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Stories from the fourth age: autonomy and the lives of older care home residents
- Authors:
- POCOCK Lucy V., et al
- Journal article citation:
- Ageing and Society, 41(7), 2021, pp.1637-1650.
- Publisher:
- Cambridge University Press
Transition to a care home often follows a hospital admission and can be distressing. Care home settings play an important role in the care of many people at the end of life. This longitudinal study employed a narrative approach, aiming to explore the perspectives of older care home residents on transitions to, and life and death within, care homes. Five participants, aged 85 years and over, were recruited from two privately owned care homes in the South-West of England. All participants had a diagnosis of an advanced progressive condition (excluding advanced dementia), or were thought to be frail. Longitudinal interviews (19 in total) were conducted over a ten-month period. A structural narrative analysis was performed and participants’ narratives are presented under three headings, with one participant's story chosen to illustrate each narrative type: ‘becoming a care home resident’, ‘living in a care home’ and ‘death and dying’. Findings revealed that care home residents experience a loss of autonomy and a lack of agency; they are often excluded from decision-making. Older care home residents have few choices with regard to care at the end of life. Further work is required to improve transition into care homes, including support and advocacy during decision-making, which often takes place in hospitals at a time of crisis. (Edited publisher abstract)
Challenges faced by residential aged care staff in decision-making for residents with dementia
- Authors:
- CAMERON Nadine, FETHERSTONHAUGH Deirdre, BAUER Michael
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 20(4), 2021, pp.1270-1283.
- Publisher:
- Sage
Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents’ decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents’ rights and inconsistent treatment by staff, placing residents’ wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents’ self-determination and their own need for greater organisational support. (Edited publisher abstract)
Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity
- Authors:
- DUNER Anna, GUSTAFSSON Gerd
- Journal article citation:
- International Journal of Care and Caring, 4(4), 2020, pp.479-495.
- Publisher:
- Policy Press
The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care. (Edited publisher abstract)
Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest
- Authors:
- OLAISON Anna, TORRES Sandra, FORSSELL Emilia
- Journal article citation:
- Journal of Social Work Practice, 32(2), 2018, pp.153-167.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work. (Publisher abstract)
Deciding to move into extra care housing: residents’ views
- Authors:
- BÄUMKER Theresia, et al
- Journal article citation:
- Ageing and Society, 32(7), October 2012, pp.1215-1245.
- Publisher:
- Cambridge University Press
In England in 2003, the Department of Health announced funding to support the development of extra care housing, and made the receipt of funding conditional on participating in an evaluative study. Drawing on data from residents in 19 schemes, this paper presents findings on the factors motivating older people to move to extra care housing, their expectations of living in this new environment, and whether these differ for residents moving to the smaller schemes or larger retirement villages. In total, 949 people responded, 456 who had moved into the smaller schemes and 493 into the villages. Of the residents who moved into the villages, 75% had not received a care assessment prior to moving in, and had no identified care need. There was evidence that residents with care needs were influenced as much by some of the attractions of their new living environment as those without care needs who moved to the retirement villages. The most important attractions of extra care housing for the vast majority of residents were: tenancy rights; flexible onsite care and support; security offered by the scheme; and accessible living arrangements. The results suggest that, overall, residents with care needs seem to move proactively when independent living was proving difficult rather than when staying put was no longer an option.
“It keeps me going” – older people's perception of well-being and use of complementary and alternative medicine (CAM)
- Authors:
- LORENC Ava, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 13(2), 2012, pp.135-144.
- Publisher:
- Emerald
Significant proportions of older people appear to use complementary and alternative medicine (CAM). Common CAM treatments used by older adults include nutritional supplements, herbal medicine, spiritual healing, and chiropractic. The aim of this paper was to explore older peoples' decision making regarding CAM use and their perceptions and experiences of well-being. Qualitative focus groups were held at a community centre in southwest London with 37 volunteers aged over 61 years. Transcripts of the discussions were content analysed. Five themes emerged from the participants’ discussions of well-being: physical well-being; impact on activity; emotional issues; community and health services; and keeping positive. A range of CAM was used, most commonly mind/body or physical therapies. The main reason for CAM use was to ‘keep going’ and maintain well-being. ‘Keeping going’ is often promoted by CAM, including manipulative and exercise therapies. Conventional medicine was perceived as central to well-being, with CAM used to address its limitations. Decision making was rarely systematic; anecdotal information dominated, and disclosure to conventional practitioners was uncommon. Healthcare providers should consider exploring CAM use with older people and facilitating access to CAM information.
