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In Sweden, most "pensioners" over 65 are healthy and living by themselves, and they can come to the library and take part in programs, borrow books, use the computers, read newspapers and magazines. For those elderly persons who are ill or handicapped and homebound, the library can send books and arrange other services. In Sweden there are different kinds of care centers for the elderly that are too ill to be able to stay in their own homes. In the beginning of the 1990s the municipalities took over the responsibility for the elderly. Libraries cooperate with the social authorities in the municipalities in creating services for the elderly in institutions. This paper discusses library services to the elderly in Sweden, including different ways to organize library service at institutions for the elderly; the example of Handen hospital; reading circles; memory training groups; cultural "ombudsmen"; and help from relatives or friends. (Contains 3 references.) (AEF)

The number of elderly people in Denmark continues to grow, which means there is an increasing need for special library services to those elderly who are not able to come to the library because of physical or mental limitations. This paper uses the practices of Sollerod Public Libraries (Sollerod, Denmark) to frame the discussion of the following: criteria for participating in outreach services; personal contact with patrons; how to select materials; the difference between reading habits of the younger (mobile) generation and the elderly, with examples of types of materials that are most in demand (talking books, magazines on cassette, large print books, music on CD or cassette, videos, talking newspapers, and reading services); examples of effective marketing methods to attract potential borrowers (announcements in local papers, articles in local newspapers and various magazines aimed at elderly and disadvantaged populations, personal contact with the news media, information brochures from the library, close contact with institutions and organizations for the elderly and disabled, close contact with home-help providers, and daily contact with other citizens of the community); partnerships with other service providers; and special arrangements for the homebound elderly. (AEF)

There is a potential crisis in caring for the elderly in California as the over-65 population is expected to double by 2020 and several demographic dynamics a lower growth rate in the population segment of women aged 24-54 that traditionally care for seniors; increasing participation of women in the workforce who have traditionally been at-home caregivers for seniors; and a robust economy offering many competing entry-level occupations at comparable or higher wages may contribute to a shortage of caregivers. Legislation passed in July 2000, the Caregivers Training Initiative, directed the Employment Development Department to develop an understanding of the labor supply-demand principles affecting workers in entry-level direct care occupations in relationship to nineteen other comparable occupations competing for the available labor force. Caregiver occupations may be viewed as less desirable compared to competing occupations for the following reasons: (1) wages are often lower; (2) there is less access to affordable benefits such as health insurance; (3) there is a greater chance for occupational injury or illness; (4) there are greater training and certification requirements; and (5) there is less opportunity for advancement. The following suggestions are made to improve caregiver recruitment and retention: conduct exit interviews and identify best practices; develop core competencies and career paths; and give financial incentives. (Contains 6 appendices, 21 exhibits, and 35 references.) (MO)

The success of the Champaign County Nursing Home Child Care Center (CCNHCCC) in Illinois provides a model for the establishment of child care centers in nursing homes. Needs assessment, financial support, licensing, staff hiring and training are all important factors that need to addressed in the start up and running of such a program. The establishment of an intergenerational program at a facility of this type is intended to draw elderly residents out of seclusion and isolation and to make it possible for the children to benefit from the residents' love and affection. Mutual activities and interaction promote a fresh and unique understanding between the two age groups in an atmosphere of happiness and compassion. An onsite child care center helps recruit and retain employees with child care needs, while the nursing home atmosphere takes on a personal, friendlier, and more family-like tone. The program has a positive influence on children's perceptions of the elderly, of disabilities, and of nursing homes, as well as providing the elderly with an atmosphere of revitalized interest and social enrichment. (MT)

The goal of the faculty development program that formed the basis of this project was to provide more social workers trained in working effectively with the elderly. Demographics indicate that the number of elderly, including frail elderly, will increase, and the need for social workers in this area already exceeds the available supply. Objectives of the program were: (1) develop and test a model for field instruction for Baccalaureate Social Work programs; (2) increase the gerontologic information and techniques for current field instructions; (3) share project outcomes with professional associations; and (4) project evaluation. It was found that only 16 percent of field work sites served clients over 50 and that instructional staff in these sites was limited. Topics that field instructors would have found more useful include updated information about psychological evaluation of the aged, counseling, functional assessment, depression, and dementia among others. Ten objectives for training in gerontological social work were identified and appropriate learning activities were devised. An educational resource manual was designed for undergraduate social work students. Two of the participating institutions chose to upgrade social work curriculum to include more gerontology. One project site also worked to improve local service delivery. An extensive set of appendices include: (1) key activities of the project; (2) project organization and advisory committee meetings; (3) baseline surveys instruments and results; (4) design of model field site; (5) evaluation; (6) dissemination. (KM)

