Old-age homes and services: old and new approaches to aged care

Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.     

Creating elder-friendly communities: preparations for an aging society

Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. "Age-prepared communities" utilize community planning and advocacy to foster aging in place. "Elder-friendly communities" are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.     

Re‐invigorating democracy?: White middle class identities and comprehensive schooling

Recent research on social class and whiteness points to disquieting and exclusive aspects of white middle class identities. This paper focuses on whether ‘alternative’ middle class identities might work against, and disrupt, normative views of what it means to be ‘middle class’ at the beginning of the 21^st Century. Drawing on data from those middle classes who choose to send their children to urban comprehensives, we examine processes of ‘thinking and acting otherwise’ in order to uncover some of the commitments and investments that might make for a renewed and reinvigorated democratic citizenry. The difficulties of turning these commitments and investments into more equitable ways of interacting with class and ethnic others which emerge as real challenges for this left leaning, pro‐welfare segment of the middle classes. Within a contemporary era of neo‐liberalism that valorises competition, individualism and the market even these white middle classes who express a strong commitment to community and social mixing struggle to convert inclinations into actions.     

Children’s Nonverbal Displays of Winning and Losing: Effects of Social and Cultural Contexts on Smiles

We examined the effects of social and cultural contexts on smiles displayed by children during gameplay. Eight-year-old Dutch and Chinese children either played a game alone or teamed up to play in pairs. Activation and intensity of facial muscles corresponding to Action Unit (AU) 6 and AU 12 were coded according to Facial Action Coding System. Co-occurrence of activation of AU 6 and AU 12, suggesting the presence of a Duchenne smile, was more frequent among children who teamed up than among children who played alone. Analyses of the intensity of smiles revealed an interaction between social and cultural contexts. Whereas smiles, both Duchenne and non-Duchenne, displayed by Chinese children who teamed up were more intense than those displayed by Chinese children who played alone, the effect of sociality on smile intensity was not observed for Dutch children. These findings suggest that the production of smiles by children in a competitive context is susceptible to both social and cultural factors.     

母亲结

一位美国母亲，得知体格并不强壮的儿子要去从事十分危险的骑牛运动（电视上经常见到的比赛，所有选手的下场都是被疯狂的公牛从背上甩下来），她心平气和地和儿子谈了自己的观点：她个人反时，但如果儿子坚持，她也会支持，但她要求儿子一定要以安全为主。结果，儿子还是毅然选择了这个职业。     

Perceptual identification of talker ethnicity in Vancouver English

Studies of ethnolinguistic variation typically begin by describing the speech production variables used to index social groups. In this study, we begin with indexical recognition – the perceptual identification of speakers’ self‐identified ethnic groups – to determine whether speakers produce ethnolinguistic variation and whether listeners are sensitive to it. Speech samples were recorded from thirty individuals from Metro Vancouver who self‐identified as Chinese, East Indian, or White Canadian. These utterances were used in a perception task where listeners categorized speakers’ ethnicities. Listeners’ social networks were labeled according to the ethnic group with which they reported spending the most time. Analyses indicate that while speakers vary in their productive expression of ethnolinguistic variation, listeners are consistent in their labeling choices. Listener accuracy was higher for voices from the listeners’ reported social group and White voices. These results suggest that familiarity with ethnic groups through social networks and mainstream culture influences indexical recognition.     

Implementation of a Collaborative Care Initiative for PTSD and Depression in the Army Primary Care System

Collaborative care models hold promise as a means to improve the Military Health System (MHS) to better meet the mental health needs of U.S. military personnel. This article describes an Army-wide collaborative care initiative, RESPECT-Mil (“Re-engineering Systems of Primary Care Treatment for Depression and PTSD in the Military”), aimed at improving care for soldiers with depression and post traumatic stress disorder. Essential to the implementation of RESPECT-Mil has been the use of a centralized coordinating team to facilitate collaborative care practice and policy activities across the multiple levels of the MHS. The article explores the relevance of collaborative care frameworks to the social work profession and concludes with a discussion of future directions for the social work field to promote greater involvement in the integrated care movement.     

Nursing Home Deficiencies: An Exploratory Study of Interstate Variations in Regulatory Activity

This study examines nursing home regulatory activity by the states, assesses interstate variations in the volume and severity of nursing home deficiencies, and explores state-level factors that may account for these differences. Nursing home deficiency citation data over a 5-year period (2000–2004) were obtained from the Centers for Medicare and Medicaid Services. We examined interstate variations in regulatory activity and identified predictors of deficiency volume and severity at the state level (demographics, elected officials, industry characteristics, etc.) using the linear mixed model. Deficiency volume remained stable across the 50 states from 2000 to 2004, while deficiency severity decreased significantly. California had the highest volume of deficiencies per nursing home; Wisconsin had the lowest. New Hampshire had the highest percentage of severe deficiencies; California had the lowest. Higher deficiency volume was found in states with lower median household income, a lower proportion of residents aged 85 and older, and a Democratic legislature. Higher deficiency severity was associated with higher median household income and a higher proportion of Medicaid nursing home residents in a state. In contrast, greater state agency funding, higher state standards for nursing home administrators, and a Democratic and more professional legislature predicted lower deficiency severity. Nursing home residents in the United States receive unequal protection from abuse and neglect, and this is partly due to their state of residence. Interstate variations in deficiency volume and severity are due to a complex set of factors beyond nursing home quality.