Voluntary and involuntary driving cessation in later life
- Authors:
- CHOI Moon, MEZUK Briana, REBOK George W.
- Journal article citation:
- Journal of Gerontological Social Work, 55(4), May 2012, pp.367-376.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
There is limited quantitative information about the differences between voluntary and involuntary driving cessation or the factors associated with these transitions. This study explored the decision-making process of driving cessation in later life, with a focus on voluntary decisions. The sample included 83 former drivers from the Baltimore Epidemiologic Catchment Area Study (mean age 75.3 years and 73.5% females). A majority of participants (83%) reported stopping driving of their own volition. 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. The authors conclude that the distinction between voluntary and involuntary driving cessation is in practice ambiguous and that factors beyond health status, including financial strain, play a role in the transition to non-driving.
The needs and experiences related to driving cessation for older people
- Authors:
- LIDDLE Jackie, et al
- Journal article citation:
- British Journal of Occupational Therapy, 71(9), September 2008, pp.379-388.
- Publisher:
- Sage
Older people may cease driving owing to health concerns, discomfort while driving, cancellation of their licence or financial reasons. Because driving is fundamental to the freedom and independence of older people, driving cessation can lead to depression, loss of roles and unsafe use of alternative transport. Little consideration has been given to the development of approaches to improve outcomes for retiring drivers. This study aimed to understand the experiences of driving cessation for older people to inform the design of interventions for retiring drivers. Qualitative methodology was used to explore the experiences of driving cessation from the perspective of nine retired drivers, three family members and six service providers. The retired drivers experienced challenges during three phases of driving cessation, in addition to discussing their driving history. The challenges were (1) a predecision phase - a balancing act and achieving awareness; (2) a decision phase - making the decision and owning the decision; and (3) a post-cessation phase - finding new ways and coming to terms. Interventions to facilitate the process of driving cessation may need to be designed according to the phase of driving cessation and the challenges that the person is experiencing and to be underpinned by behaviour change and life transition theories.
Actuation of mobility intentions among the young-old: an event-history analysis
- Authors:
- BRADLEY Don E., et al
- Journal article citation:
- Gerontologist, 48(2), April 2008, pp.190-202.
- Publisher:
- Oxford University Press
Although migration decision making is central to understanding later-life migration, the critical step between migration intentions and mobility outcomes has received only limited empirical attention. The authors discuss two questions: How often are intended moves actuated? What factors condition the likelihood that mobility intentions will be actuated? Data were employed from the 1994-2002 Health and Retirement Study in the US, which is a nationally representative panel targeting households containing persons aged 53 to 63 years at baseline. Event-history techniques are used to examine the link between reported mobility intentions at baseline and mobility outcomes across the study period, net of relevant controls. Separate household-level analyses were conducted for couple and noncouple households and recognize three types of moves: local, family oriented, and nonlocal. Findings confirm the utility of mobility expectations as a predictor of future mobility. More importantly, results highlight the complex nature of later-life mobility. The actuation of mobility intentions appears to operate differently in couple than in noncouple households. Moreover, the findings suggest that the role of several key variables depends on the type of move under consideration. The ability to identify potential "retirement migrants" may be of practical importance for state and local government officials as well as developers interested in recruiting or retaining young-old residents. The study offers insight on the interpretation of stated mobility intentions. Moreover, consistent with early theoretical work in the field, our analysis suggests that empirical studies must account for heterogeneity among older movers in order to avoid misleading results.
Clinical evidence in guardianship of older adults is inadequate: findings from a Tri-State study
- Authors:
- MOYE Jennifer, et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.604-612.
- Publisher:
- Oxford University Press
This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform. Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded. The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in the ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D – with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania. Implications: In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.