Showing papers in "Journal of Gerontological Social Work in 2012"
TL;DR: The background to the demographic shifts resulting in the emerging need for LTC in China is set out and the issues facing LTC services are analyzed, including the structure, operation, financing, and interfacing of residential and community-based home care services.
Abstract: One of the major socioeconomic challenges China faces is the rapid aging of its population. China is now an aging society, even though it is still regarded as a middle-income economy. Coupled with the market-driven reform of social services and rapid erosion of family support, the provision of affordable and accessible social care services to older people has already become an urgent issue for the government to address. Looking into the future, the formulation of a sustainable position on long-term care (LTC) will increasingly become the major focus of social policy. This article sets out the background to the demographic shifts resulting in the emerging need for LTC in China. It analyzes the issues facing LTC services and reviews their prospects, including the structure, operation, financing, and interfacing of residential and community-based home care services.
99 citations
TL;DR: Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests.
Abstract: This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.
65 citations
TL;DR: A composite description of who LDCs are and what they do is presented and Implications for future research were identified.
Abstract: There are an estimated 5-7 million long-distance caregivers (LDCs) in the United States, but little is known about this growing population. This study reviewed the literature on LDCs and examined 16 identified studies. Although studies defined LDCs differently, a composite description of who LDCs are and what they do is presented. LDCs make substantial contributions in terms of physical, financial, and social support. Distance complicates communication about care recipients' health and care needs, as well as the types of care that can be provided. Related to this, geographic separation can exacerbate care-related stressors. Implications for future research were also identified.
55 citations
TL;DR: The final section explores how organizational barriers might be mitigated through the complementary use of relational care.
Abstract: Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization. A qualitative study conducted with 4 social workers and 1 physician employed in residential care facilities demonstrates not only the structural barriers to PCC, but also the importance of meaningful relationships to residents' socio-emotional well-being. The final section explores how organizational barriers might be mitigated through the complementary use of relational care.
51 citations
TL;DR: Concerns at different levels were interrelated and pointed to the need for multilevel interventions to help skipped-generation families and implications for future interventions are discussed.
Abstract: This study examined the family well-being concerns of grandparents in skipped-generation families. Co-resident grandparents who are responsible for raising their grandchildren completed surveys, focus groups, or individual interviews. Service providers to skipped-generation families also participated in individual interviews to provide an additional perspective to grandparents' concerns. Results indicated 5 levels of concerns: intrapersonal, interpersonal, organizational or institutional, policy, and societal. Concerns at different levels were interrelated and pointed to the need for multilevel interventions to help these families. Implications of the findings for future interventions with skipped-generation families are discussed.
50 citations
TL;DR: Variations between rural and urban elders' perceptions appear to reflect differences in socioeconomic development and institutional structures.
Abstract: This study aims to understand what older Chinese people with chronic illness and their family caregivers perceive to be good care, and to compare perspectives of those living in rural and urban areas. We conducted semistructured interviews with 24 care recipients and 23 caregivers in Shandong, China. Two major themes were identified: (a) filial piety as the standard, and (b) modifying cultural ideals to meet reality. There was overall consistency in perceptions of study participants. Variations between rural and urban elders' perceptions appear to reflect differences in socioeconomic development and institutional structures.
41 citations
TL;DR: In this analysis, it is argued that the government's emphasis of certain ideology allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.
Abstract: Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.
36 citations
TL;DR: Culturally competent education about advance directives for Korean American older adults is necessary to help them make informed decisions about end-of-life care and informing family and health care providers of these preferences.
Abstract: The study objective was to explore knowledge, attitudes, and behavior about advance directives and how cultural values influence these beliefs Three focus groups with 23 Korean American older adults were conducted Advance directives were seen as helpful for ensuring that preferences for unwanted end-of-life treatment are honored and for relieving the decision-making burden on family members However, some viewed completing advance directives as contrary to focusing on living Culturally competent education about advance directives for Korean American older adults is necessary to help them make informed decisions about end-of-life care and informing family and health care providers of these preferences
35 citations
TL;DR: These facilities afford older adults a home-like environment with opportunities for social activity and a minimal level of professional care, although relocation can negatively impact well-being.
Abstract: An increasing number of older adults are moving into assisted living facilities when living independently becomes difficult. These facilities afford older adults a home-like environment with opportunities for social activity and a minimal level of professional care, although relocation can negatively impact well-being. Because it is important to study home environments of aging adults, 10 residents of an assisted living facility were engaged in Photovoice to explore perceptions of the facility as home. Through photographic expression, residents identified environment enhancements for home at an assisted living facility. Findings of this study have implications for program planning at long-term care facilities.
35 citations
TL;DR: Results are presented which challenge established knowledge regarding disability policies, autonomy, body, biographical disruption and prerequisites of active aging.
Abstract: What does it mean to live a long life and grow old with disabilities? Or to be an aging parent and still be a caregiver to a disabled adult child? These are questions discussed in this article, the aim of which is to show how a life course perspective adds insight to the lived experience of disability and ageing of adults with disabilities. It is argued that the time concept is fundamental to the understanding of the lives of disabled people. Results are presented which challenge established knowledge regarding disability policies, autonomy, body, biographical disruption and prerequisites of active aging.
