Two groups of urban residents present ongoing problems, the frail elderly and disadvantaged youth who are approaching transition from school to the work force. Many of the disadvantaged youth are at risk because of family background, inadequate education, and lack of work experience. Many of the frail elderly are unable to care for themselves because of debility, chronic illness, or functional impairments (Eustis, 1974). The United States is experiencing an unprecedented increase in the numbers of persons over 65 years of age and it is expected that between 1980 and 2000 there will be a 67 percent increase in persons 80 and over. These demographic changes are significant especially for long-term care policy for the elderly. There is an urgent need to provide the kind of care that permits them to continue to live in their own homes. The frail elderly perceive their need for a dependable source of food as a primary requirement. If this is not met, institutional care becomes the only possible option. Urban youth face an increasing pressure to take a job in order to earn money, often at the expense of further education. Part-time work and school can be managed, and with planning, the classroom curriculum can be blended with the job. Intergenerational programs present a possible solution to some of the problems of the frail elderly and youth. They can be brought together through one of these programs for their mutual benefit. Intergenerational programming is the process of planned and purposeful interaction between generations. The programs encompass a range of ideas as they are guided by the needs of the community and its resources to meet these needs (Newman, 1983). Project MAIN was one of these projects. In 1983 under the auspices of Portland Youth Advocates, Project MAIN was created to meet the needs of the frail elderly and youth in an urban area. Many of the frail elderly were confined to their homes, unable to do ordinary tasks such as grocery shopping. Low-income teenagers needed access to an income-generating jobs program that would permit them to remain in school. Project MAIN was planned to help disadvantaged youth and simultaneously enrich the lives of the elderly (Ventura-Merkel, 1988). Project MAIN was conceived as a dynamic entity that could not be seen directly, but perceived as a process that had qualitative effects on those with whom it came in contact. It was planned as an active participatory learning experience for youth. Relevant classroom curricula blended with part-time jobs. The focus was on full participation by the youth in the process of providing a shopping service for the homebound elderly. Two important elements of the project were active youth participation and project-oriented learning. The youth planned and operated a shopping service for the frail elderly clients. The youth continued with their education and worked part-time. They began with minimum wage and increases came regularly, following satisfactory evaluation by peers and staff. As they became more competent, they assisted the staff with supervision and instruction. A case study explored the outcomes of Project MAIN. A weakness in the data from guided interviews of the clients resulted from memory loss and confusion encountered in a few of the elderly. A strength was the flexible interviews which gave the elderly time to explore new ideas as they emerged. The outcomes of Project MAIN were measured by the level of satisfaction for both the elderly clients and the participating youth. The levels of satisfaction were high in the pilot project, with its four weeks of intensive training and careful supervision. Adequate funding from private organizations made this possible. In the demonstration phase, funding became an acute problem. Training and supervision of the youthful shoppers was curtailed. Although the clients found the service better than they had before Project MAIN, complaints of broken appointments and declining dependability began to be heard. It became evident that the youth were in need of better preparation and more intensive supervision. Because of lack of funds, it was not possible to supply staff for these tasks. From the outcomes of the pilot project, it is evident that the concept of Project MAIN is a viable one for meeting the needs of the frail elderly and youth. However, from the demonstration phase, it was seen that without adequate funding, the quality of the shopping service declined. Decisions need to be made in the early planning of a program like Project MAIN. Elimination of staff needed for training and supervision in favor if increasing the number of youthful shoppers can threaten the viability of the program.

Structural equation modeling was utilized in studying the voluntariness of the assumption of caregiving status. A model hypothesizing the stress flow that occurs when assuming a new life schema was presented. Utilizing three groups of caregiving populations, Home Caregivers, Intermediate Care Facility Aides, and Intensive Care Units and Emergency Room Nurses (N = 66), measures were administered to determine the voluntariness of the assumption of the role of caregiver. Path analysis and causal interpretation were utilized to determine outcomes. The involuntary assumption of the role of caretaker was shown to significantly affect depression and burnout rates negatively when perceived feelings of burden were high. When caretaker age was greater upon assumption of the role, self-esteem was low and family support was perceived to be lacking. When the role of caretaker is assumed on a voluntary basis and support from outside sources is perceived as helpful (i.e., social or financial support from the family), job stress and the subjective manageability of the symptoms were viewed as manageable. Implications for those assuming the role of caretaker with the elderly were examined, and recommendations for further training and interventions within the caretaker population were offered.

