The Department of Social Development has made good progress in finalizing children's court enquiries and placing children officially in formal foster care with relatives. This has major implications for accessing social support in the form of foster care grants and is aimed at reducing the burden of poverty. However, there are challenges in terms of follow-up and professional foster care supervision to meet the goals or vision of the Department. Supervision of placements is not done and it is not known how placements are progressing after Children's Court enquiries. Foster parents are referred to South African Social Security Agency (SASSA) for foster grant processing and no further contact is made with the clients unless there is a problem with the foster care grant. The foster family is seen after two years when it is time for review of care placement of the child. We do not provide support to kinship carers or close supervision to children in kinship care. The overall aim of the research was: • To investigate the physical and material circumstances of the families. • To explore the psycho-social needs of the children. • To explore the physical and emotional problems of the kinship carers • To identify support systems available to kinship carers. This research provides a comprehensive description of the living circumstances of the children and the families. This will enable social workers at the Department of Social Development to develop tailor made community and group work programmes to address specific areas of concern and so improve social service delivery to children and their caregivers. It has also provided a baseline for further studies which may be pursued to establish whether the type of care has improved. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

This study described kinship care placement in the Nseleni area. The study aims to describe the type of care in kinship foster care placements in the Nseleni area, Richards Bay. The objectives of the study were to investigate the physical and material circumstances of the families, to explore the psycho-social needs of the children, to explore whether or not the kinship carer is experiencing physical and emotional problems and to identify support systems available to kinship carers. The study was guided by the ecosystems perspective. This perspective attempts to appreciate and understand people in their environment. The ecosystems perspective was pertinent in this study as it provided a framework for understanding the individual, family, community and society context in which kinship carers operate. A quantitative descriptive (survey) approach guided this study. This design is useful for describing the characteristics of a large population and therefore it was an appropriate design for this study which aimed at describing how children in kinship care are being cared for. The sample comprised of 30 kinship carers who were respondents. Probability sampling was used to ensure representativeness and that all the members of the identified population had an equal chance of being selected. Structured interview questionnaires were personally administered to the respondents. Data was analyzed manually. Each of the questions was recorded in the manual table for data entry. All variables were added and checked. The totals were converted into percentages for easy calculation and analysis. Using Microsoft excel, tables and figures were formulated. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

In Canada and internationally, increases in Home Care (HC) services for the elderly have been a policy priority in recent decades. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HM). The primary objectives of this study were to explore the interrelationship among publicly funded, privately funded, and informal HC services in terms of potential for substitution, and between publicly funded HHC and HM services; and the determinants of the receipt of each type of HC services. Stabile, Laporte, and Coyte’s family home care decision model (2006) was extended, to develop an understanding of the demand for HHC and HM services separately and to include different household arrangements. The consequential hypotheses were tested in two empirical studies. Individual panel data for those aged 65 and over were derived from 8 biannual waves of the Canadian National Population Health Survey (1994-95 to 2008-09). A Panel Two-Stage Residual Inclusion method was used to estimate the likelihood of the receipt of HC services, adjusting for socio-demographic, health status, disability, dependence on help with Activities of Daily Living (ADLs), and regional characteristics. The results showed that receipt of publicly funded HM is complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Receipt of publicly funded and privately funded HM services did not show an effect on each other. Receipt of publicly funded HM did not affect the receipt of informal HM services. The availability of informal care from a partner or other adult sharing the household reduced the likelihood of publicly funded HM receipt. Age, dependence on help with ADLs, health status and income are determinants of the propensity to receive publicly funded HHC and HM services as well as privately funded and informal HM. Findings in this study suggest that changes in the availability of publicly funded HC services may not greatly affect the provision of informal care in Canada. The complementary effect between publicly funded HHC and HM services and the income effect in the receipt of publicly and privately funded HC services may raise concerns about equitable access to HC services in Canadian jurisdictions.