34 citations
TL;DR: Examination of the resilience of older adult survivors of Hurricane Katrina in light of their traumatic experiences and multiple losses revealed three major themes: finding personal gratification, realizing their ability to cope, and developing a new interest in life through their novel experiences.
Abstract: The purpose of this study was to examine the resilience of older adult survivors of Hurricane Katrina in light of their traumatic experiences and multiple losses. Ten Mississippi Gulf Coast residents who have survived Hurricane Katrina and its aftermath were interviewed. The participants were 65 years old or older. Their responses were audiotaped and transcribed. The transcripts were analyzed using phenomenological methodology and NVivo 2.5 software. Three major themes emerged. Participants described finding personal gratification, realizing their ability to cope, and developing a new interest in life through their novel experiences.
TL;DR: The challenges facing social workers in meeting the growing health and social needs of aging adults with IDD and their families are explored.
Abstract: Similar to the general population, adults with intellectual and developmental disabilities (IDD) are living into their 70s and beyond. Health care disparities have been well-documented for this vulnerable and underserved population. Social workers are often responsible for assessment, coordination of care, and negotiation of needed services for people with IDD. This article explores the challenges facing social workers in meeting the growing health and social needs of aging adults with IDD and their families. Trends in social work practice and gaps in education are discussed as they relate to addressing and reducing current health disparities.
TL;DR: Findings imply that distinction between voluntary and involuntary driving cessation is ambiguous and that factors beyond health status, including financial strain, play a role in the transition to non-driving.
Abstract: This study explores the decision-making process of driving cessation in later life, with a focus on voluntariness. The sample included 83 former drivers from the Baltimore Epidemiologic Catchment Area Study. A majority of participants (83%) reportedly stopped driving by their own decision. However, many voluntary driving retirees reported external factors such as financial difficulty, anxiety about driving, or lack of access to a car as main reasons for driving cessation. These findings imply that distinction between voluntary and involuntary driving cessation is ambiguous and that factors beyond health status, including financial strain, play a role in the transition to non-driving.
TL;DR: Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs and patients' use of formal services was marginally related to their un met service needs.
Abstract: This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.
TL;DR: Lone social workers were significantly more likely to confirm financial exploitation, physical abuse, and neglect by others; while the team approach resulted in significantly greater risk reduction.
Abstract: This study compared 2 approaches to the assessment of Adult Protective Services (APS) cases. Using administrative data from 869 cases in 2 counties in Maryland, the differences between a nurse/social worker team and a lone social worker in case disposition, risk reduction, recidivism, and cost effectiveness were examined. Lone social workers were significantly more likely to confirm financial exploitation, physical abuse, and neglect by others; while the team approach resulted in significantly greater risk reduction. No differences were observed in relation to recidivism, self-neglect and cost savings. Given limited resources, research that examines optimal staffing patterns in APS agencies is warranted.
TL;DR: The results indicated that Asian ethnicity, English proficiency, and immigration status have significant independent effects on older Asian Americans' access to care.
Abstract: Most Asian American elders are immigrants to the United States, and sociocultural factors such as English proficiency and immigration status are prominent factors in their lives. Using data from the California Health Interview Surveys to focus on Asian Americans over age 50, this study seeks to identify interethnic differences, and the effects of English proficiency and immigration status in the way older Asian Americans access healthcare. The results indicated that Asian ethnicity, English proficiency, and immigration status have significant independent effects on older Asian Americans' access to care. Implications for social work's role in addressing access disparities are discussed.
TL;DR: Findings suggest variable progress regarding the range and style of support available to older people in the context of service integration, community-based services, and consumer-directed care.
Abstract: This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.
TL;DR: Case studies were undertaken through in-depth semistructured interviews to examine the social exclusion risks ENEs may face and the influence of neighborhood support on such risks and the results show 5 aspects of social exclusion E NEs are experiencing.
Abstract: The phenomenon of empty-nest elderly (ENE) has become a significant social issue in China. In this research on ENEs in urban Shanghai, a coastal city in China, case studies were undertaken through in-depth semistructured interviews to examine the social exclusion risks ENEs may face and the influence of neighborhood support on such risks. The results show 5 aspects of social exclusion ENEs are experiencing. Moreover, the neighborhood has the potential for providing different forms of support to reduce social exclusion risks. The research and service implications of our findings for promoting the holistic well-being of ENEs in China are discussed.
TL;DR: This study assessed knowledge outcomes among concurrent, concurrent/sequential, and sequential rotation models of field instruction for field instruction related to older adults.
Abstract: This study assessed knowledge outcomes among concurrent, concurrent/sequential, and sequential rotation models of field instruction. Posttest knowledge scores of students (n = 231) in aging-related field education were higher for students who participated in the concurrent rotation model, and for those who completed field education at a long-term care facility. Scores were also higher for students in programs that infused a higher number of geriatric competencies in their curriculum. Recommendations are provided to programs considering rotation models of field education related to older adults.