Theoretical Basis Demographic data show that the world's population has been aging and there are more and more elderly people who need health and social care. The same situation is in our country. Every person lives his/her life in a unique way. With aging changes occur in physical, mental and social aspects. To cope with them requires help, tolerance, respect and patience shown by other people. The current forms of care for seniors are carried out in health facilities, social facilities as well as families. The changes bring about the need to find a new way of life. The most frequent changes occur in self-care which results in increased demands on the care of other people. Some seniors do not need almost any services and some are dependent on permanent comprehensive care. Definitely, the best way for seniors is living at home with the support of their families and the cooperation with home care agencies when health care is necessary. Everyday nursing care for seniors depends on the degree of their self-sufficiency and is extremely challenging. Caring for seniors is often complicated by changes in the behavior of seniors in communication, aggressiveness, disorientation caused by today's relentlessness and memory disorders. Caring for immobile seniors also places an enormous physical strain on nurses. Aims of the Study In this thesis, one goal was set, that is to survey the activities of nurses in nursing care for seniors in selected health care facilities, home care agencies and nursing homes. Methods Used in the Study In the empirical part of this thesis the qualitative research method of observation was used to conduct the research survey. The research survey was conducted through observation, in which the frequency of nursing activities was observed, and the time consumption of selected nursing activities (recording nursing documentation, intramuscular injection administration, subcutaneous injection administration, insulin administration with an insulin pen, capillary blood collection, venous blood collection, a planet urinary catheter insertion in women, blood pressure taking, blood sugar levels testing using a glucometer and colostomy care) were recorded into pre-prepared observation sheets (Appendix 2) and (Appendix 3) in the Home care Agency in České Budějovice from May 1 to July 5, 2013, in the Home for Seniors in České Budějovice from July 8 to July 12, 2013 and in České Budějovice Hospital, plc, in the Aftercare department from July 22 to July 26, 2013. The data sheet with activities when time measurements were carried out was compiled based on a preliminary research, when all the mentioned facilities were visited beforehand to find out which activities were carried out in all the facilities where the research study was conducted. A digital stopwatch was used for measurements. The time measurements are stated in units of time rounded up to the nearest minute. Each nursing activity was measured from its preparation through implementation to completion. Observations were carried out eight hours a day, 5 days a week in each facility. Overall, 160 hours for 3 weeks. Observations were conducted during regular operating hours in the facilities; every day one nurse treating fifteen seniors in each facility was observed. The frequency of nursing activities and the measured values were statistically processed - summed, averaged, and standard deviations were calculated. Results of the Thesis The analysis of the data implies differences in nursing activities carried out by nurses in particular facilities and the time measurements show time differences between particular facilities in nursing activities performance. The goals of this thesis were achieved after the research investigation and the research questions were answered.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-07-18T12:06:53Z No. of bitstreams: 1 Rosiran Carvalho de Freitas Montenegro.pdf: 3404752 bytes, checksum: b35ed209efbf1427030dd246b09f9115 (MD5) / Made available in DSpace on 2017-07-18T12:06:53Z (GMT). No. of bitstreams: 1 Rosiran Carvalho de Freitas Montenegro.pdf: 3404752 bytes, checksum: b35ed209efbf1427030dd246b09f9115 (MD5) Previous issue date: 2017-06-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This thesis’ object is the eldercare in cases of dependency, through the analysis of the “arrangements” built by the families with some support from the Government. Objectives: this study aims to comprehend the answers found by the families for the care of their elderly by breaking these answers down in some specific objectives: to debate around the responsibility of the family; to identify the “arrangements” for the care; to identify the aspects related to the preparation of this task; to discuss the opinion around the duty of the family in providing the care; to identify the support provided by the health policies and the social care; to know the demands and suggestions about the subject. Type of study and methodology: qualitative, descriptive and analytical research, anchored in the critical and dialectical method, comprised of the reality as processual, historical and constantly under transformation. The type of researches made were bibliographic, documental and based on