Andelen äldre personer i Sveriges befolkning ökar, vilket leder till större behov av väl fungerande äldreomsorg. Kommunerna har ansvar för äldreomsorgen oberoende om den utförs i offentlig eller privat regi. Den 1 januari 2009 trädde lagen om valfrihet i kraft som bland annat syftar till att öka individens möjlighet att välja hemtjänstutförare. Idag har privata aktörer större möjligheter att etablera sig inom hemtjänsten. Kontrakten som tecknas mellan kommunen och en privat utförare är den enda direkta legala möjligheten för den ansvariga kommunen att påverka kvaliteten i verksamheterna. Därför är det viktigt att kraven som ställs i kontrakten tydligt beskriver vad kommunen vill att de privata aktörerna ska utföra och vilken kvalitet dessa tjänster ska ha. Syftet med studien var därför att undersöka om och hur kommunernas kontrakt med de privata utförarna fångar upp centrala aspekter av omsorgskvalitet inom hemtjänsten. En kvalitativ deduktiv ansats användes och en innehållsanalys genomfördes för att besvara frågeställningarna. Med hjälp av en utformad analysmodell besvarades vilken typ av kvalitetskrav som ställs i kontrakten. Resultaten visade att majoriteten av de identifierade kvalitetskraven i kontrakten beskrev hur omsorgstjänsterna ska utföras. Kraven utifrån de sex kategorierna, som ingick i analysmodellen, diskuterades i kontrakten. De flesta av kraven som ställdes i kontrakten var specificerade och uppföljningsbara. Dock visade det sig att det inte gick att mäta i vilken grad kraven var uppnådda. Utifrån studiens resultat verkar svårigheterna för kommunerna vara att formulera tillräckligt omfattande och mätbara krav, vilket kan försvåra styrningen av kvaliteten inom äldreomsorgen. / The elderly population in Sweden is growing, which means that more efforts by the home care services are needed. The municipality is responsible to ensure that their population gets the services they need by public or private home care agencies. In January 2009 the law of system of choice was introduced. One aim of the law was to give the individual more freedom to choose home care provider. The only legal way for the municipality to control the quality in private services is to establish a contract between them. Therefore it is important that the contract is well written, and that the municipality clearly expresses what quality they expect the home care provider to perform. The aim of this study was to examine how the contracts are written and what kind of quality the text expresses. A qualitative deductive approach was used and a content analysis was made to examine the contracts. A model for analysis was developed with the purpose to examine the contracts. The results showed that the majority of the text about the quality in the contracts described specific how the services should be performed. The six categories, included in the model of analysis, were represented in the contracts. However, the requirements described in the text were not designed to be measurable. The results showed that it seems difficult for the municipality to formulate requirements that are measurable. This can be a reason for the difficulties for the municipality to control the quality in the elderly care.

Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.

Purpose: The purpose of this project was to look at the costs of individuals with Alzheimer’s disease and related dementias (ADRD), ALS, and MS in long stay home care in Ontario, Canada. The specific goals were to produce estimates of costs for these individuals, as well as identify clinical and personal characteristics associated with these costs. This project also tested the effectiveness of the Resource Utilization Group for home care case-mix system for use in these special populations. Methods: This project was conducted using a secondary analysis of assessment data from the Canadian Staff Time Resource Intensity Verification Project, a 13-week study of home care costs (N=435 141). The project was guided by the Andersen and Newman (1973) framework for healthcare resource utilization. Descriptive characteristics and mean costs were produced using bivariate frequency and means procedures for each of three conditions. Predictors of costs were identified for each of the three neurological conditions through multivariate regression analysis conducted separately for each condition. In total 41 independent variables were included into the bivariate and multivariate analyses. The dependent variable was the total weekly formal and informal home care costs across all multivariate analyses. Results: In total, ADRD, ALS, or MS diagnoses were present in 16% of the assessments. The mean costs for the three conditions combined were $594.81. The mean costs for ADRD, ALS, and MS were $593.32, $898.41, and $574.92, respectively. Characteristics that were predictive of cost across all conditions included the Resource Utilization Group for home care case-mix system, ADL functionality, IADL functionality, cognitive performance, unsteady gait, stair use, difficulty swallowing, respiratory challenges, and bowel incontinence. The Resource Utilization Group for home care case-mix system had the highest level of explained variance of any single item tested in this project across all conditions. However, other clinical characteristics also contributed substantial levels of explained variance to the models for each of the three conditions. Conclusions: The findings from this project suggest that although diagnosis of ADRD, ALS, and/or MS can describe cost, clinical characteristics are the most important predictors of costs for individuals with these conditions. In addition, the Resource Utilization Group for home care case-mix system can adequately predict costs of individuals with these conditions. The addition of some clinical characteristics would likely improve the predictive abilities of the Resource Utilization Group for home care case-mix system.

An exploratory, qualitative study on the experiences of Polish older adults who made a transition from independent living to an ethno-specific residential care facility in Toronto is presented. Using the framework of Continuity Theory of Aging, the impact of ethnic/cultural identity on the process of relocation and subsequent adjustment to a nursing home environment was investigated. A purposive sampling strategy was used to select 2 male and 4 female participants. The data was collected using long interviews that were tape recorded and transcribed verbatim. The findings of this study indicate that the subjects employed specific coping strategies that stem from traditional value orientation and life experiences hence suggesting that ethnic/cultural identity may have played a role in their successful adaptation to residential care setting. Although this research study is limited to one group of older adults and cannot be generalized to other ethnic groups, it has a potential to contribute to increasing the body of knowledge about the dynamics of residential care placement among ethnic minority seniors. Implications for social work policy, research and practice are discussed.