In this proposed training model for caregivers working with the frail elderly, the focus is first on encouraging participants to construct and share fragments of their lived experiences with elderly people and their beliefs about the aging process. Next, participants are asked to bring back written observations of their own work styles and working conditions in skilled nursing facilities. The model is adapted from the life history approach, an important tool for social science research in both sociology and anthropology. This radically abridged version of the approach involves oral sharing, elaboration and recording of life history events in writing, analysis, and group discussion in each session. Much current writing on use of the life history approach in adult education and training is in French by French, Canadian, and Swiss adult educators. Focus of adult educators using this approach seems to be on the education and training of adult educators and trainers. Components of the training program include the following: a program goal, objectives, design, and brief outline for three sessions that cover a life history approach to understanding conceptions of aging, understanding working with the elderly, and developing a work style. (Contains 16 references.) (YLB)

Two studies were carried out in 1991-92 in Brisbane, Australia on the effects on frail elderly people of cognitive challenge by teleconference. In the first study, 20 residents of aged care centers watched specified programs on television. Later, they discussed the content over the telephone using conference link equipment. The study found that the technology must not interfere with the program; that the frail elderly participants should not have to turn on a program at a specific time, but should have readings or tapes that they can use at will; and that the substance of the program should be varied in order to appeal to as many people as possible. In the second study, the program content was specifically developed for the participants, 18 randomly selected frail elderly people who were all living independently in their own homes. Teleconferencing was used to provide the content, as well as for discussion. All participants stayed in the program through 144 participatory hours; results suggested that teleconferenced programs, along with an increase in social contact, can improve the quality of life for the frail homebound elderly. Includes 23 references and 6 appendices containing: participant and staff questionnaires; a participant health status report and a program of activities for the second study; and a description of the "University of the Third Age" (U3A), a higher education format designed to remove most institutional impediments to participation by the aged. (KC)

This handbook attempts to answer questions about informal caregiving and caregivers, focusing on the rural elderly. The first section presents a national perspective on caregiving. Recipients of caregiving, providers of caregiving, the caregiving dilemma, and psychological, physical, family, and financial issues are discussed. The second section focuses on the rural factor. The third section discusses services used by caregivers, including home maintenance, homemaking, transportation, nursing services, personal care, companion services, adult day care, etc. The fourth section discusses potential solutions to service problems. The fifth section discusses caregiver supports and focuses on respite care. The sixth section discusses support groups for family caregivers, noting that support groups which do work in rural areas tend to focus on education and less on support with personal concerns. This section also discusses the role of education programs for caregivers. The seventh section examines the caregiving issue as a family issue and describes research needs. Appendices include an Education and Training Resources Manuals list (9 items) and a Caregiver Bibliography of approximately 130 items. (Contains 20 general references.) (ABL)

For people in the United States, the risk of dependency upon social and economic support systems is generally associated with demographic characteristics--age, sex, race or ethnicity, geographic location, marital status, family composition, education, and income. In order to address the needs of dependent populations both now and in the century ahead, a better understanding of the realities of demographic change is required. This report looks at the circumstances of several of the most vulnerable population groups in the United States--children at risk, families in need, the frail elderly, and persons with disabilities. A number of tables and figures containing population data are included, as is a 16-item list of background readings. (DB)

Literature on health professionals describes the problems associated with unresolved or poorly resolved grief. Previous research has indicated that the most important reason why health professionals stay in their jobs is their relationship to patients. This study examined how nursing home personnel resolve their grief following deaths of clients. Nursing homes (N=13) in the central New York area were surveyed. In-depth interviews were conducted with administrative and social services key informants from all homes and with staff from one center representing medicine, nursing, social work, therapy, food services, activities, housekeeping, and pastoral care. Detailed information from 30 interviews were submitted to content analysis, cross-validated by artificial intelligence analysis, using the personal computer software PROLOG. Results indicated that the personal needs of staff for grief resolution go largely unrecognized by management and/or staff themselves, or go unmet. Negative consequences do follow for staff and resident caring relationships. The results emphasized that informal supports had great impact, suggesting that they should be recognized and sustained within effective administrative practice. In particular the artificial analysis presents a pattern which suggests the value of informal support for grief resolution, mitigating even the impact of staff experience with resident death. (ABL)