databases. They compose the theoretical foundation and the identification of the existing answers to the demand of aging. The field research was realised in the Southeast region of São Paulo city with individuals, designated by health and social care public services, that took care of the elderly entailed to those services. Twenty-four interviews were realised using the content analysis method, obeying to the following components: profile of the individuals of the care system; the arrangements and processes of care; the dialog involving the Government through the support received from the health and social care policies; and finally, the debate around the care as a social right, projecting the need of a policy that handles this matter based on the suggestions made by the individuals involved in the research. Results: the results show that most of the people responsible for the care are women related to the elderly and with low chances of getting support from other relatives. This scenario affects negatively those women’s physical and emotional health, as well as their personal life projects. Final considerations: the care of elder people under dependency must be conceived as a social right and be treated based on democratic instances – not anymore under the private and domestic instance, where it is treated solely as responsibility of the family. It must be recognized that the population longevity is facing a growing demand for care. It is needed public services that handle the aging under dependency, notwithstanding the current measures the country is taking, that goes against the notion of the State as the provider of rights and social protection / Esta tese tem como objeto o cuidado de idosos em situação de dependência, através da análise dos “arranjos” construídos pelas famílias, com relativo apoio do Estado. Objetivos: o estudo busca compreender as respostas encontradas pelas famílias para os cuidados de seus idosos, desmembrando-se em alguns objetivos específicos: debater a responsabilização da família; identificar os “arranjos” para o cuidado; identificar aspectos relacionados ao preparo para essa tarefa; discutir a opinião sobre o encargo da família para prover os cuidados; identificar os suportes oferecidos pelas políticas de saúde e de assistência social; conhecer as demandas e sugestões sobre o tema. Tipo de Estudo e Metodologia: pesquisa qualitativa, descritiva e analítica, ancorada no enfoque dialético e crítico, compreendendo a realidade como processual, histórica e constantemente em transformação. Foram realizadas pesquisas bibliográfica, documental e em banco de dados, as quais compõem a fundamentação teórica e a identificação das respostas existentes para a demanda do envelhecimento. A pesquisa de campo foi realizada na região sudeste da cidade de São Paulo, com pessoas indicadas por serviços públicos de saúde e de assistência social, as quais realizavam cuidado de idosos vinculados a esses serviços. Foram 24 entrevistas, utilizando-se a técnica de análise de conteúdo, obedecendo-se aos seguintes eixos: o perfil dos sujeitos da “engrenagem” do cuidado; os “arranjos” e processos de cuidados; o diálogo envolvendo o Estado, através do apoio recebido através das políticas de saúde e de assistência social; e por fim, o debate sobre o cuidado como direito social, projetando-se a necessidade de uma política que aborde a questão, através de sugestões colhidas dos sujeitos da pesquisa. Resultados: Os resultados apontam que a maioria das pessoas que cuidam são mulheres com grau de parentesco, com poucas possibilidades de apoio de outros membros da família, o que traz sobrecarga e impactos nas condições de saúde física e emocional, acarretando também em alterações nos projetos de vida dessas mulheres. Considerações Finais: O cuidado de idosos em situação de dependência deve ser concebido como direito social, saindo da instância privada e doméstica - sob a responsabilidade única da família - para ser pautado nas instâncias democráticas, reconhecendo-se a crescente demanda para cuidados com a longevidade da população. É necessária a oferta de serviços públicos que atendam ao envelhecimento com dependência, a despeito das atuais medidas no país que caminham no sentido contrário ao do Estado provedor de direitos e de proteção social

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-11-07T11:43:28Z No. of bitstreams: 1 Christina Mello Amorim Costa.pdf: 959471 bytes, checksum: 50cb352ef6d9b8cc1219bbe76781e433 (MD5) / Made available in DSpace on 2017-11-07T11:43:28Z (GMT). No. of bitstreams: 1 Christina Mello Amorim Costa.pdf: 959471 bytes, checksum: 50cb352ef6d9b8cc1219bbe76781e433 (MD5) Previous issue date: 2017-09-27 / This dissertation was elaborated with the intention of knowing lived experiences of the relatives along the elderly people, in relation to the dismissed care to them, in a intergenerational perspective, emphasizing the concept of invisible loyalties. The dissertation was executed from the systematic review of literature about the family and elderly people; we conducted a brief history of family in Brazil, including the legal questions. We treat the unfairness and violence suffered by the elderly in brazilian society, as well as the