Making Care Work

2018 ◽  
pp. 88-125
Author(s):  
Elana D. Buch

In making care into work, agencies justify their existence in the market as managing the predictable tensions that regularly arise in home care. Home care agencies build upon women’s familial experience of care while seeking to transform them into workers whose labor conforms to the ethical and temporal norms of American workplaces. Conflicts regularly arise between people’s moral ideologies about care, the economic pressures of capitalist markets, and the laws that govern labor and elder care in the United States. This chapter traces the transformation of moral values into economic value by focusing on the everyday ethics practiced by home care agency training and management staff as they mediate between national moralities, the needs of their agencies, the needs of clients, and their own ethics. Agencies’ different funding sources affect how they imagine and generate their clients’ independence. Publicly funded care policies view older adults as liberal persons in a democratic state in which rights and services are the result of citizenship and need rather than social position. In privately funded care, older adults’ independence was authorized by their privileged position as consumers whose subjective tastes and preferences determined the kinds and quantity of care they received. Their independence was not the result of fair treatment by an equitable state, but rather determined by their ability to wield economic power.

2017 ◽  
Vol 15 (1) ◽  
pp. 20-26
Author(s):  
Guillermina R. Solis ◽  
Jane Dimmitt Champion

Introduction: Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person’s quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. Method: A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. Results: A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Conclusion: Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.


2020 ◽  
pp. 073346482094432
Author(s):  
Athena Koumoutzis ◽  
Sara E. Stemen ◽  
Renusha Maharjan ◽  
Jennifer Heston-Mullins ◽  
Pamela S. Mayberry ◽  
...  

Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an array of data sources including a national survey, telephone contacts, and a web review, we identified 15 states that are using local funding to support aging services. Communities are using a variety of local revenue streams, such as property tax levies, payroll, and sales taxes to provide services for older adults and/or their family or friend caregivers. There are considerable differences in community approaches including the following: amount of revenue generated, service eligibility criterion, type of services covered, and management infrastructure. Critical policy questions surrounding equity issues within and across states are raised as communities create these alternative funding mechanisms.


2015 ◽  
Vol 16 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Cindy L. Marihart ◽  
Ardith R. Brunt ◽  
Angela A. Geraci

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.


2018 ◽  
pp. 176-200
Author(s):  
Elana D. Buch

Across the United States, home care faces perpetual worker shortages and endemically high turnover levels estimated at between 60% and 90% per year. This chapter examines cases of turnover in rich ethnographic detail, arguing that the inability of agency and public policy to recognize the interdependence of older adults, workers, and their families contributes to this startling statistic. In observed cases of turnover; job loss stemmed from workers’ inabilities to sustain both their own households and those of their older adults without blurring the boundaries between them. Workers lost jobs because of conflicts with family care and because they engaged in unsanctioned reciprocities with clients. Current attempts to protect vulnerable older adults from possible exploitation actually exacerbate the exploitation of care workers and increase instability in home care.


2018 ◽  
Vol 21 (7) ◽  
pp. 792-798 ◽  
Author(s):  
Mina Kabiri ◽  
Michelle Brauer ◽  
Jason Shafrin ◽  
Jeff Sullivan ◽  
Thomas M. Gill ◽  
...  

Author(s):  
Roslyn M. Compton ◽  
Alex Olirus Owilli ◽  
Vera Caine ◽  
Charlotte Berendonk ◽  
Donna Jouan-Tapp ◽  
...  

ABSTRACTGiven the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First – Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.


2009 ◽  
Vol 10 (3) ◽  
pp. 110-114 ◽  
Author(s):  
Steven H. Landers ◽  
Paul W. Gunn ◽  
Kurt C. Stange

House calls to older adults have become more common, in part related to the emergence of medical practices that either emphasize or exclusively provide house calls. In this article we seek to describe organizational, clinician, and patient characteristics of house call–home medical care practices in the United States. We conducted telephone interviews with clinicians representing 36 randomly selected practices from across the United States. This study found that house call–home care practices typically are recently formed small groups of physicians and nurse practitioners that provide in-home primary care, especially chronic disease care, to Medicare beneficiaries. Clinicians are motivated by the opportunity to improve care and to maintain autonomy. This emerging model may represent a mutually beneficial trend for older adults and physicians.


2016 ◽  
Vol 12 ◽  
pp. P221-P221
Author(s):  
Richard H. Fortinsky ◽  
Laura N. Gitlin ◽  
James Grady ◽  
Catherine V. Piersol ◽  
Laura T. Pizzi ◽  
...  

Author(s):  
Elana D. Buch

Paid home care sits at the nexus of two of the United States’ biggest social challenges: rising inequality and an aging population. Policy and advocacy initiatives typically treat poverty and care of the aged as distinct forms of vulnerability. They are seen as having separate social causes that require different solutions. Using rich ethnographic narrative based on fieldwork in Chicago, this book examines the diverse relationships generated by care and their connections to longer national histories, policies, and institutional contexts. The vulnerabilities of older adults and care workers are commingled: low wages and poor working conditions render workers’ lives precarious. In turn, high turnover rates and endemic worker shortages translate into wait lists and lower quality care for older adults. In home care, the fate of older adults and the working poor are bound together, entangled by the broader indifference of a society that devalues both aging and care.


2021 ◽  
pp. 140349482110610
Author(s):  
Anna C. Meyer ◽  
Glenn Sandström ◽  
Karin Modig

Aims: All Swedish municipalities are legally obliged to provide publicly funded elder care to individuals in need. The Swedish Social Service Register collects data on such care. It is the only nationwide source of information on care home residency and use of home care but has rarely been used for research. This study aims to present the content and coverage of the Social Service Register and to provide guidance for researchers planning to use these data. Methods: For each month between 2013 and 2020, we examined which of Sweden’s 290 municipalities reported data to the Social Service Register. We calculated proportions of the population (restricted to ages 80–89 years to enable comparison) that were reported to the Social Service Register in each municipality and presented the types and amount of care recorded in the register. Results: The proportion of municipalities reporting to the Social Service Register increased from 82% to 98% during the study period but several municipalities reported fragmentarily and inconsistently, particularly during earlier years. Among municipalities reporting to the Social Service Register, 9% of the population aged 80–89 years resided in care homes and 19% received home care, but the registered amount and types of care varied substantially between municipalities and over time. Conclusions: The Swedish Social Service Register provides valuable data for research on aging and elder care utilisation, but data should be selected and vetted carefully, especially for earlier years. The amount and types of care may not always be comparable between geographical regions and different time periods. In recent years, however, the coverage of the Social Service Register is good.


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