first, while implicit discourse deals with hidden or unexpected consequences. The article discusses future research in the conclusion.