Little is known about urban American Indian elders, although most American Indians live off reservations in the nation's cities. Accordingly, this research project compiled information about these older Americans from the following databases: (1) results of academic and applied research; (2) Management Information System (MIS) reports of service providers in selected urban areas with significant American Indian populations; (3) surveys of selected urban American Indian organizations; and (4) results or data from federally funded demonstration projects which have targeted or incidentally served this population. The project produced a comprehensive research database which includes three topical bibliographies; demographic data; and documented needs for support services, availability and access to support services, and sociocultural factors which influence service delivery and use. The final report also identifies research gaps and recommends a national research agenda on aging among urban American Indians. This report also recommends policy and practices to increase access and availability of support services to older urban American Indians. (Author/TE)

Studies consistently have found that caregivers who use respite care are satisfied with and appreciate such care. However, preliminary evaluations of the effect of respite care on caregiver burden have had mixed, limited, and in some cases null empirical findings of program effectiveness. This study explored the relationship between caregiver characteristics and utilization of respite care in order to understand the caregivers' perceptions of burden and social support as well as their need for formal support services. Subjects included 22 caregivers using respite care for families with dementing relatives and 26 demographically matched caregivers not using respite care. Also included were 43 caregivers of mentally or physically disabled children using the in-home respite care program. Subjects responded to a questionnaire focusing on caregiver demographics, length of care, sources and availability of social supports, and attitudes toward and utilization of respite care. Results indicated that caregivers who used the respite care perceived a higher level of burden than did non- users. While differences in burden could be due to varying degrees of physical, cognitive, or behavioral problems that drive caregivers to seek respite, examination of severity, mental status, and prescription of behavioral management medications revealed no differences in the patient samples. (ABL)

Although the oldest-old are the fastest growing segment in the rural population, little is known about their social and economic needs, their awareness of social programs, or their use of social services. This study was conducted to assess the social, economic, and health needs of the oldest-old (over the age of 85 years) as compared to those of the old-old (ages 75-84) and the young-old (60-74) in rural upstate New York. A proportionate stratified cluster sample of older adults (N=456) were interviewed. Factors that might be predictive of program use, such as the respondent's awareness of the program, involvement or participation in groups, level of need, years of education, and control over one's life were examined. Analysis of variance showed that, compared to younger elderly respondents, the oldest-old respondents had the greatest social and economic need and were least likely to actually use programs. These findings have important implications for agencies at all levels of government responsible for the delivery of services and programs aimed at the well-being of the aged. (Author/NB)

Increasing demands for home health aides to the frail elderly and disabled, coupled with a high rate of turnover among these aides, has led to growing concerns over worker recruitment and retention in the home care industry. This paper therefore describes a model developed to explain job satisfaction and turnover among home health aides. The model was tested using survey data collected for a Ford Foundation-sponsored home care demonstration in five cities. The methods used to estimate the model included an adaptation of the Michigan Organizational Assessment Questionnaire to the circumstances of the home aide's job. This instrument was administered to workers employed by 17 agencies in five cities (Boston, Massachusetts; Milwaukee, Wisconsin; New York City, New York; San Diego, California; and Syracuse, New York). Based on critical path analysis, a causal model was developed to explain two outcomes of the questionnaire: intrinsic job satisfaction and intent to leave the job. Youth, loneliness, and dissatisfaction with pay and benefits were the major determinants of aides' intent to leave, while factors affecting workers' job satisfaction included positive attitudes about pay and benefits, supervisor supportiveness, and task variety. The importance of age as a predictor of turnover suggests that employers should focus their recruiting efforts on older workers, who because of temperament or lower employment aspirations seem more inclined to stay with the job. (Tables are included.) (TE)