TL;DR: 3 interrelated issues critical to the fields of aging and disability are addressed: increasing demand for community-based long-term services and supports, a paucity of evidence-based programs demonstrating effectiveness in facilitating independence for those aging with a disability, and lack of a federal infrastructure to support coordinated investments in research-to-practice for this population.
Abstract: The nexus of aging and disability, characterized by the phenomenon of aging with a disability, will become more visible as the population ages and the number of people with disabilities surviving to midlife increases. This article addresses 3 interrelated issues critical to the fields of aging and disability: increasing demand for community-based long-term services and supports, a paucity of evidence-based programs demonstrating effectiveness in facilitating independence for those aging with a disability, and lack of a federal infrastructure to support coordinated investments in research-to-practice for this population. Suggestions for federal interagency collaborations are given, along with roles for key stakeholders.
TL;DR: The incorporation of CD in long-term care policy is reviewed, the current barriers to providing older adults the right to self-direct are addressed, and recommendations for overcoming these barriers are made through social work practice, policy, and research.
Abstract: There has been a growing trend in long-term care policy to offer individuals with disabilities the option of consumer direction (CD), where responsibility of managing care and support services is transferred from agencies to care recipients, thus supporting clients' self-determination. Although CD has been accepted as an option for non-elderly individuals with disabilities, barriers persist to promoting older adults' autonomy through CD. This article reviews the incorporation of CD in long-term care policy, addresses the current barriers to providing older adults the right to self-direct, and makes recommendations for overcoming these barriers through social work practice, policy, and research.
TL;DR: To better understand how community-based long-term care providers define advance care planning and their role in the process, 8 focus groups with care managers providing care for Ohio's Medicaid waiver program were conducted.
Abstract: To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.
TL;DR: Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities.
Abstract: Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.
TL;DR: Individual and organizational characteristics associated with aggressive behavior among nursing home residents were examined among a sample of 5,494 residents from 23 facilities and findings suggest multi-faceted change strategies are needed.
Abstract: Individual and organizational characteristics associated with aggressive behavior among nursing home residents were examined among a sample of 5,494 residents from 23 facilities using the Minimum Data Set 2.0 and the Organizational Social Context scale. On admission, some individual level variables (age, sex, depression, activities of daily life [ADL] impairments, and cognitive impairments) and no organizational level variables were associated with aggressive behaviors. Over time, aggressive behaviors were linked with some individual characteristics (age, sex, and ADL impairments) and several organizational level variables (stressful climates, less rigid cultures, more resistant cultures, geographic location, facility size and staffing patterns). Findings suggest multi-faceted change strategies are needed.
TL;DR: It was a pleasure to act as the guest editor for this special issue on longterm care (LTC) in Asia, as the idea for this issue arose out of a symposium on a similar topic I organized at the 2010 Joint World Conference on Social Work and Social Development.
Abstract: I am deeply grateful for the support and patience of Dr. Amanda Barusch and Dr. Carmen Morano, respectively the Editor-in-Chief and Managing Editor of the Journal of Gerontological Social Work, dur...
TL;DR: Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.
Abstract: A multicomponent support services program was implemented for veterans aging with disabilities and their informal caregivers (n = 42 dyads). Caregiver outcomes (satisfaction, physical and mental health status, burden, and benefits) were evaluated before and after program use. Caregivers reported significant improvements in mental health post-program. Caregivers who provided care to individuals with impaired physical health experienced meaningful improvements in burden after the support services were rendered. Supporting caregiver health status through such programs is vital to preserve noninstitutional long-term care for persons aging with disabilities, particularly when care is provided over many years to an individual with physical impairments.
TL;DR: An overview of the long-term care insurance (LTCI) system in Japan is provided and the current state of Japan's LTC is analyzed to assess whether the supply meets the demand for care by frail elders and their families.
Abstract: This article discusses Japan's long-term care (LTC) from the perspective of balancing the provision and financing of care. Specifically, this article provides an overview of the long-term care insurance (LTCI) system in Japan and analyzes the current state of Japan's LTC with current statistical data as to whether the supply meets the demand for care by frail elders and their families.
TL;DR: The prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid, are identified, particularly how existing health care policy and financing contributes to fragmentation of care.
Abstract: Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.
TL;DR: Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics.
Abstract: The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics Implications and future directions for research, practice and policy are discussed
TL;DR: In a nationally representative study of nursing home social services directors 80% of social services departments provided resident rights training and 60–70% were involved in abuse training, and education and licensure were related to ability to train.
Abstract: In a nationally representative study of 1,071 nursing home social services directors 80% of social services departments provided resident rights training and 60–70% were involved in abuse training. Departments headed by recent grads and in chain nursing homes or in the northeast were more likely to be involved in training. Seventy-two percent of social services directors were able to provide one-on-one training about reporting suspected abuse; education and licensure were related to ability to train.