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Multidisciplinary team perspectives on older adult hoarding and mental illness
- Authors:
- KOENIG Terry L., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 25(1), 2013, pp.56-75.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Hoarding, characterised as animal or inanimate object hoarding, can have debilitating consequences for older adults who hoard, as well as for their families and communities. Because of the complex nature of hoarding, many believe that a multidisciplinary approach is needed to respond to hoarding. The purpose of this qualitative study was to examine multidisciplinary team perspectives on their involvement in older adult hoarding cases. Fifteen informants, as members of 4 hoarding teams and representing multiple agencies (e.g. adult protective services, mental health services, and animal control), were specifically asked to describe cases in which their team did or did not work well together to resolve a case. In doing so, the informants described: their team’s characteristics (e.g. team composition, and processes for working together); the need for team members’ increased awareness of hoarding as a mental illness; barriers to providing mental health services for older adults who hoard; and components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.
From the woman's viewpoint: ethical dilemmas confronted by women as informal caregivers of frail elders
- Author:
- KOENIG Terry L.
- Journal article citation:
- Families in Society, 85(2), April 2004, pp.236-242.
- Publisher:
- The Alliance for Children and Families
Women as informal caregivers face complex ethical dilemmas in caring for a frail elder. Through in depth interviews with 13 ethnically diverse caregivers, this qualitative study explored women’s ethical decision-making. Focus group interviews of home health staff, key informant caregivers, and interviewees provided guidance for research design, reflection on findings and development of implications. Findings are integrated into an ethical decision-making model that includes types of ethical dilemmas (e.g. protection of life vs. autonomy); feelings that permeate decision making (e.g. fear); processes for addressing ethical dilemmas (e.g. family collaboration); and supportive services. Implications include expansion of services to meet caregivers’ ongoing needs, research that acknowledges multiple decision-making components, and the use of caregiving vignettes in the classroom.
Older adult and family member perspectives of the decision-making process involved in moving to assisted living
- Authors:
- KOENIG Terry L., et al
- Journal article citation:
- Qualitative Social Work, 13(3), 2014, pp.335-350.
- Publisher:
- Sage
The decision to move into assisted living (AL) can be viewed as a life-changing process for older adults and their families; and each may possess differing views of this process. This qualitative study examined the AL decision-making process as described by twenty-two older adult and family member dyads. Participants described emotional and logistical components related to the AL moving decision. Further, fifteen of twenty-two dyads expressed conflicting or differing views of the AL moving decision. Our discussion examines the need for future studies to explore the impact of family and older adult disagreements on the older adult’s AL adjustment; the necessity for community-based agencies and AL settings to provide social services over the duration of the decision-making process; and the importance of employing social workers skilled in family practice in the AL setting. (Publisher abstract)
Multidisciplinary teams’ practice strategies with older adult clients who hoard
- Authors:
- KOENIG Terry L., et al
- Journal article citation:
- Social Work in Mental Health, 12(1), 2014, pp.81-97.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Social workers are integral members of multidisciplinary teams designed to address older adults’ hoarding behaviours. However, few studies have examined practice strategies used by these teams. This qualitative study examined multidisciplinary teams’ use of a political approach that involved bargaining and coercion as practice strategies. Ten informants, as members of four multidisciplinary teams, described their practice strategies and client outcomes regarding older adult hoarding cases. Outcomes of these strategies resulted in a majority of elders being removed from their home. Implications include the need for teams to increase understanding of their roles in service delivery; and additions to the political approach for addressing hoarding behaviours (Publisher abstract)
Perceived benefits of VFW post participation for older adults
- Authors:
- LEEDAHL Skye N., KOENIG Terry L., EKERDT David J.