A Ford Foundation demonstration project intended to improve the quality of work life and reduce turnover among homemakers/home health aides in the home care industry was evaluated. The project supported three separate work life demonstration at home care agencies in New York City and Syracuse, New York and in San Diego, California. The demonstration sites included both independent and chain-affiliated agencies as well as both non-profit and for-profit agencies. The demonstrations modified training and support, pay and benefits, status, opportunities for advancement, and hours of work--all dimensions of the job found to be sources of dissatisfaction in the home aide work force. In each case, the aim of the intervention was to increase worker satisfaction, decrease turnover, and improve reliability and continuity of care. At each site, the evaluation design provided for random selection of program participants (experimentals) and controls. One-year and 18-month turnover data were collected for experimentals and controls. Depending on the particular demonstration, program participants were 21 to 44 percent more likely to be on the job one year after the start of the demonstration than were their relevant control group. These differences persisted at the 18-month measurement point. References are included. (Author/TE)

Developmentally disabled adults who are cared for at home by their older parents present a challenge because community-based social and health services are required to meet the needs of both the aging parents and the offspring. In this study, 11 local case managers were interviewed in depth, for 2 hours, about their work with parents of developmentally disabled adults. Findings from this pilot study affirmed parents' resistance to planning for permanency despite increased frailties. Augmenting resistance and impeding assistance is a scarcity of residential options. Like the parents, workers were ambivalent about disrupting interdependence. They wished to provide help with future plans before crises occur, and also to keep aging families together for as long as possible by arranging needed services. Workers remarked that parents were intimidated by their youth and professional status, and that they feared them as threatening separation. Also reported was frustration over the mandate not to treat parents as clients, as well as excessive caseloads prohibiting more interaction with older families. Workers desired, instead, to assist parents when they first encountered age-related losses, and to learn more about aging services. Results of this pilot investigation suggest that geriatric specialists are needed to serve both aging developmentally disabled clients and their elderly caregivers. Sixteen references are included. (TE)

A recently published national profile of caregivers of the frail elderly suggests potentially negative consequences of caregiving for work and employment for as many as one-third of the employed caregivers in a large 1983 sample. The study was undertaken to explore a comprehensive set of issues on informal caregiving and to determine the extent to which caregiving by employees has consequences for work and job. A survey instrument adapted from The Travelers Employee Caregiver Survey was completed by 583 employees, 159 of whom identified themselves as caregivers for at least one person age 60 or older. Women are not more likely to be caregivers than men. Of all women in the sample, 28.71% were caregivers and of all men, 27.27%. The findings revealed that only 10% of men surveyed experienced caregiving related problems on the job, compared to 52% of the women. The difference was accounted for in part by men's greater freedom to rearrange their job schedules and reduce work time to render care. Men are more likely than women to give personal care and medication care. Men are almost as likely as women to offer companionship. (NB)

This report makes specific references to Jewish concerns while examining the respective responsibilities of the state, community, family, and the individual in caring for the elderly. It makes the critical point that reliance on the nuclear family in modern societies for elderly support becomes more tenuous to the extent that there are fewer adult children to provide support to their elderly relatives. The ratios of caregiving-aged adults (ages 45- 59) for every 100 older adults (ages 75+) in Jewish populations in different areas of the world are compared, and it is noted that differences in these ratios are reflected in major differences in the degree to which financial, social, health, and psychological needs are adequately met through networks of family, friends, and neighbors. Special attention is paid to the population of very old adults (those aged 85 and older) and their offspring in their 60's. The marital status of older adults and the prospect of caregiving support from a spouse are also considered. Intergenerational families are described and relationships between grandparents, their children, and their grandchildren are examined. The effectiveness of the creation of separate policies, programs, and services for the elderly is explored in a section on age integration and segregation; the view of the aged as a burden or asset is discussed; and loneliness and leisure time roles are also investigated. Care of the elderly and leadership roles are addressed. (NB)