contributions of the family vital cycle theory, emphasizing the last phase, from a reflection about experiences of people with more than eighty years old. We discussed about the situation of family and professional caregivers, how they behave and their impacts inside the family nucleus. Inside the family psychological parameter, the invisible loyalties present a dynamic interaction among the elements which compose a family, through generations that, in coexistence, confers an adherence to the relation system. We count with the participation of four families, which their experiences enriched the comprehension and elucidation of the treatment given to the old people through one construction of genograms and interviews, that shows us the quality of the relationship between sons and elderly parents are the consequences of a whole history of past generations / Esta dissertação foi elaborada com o intuito de conhecer as experiências vividas dos familiares junto ao idoso, no que se refere aos cuidados dispensados a eles, numa perspectiva intergeracional, enfatizando o conceito de lealdades invisíveis. A dissertação foi executada a partir da revisão sistemática de literatura em família e idosos; realizamos um breve histórico da família no Brasil, incluindo questões jurídicas. Tratamos, na sociedade brasileira, das deslealdades e violência sofridas pelos idosos, bem como das contribuições da teoria do ciclo vital familiar, enfatizando a fase última, a partir de uma reflexão acerca das vivências das pessoas com mais de oitenta anos. Discorremos sobre a situação dos cuidadores familiares e profissionais, como eles se portam e seus impactos dentro do núcleo familiar. Dentro do parâmetro psicológico familiar, as lealdades invisíveis apresentam uma dinâmica de interação entre os elementos que compõem a família, por meio das gerações, que, na convivência, confere uma adesão ao sistema relacional. Contamos com a participação de quatro famílias que com suas experiências enriqueceram a compreensão e elucidação do tratamento dado aos idosos, por meio da construção de genogramas e entrevistas, que nos mostra a qualidade da relação entre filhos e pais idosos são consequências de toda uma história de gerações passadas

Merparten av kommunala verksamheter har under senare decennier implementeratstyrformen New Public Management - som innebär större fokus på kostnadsbesparingar,effektivisering och resultat. En av flera viktiga samhällsfunktioner som verkar inomkommunal verksamhet är hemtjänsten. Inom verksamheten utgör enhetschefen enbetydande roll för både organiseringen och omsorgsarbetets kvalité. Studiens syfte äratt undersöka hur enhetschefer inom den kommunala hemtjänsten upplever chefsstödi förhållande till yrkesspecifika krav och förväntningar avseende kostnadsbesparingaroch effektivisering. Studien inriktas på krav och förväntningar från överordnade cheferoch medarbetare. Metoden som använts för att uppnå syftet är av kvalitativ natur ochbestår av semistrukturerade intervjuer med enhetschefer från åtta olikahemtjänstorganisationer i två olika kommuner. Genom att jämföra intervjupersonernasutsagor samt relatera dem till tidigare forskning och teorier genererades ett resultatkring att enhetschefer inte upplever rollkonflikter och känslan av att vara klämd i denutsträckning som litteraturen skildrar. Medarbetares krav och förväntningar som ärmotstridiga överordnades riktlinjer påvisar brist på förståelse för en politikerstyrdorganisation och enhetschefers yrkesroll. Enhetscheferna upplever rollen somutmanande, komplex och beroende av chefsstöd. Det råder delade meningar om detchefsstöd som i dagsläget erbjuds. / Most municipal public service organizations have during recent decades implemented the New Public Management  approach – which means that the organizations focuses more on results through cutting costs and streamlining. Within public service there is an Elderly home care-unit. The elderly home care-units manager constitutes an important role in terms of both organizing and securing the quality of the care. The purpose of this study is to examine how the managers, within the Elderly home care-units in public service, experiences managerial support in relation to demands directly associated with ”New Public Management”. The study focuses on the demands and expectations from superiors and coworkers. The method which has been used in order to achieve the purpose of the study is of qualitative nature and consists of semi-structured interviews with Elderly home careunit managers from eight different districts in two different municipalities. Through comparing the interviews and weighing in previous research and theories, this study finds that Elderly home care-unit managers do not experience conflicting demands associated to their role in the same extent as prior research has shown. Coworkers’ demands and expectations, which are in conflict to those of superiors, shows lack of understanding for both a politically controlled organization and the role of an Elderly home care-unit manager. The Elderly home care-unit managers experiences their role as demanding, complex and dependent on managerial support. The opinions are split concerning what managerial support that is provided today.