- Journal article citation:
- Journal of Gerontological Social Work, 54(7), October 2011, pp.712-730.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Voluntary involvement in organisations provides older adults with a source of civic engagement which can develop into supportive social networks. These supportive networks have been shown to contribute to health and well-being for this population. Older adults, as active members of the Veterans of Foreign Wars (VFW), describe multiple benefits of participation in the organization to their overall well-being. This qualitative study, via a series of interviews, examined the perspectives of 20 active participants, aged 50 to 89, of a VFW Post and its Ladies Auxiliary. Results revealed that the VFW served as a primary source of cross-generational influence, emotional support and meaningful activity, and provided a safe and secure environment for members to enjoy. The authors provide additional information that social work researchers and practitioners could use to help increase older adults' civic engagement and address service gaps.
The role of the gerontological social worker in assisted living
- Authors:
- KOENIG Terry L., et al
- Journal article citation:
- Journal of Gerontological Social Work, 54(5), July 2011, pp.494-510.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Assisted living (AL) is currently the most preferred and fastest growing area of long-term care for older adults. The purpose of this qualitative study was to examine the role of social work in AL and the potential barriers to using social workers from the perspective of AL administrators. The study involved semi-structured interviews with 13 AL administrators in an urban county in New York State. The interview questions were designed to explore the administrator’s perspectives of the role and the importance of the AL social worker in addressing the unmet needs of older adults as they move and transition into AL. Five major roles of the AL social worker were identified by all 13 administrators: decision-making and adjustment coordinator; resident advocate; mental health assessor and counsellor; family social worker; and care planner. The study points to the important and value of AL social workers. Implications for research and practice are discussed.
An examination of the adult day services industry using the resource dependence model within a values context
- Authors:
- DABELKO Holly I., KOENIG Terry L., DANSON Kwofie
- Journal article citation:
- Journal of Aging and Social Policy, 20(2), 2008, pp.201-217.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Although adult day services have continued to grow in the USA, providing support for older people and their carers, there has been no systematic examination of the sector from a policy perspective since the mid-1990s. This paper analyses the development of the sector using the resource dependence model within a values-based context to determine whether public reimbursement opportunities match the needs of older people and their carers. The findings suggest that, as in the mid-1990s, the sector is characterised by resource constraints, a lack of uniform regulations and a lack of consensus on service delivery models. However, a shift away from reimbursement-centred care to care models that acknowledge the ongoing needs of older people and their carers may begin to occur with the increasing linkage of public funding to outcomes. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Female caregivers' reflections on ethical decision-making: the intersection of domestic violence and elder care
- Authors:
- KOENIG Terry L., RINFRETTE Elaine S., LUTZ Wendy A.
- Journal article citation:
- Clinical Social Work Journal, 34(3), September 2006, pp.361-372.
- Publisher:
- Springer
- Place of publication:
- New York
As our population ages, increasing numbers of social workers and other therapists will provide counselling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.
Using multidisciplinary teams to address ethical dilemmas with older adults who hoard
- Authors:
- KOENIG Terry L., CHAPIN Rosemary, SPANO Richard
- Journal article citation:
- Journal of Gerontological Social Work, 53(2), February 2010, pp.137-147.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Resolving conflicts between older people’s freedom to hoard versus their or the public’s safety, often falls to multi-disciplinary teams of professionals to address the ethical dilemmas posed. This article considers the current use of hoarding task force or team interventions, proposes an ethical decision making framework for use by these teams and others, and discusses the practice implications whilst implementing this framework. The authors present a case vignette of Mrs M, developed as a composite of hoarding cases analysed in the literature reviewed, and analyse it using the ethical decision making framework they advocate in this paper. Important factors to be considered are who is the client - Mrs M or Mrs M and her neighbours, what are the facts, whose account is to be believed, what motivates differing accounts, who should intervene, what will be the consequences, and what are the alternatives to intervention? Three key implications for practice are discussed. Effective ethical decision making must balance the rights and responsibilities of the multiple actors involved, say the authors. In addition, competent practice relies on a realisation that interpersonal relationships between professionals and clients and amongst professionals are the vehicles which create probable solutions to such ethical dilemmas. Finally, the use of a consistent framework by teams changes practice from individual interventions to the development of policies and system change based on good practice.