In this small qualitative study, the researcher explores how four families involved in resource foster care services conceptualize concurrent planning in the child welfare system. Analysis of the four semi-structured transcribed interviews revealed four dominant themes: hope and optimism that resource foster care could be a rewarding alternative to further infertility treatment; anger and fear of disruption related to birth family visits; identification of the foster child as their own; and uncertainty regarding resource foster care team rules, roles, and responsibilities. Each theme was influenced by an attachment to the child they were fostering and the fear of losing that child. / The findings suggest that resource foster parents do not fully embrace concurrent planning as a philosophy of care that supports and works towards the best interests of children. Practice principles central to concurrent planning were often abandoned as a result of intense identification with adoptive parenthood status. / The researcher has included a number of recommendations with respect to future studies, training needs, and recruitment strategies. The conclusion states that in the best interests of children, resource foster parents must fully embrace the concept of concurrent planning defined within child welfare context and legislation.

This qualitative study explores the experiences of adult mental health service users as well as their families upon discharge of service users, to their families in the Durban area, from Ekuhlengeni Care Centre (ECC) during May 1999 to December 2001. In so doing, the aim was to ascertain the nature of mental health service users' adjustment to living in the community, their impact on the home environment, to identify gaps in community care and to provide suggestions on resolving these gaps. The study was guided by a qualitative research paradigm and utilized an exploratory descriptive research design. Availability sampling was used. Unstructured face-to-face, in-depth interviews were conducted with four mental health service users (MHSUs) and six family members. The results of the study reveal the many dilemmas that both MHSUs and their relatives experience because of the lack of support and services available in the community. There is overwhelming evidence to suggest that the environment is ill suited at all levels to meeting the needs of MHSUs and their relatives. This study examines the challenges experienced by MHSUs and their relatives and makes recommendations for practice and policy that can contribute to improved service delivery. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

Palliative care for non-dominant ethnocultural groups is problematized in the palliative care literature, which often presents essentialist conceptions of cultural beliefs on death and dying. Death is often portrayed as a taboo topic within the Chinese community, and thus, the assumption is that dying at home may not be the preferred option. Beyond these stereotypical representations, little is known about what it is like for Chinese immigrants with terminal cancer to receive palliative home care. Home is a complex site where cultural “difference” becomes contextually salient when home care providers introduce palliative care. More is potentially at stake than the violation of a taboo, as Chinese immigrant care recipients, their family caregivers, and home care providers negotiate changes to the existing routines of the home. The purpose of this study was to examine how meanings of home condition negotiations of care between Chinese immigrants with terminal cancer receiving palliative home care, family caregivers, and home care providers. Postcolonial theory provided a critical lens for this focused ethnographic study of palliative home care for Chinese Canadian immigrants. The analysis drew on postcolonial concepts such as Othering, subjugation, and hybridity. The methods included interviews with 11 key informants, and observational visits and interviews were conducted in 4 cases of Chinese immigrant care recipients, their family caregivers, and home care nurses. Two major findings emerged: 1) colonization and distancing and 2) negotiating hybridity. The meaning of home was deeply altered as palliative home care occupied care recipients’ and family caregivers’ everyday lives and represented a form of micro-colonization - the home was metaphorically invaded. The ambivalent relationship between care recipients and home care providers was characterized by a mutuality of need, but care recipients used distancing as a way to resist colonization. Palliative care presented its own unique cultural influence, which was imbued with meanings, beliefs, and practices. For care recipients, the meaning of dying at home was fluid, situational, and contextually informed. Subsequently, differences were created and highlighted in the confrontation between the meaning of palliative care for home care providers and the meaning of dying at home for care recipients. It was in the meeting, blending, clashing, and grappling of differences where participants had to negotiate and generate new, hybrid meanings and practices so that particularized, personal approaches to dying could be achieved. The findings capture the realities and complexities of palliative home care, and highlight the sophisticated and evolving ways providers come to know and care for care recipients and families in their homes. Although culture was prominently featured in participant narratives, the pragmatics of dying at home were more pressing than was adherence to essentialized cultural beliefs of death and dying. A key implication is the need to move away from simplistic conceptualizations of culture to a critical approach that will enable providers to understand and find comfort in working with the fluid, dynamic, and contextually-driven nature of culture and dying at home.