This paper addresses issues related to the care of the aged by informal caregivers, government support of such care, and policy changes that might result in improved care of the elderly population. In its treatment of family responsibility for the elderly, it calls attention to several trends: (1) family members will be increasingly unavailable to provide care for their elderly relatives; (2) the elderly do not want to be too dependent upon family members; (3) the care of the elderly can result in serious economic, social, physical, and psychological costs to families; (4) these costs can result in abuse and mistreatment of the elderly; and (5) research findings do not support the assumed cost-savings from family care. It is questioned whether the United States and similar urban-industrialized societies can effectively adopt the practices of other types of societies in which the elderly are satisfactorily sustained by relatives. Examples are cited of Japan and Sweden where government provides financial incentives to families who provide for older relatives to live with them. A 1981 survey is referred to which found that more responsibility by government, as compared to more by the children of the elderly, or by the elderly themselves, was favored to a greater extent by the American public. Findings on international policies supporting family care of the elderly and its consequences are reviewed and the areas of assistance to families, mandating family support, and social changes affecting informal supports are addressed. (NB)

A series of discussions between the Gloucester (England) Health Authority and a research team resulted in a 3-year project designed to support elderly people, and those who care for them, in their own homes. This paper is an updated version of a discussion paper prepared during the formative phase of the project. It was created to encourage consideration of a number of key issues related to innovative programs for community care of the elderly. Included are discussions of the cost effectiveness of community care, the scope of community care, support for caregivers, care in and by the community, the domiciliary care/nursing interface, the need for psychogeriatric services, and the importance of diagnosis and reassessment. The paper concludes with a brief consideration of the nature and problems of evaluation. The conclusion notes that subsequent evaluation will focus on the effect of improved needs assessment and coordination of service delivery on the maintenance of elderly people in their homes, and on their quality of life and well-being. Also evaluated wil be the initial definitions of at-risk clients; the new tools for needs identification, biographical analysis, and the assessment of consumer satisfaction developed during the course of the project; and the economic implications of the provision of care coordinators posts. (NB)

This report consists of two papers on caregiving in Asian countries. The first, "Caregiving in Developing East and Southeast Asian Countries" by Nelson W. S. Chow, discusses the change in the caregiving pattern for the urban elderly in developing countries of East and Southeast Asia. It includes examples from studies carried out in Singapore, Hong Kong, Taiwan, the Republic of Korea, and Shanghai. It is noted that, although the majority of the urban elderly are living with their families, the difficulties they encounter are still great, and the dependent economic position in which most of the elderly find themselves has reduced the respect shown to them and has made them feel inadequate and isolated. The second presentation, "Caregiving among Middle and Low Income Aged in Hong Kong" by Alex Y. H. Kwan, highlights some of the problems faced by the elderly when a society moves from being a traditional agrarian, trading-port community into an urbanized, international finance society of nearly 6 million people. Strains being experienced by the elderly and their families are identified, with an emphasis on caregivers and how Western values tend to affect support systems and family networks. The usefulness of community care programs in Hong Kong is examined. The article concludes that, although the family system is still playing the major role in providing the elderly with necessary care, the kind of care provided is far from satisfactory. (NB)

This study examined the characteristics of elderly persons receiving help from family members as reported in published studies on family caregiving. The data were drawn from 10 volumes of the "Journal of Gerontology" and "The Gerontologist" (1978-1988). Thirty-one family caregiving studies were identified. Although few of the elderly require assistance with the activities of daily living, the data showed that family caregiving studies focused disproportionately on this severely disabled group. An analysis of the studies revealed that dementia and severe physical limitations were over-represented while less severe limitations were under-represented. Although the vast majority of family caregivers spend their time helping the elderly with transportation, shopping and errands, household chores, and meal preparation, this type of instrumental care was underrepresented in the literature. Family caregiving research appears to understate the most frequent help given to elders (instrumental help) and may over-represent caregiving burden. (Author/NB)

Because women have predominated as caregivers of the elderly, very little is known about the family support systems of men who assume this role. This study, based on a national study of male caregivers, examined the availability and level of family help received by male caregivers; the closeness, allegiance, and supportiveness in their families; and the relationship between these variables and such issues as caregiver burden and the degree of affectionate reciprocity between the caregivers and the recipients of their care. The results revealed that the average male caregiver was a white, protestant, middle class, moderately well-educated, retired man who was 68 years old. Most caregivers were husbands taking care of their wives. A minority were sons caring for a parent; instances of men helping in-laws, siblings, or friends were rare. Caregivers spent many hours each day performing a broad range of caregiving tasks and had been doing so for long period of time. Although most had living children or siblings, levels of concrete assistance from relatives were uneven. Study findings have implications for gender-sensitive service delivery and suggest directions for future research on male caregivers. (Author/NB)