Perceived Readiness for Gerontological Social Work: Insights from Recent Graduates During COVID-19.

An online qualitative survey explored perceived training, readiness, and needs of recent SW graduates serving older adults. Over half (N = 14) held a master's in social work, with 70% having taken an introductory aging course. Nearly halfcompleted other aging-specific coursework, and 80% did fieldwork with older adults. Participants indicated moderate proficiency in assessing issues like lossestransitions (46.7%), and physical health (53.3%), and advanced expertise in cognitive assessments (60.0%) and caregiver stress management (53.3%). Training deficiencies were noted in disaster readiness, telehealth, and resource coordination. Findings underscore the need for educationfor early-career social workers, ensuring their effective support to older adults.

Navigating the Storm: Challenges and Career Implications for Nursing Home Administrators in the Wake of COVID-19.

PURPOSE: Nursing homes were at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic and continue to experience its effects, including staffing shortages. Although various studies have described the experiences of frontline staff, less has been published about the experiences of those in administrative positions. The current study explored factors impacting nursing home administrators' (NHAs) perceived preparedness, day-to-day operational challenges and needs, and career outlook in the context of the COVID-19 pandemic. METHOD: A cross-sectional online survey was administered via Qualtrics®, comprising demographic and facility-level questions and eight open-ended questions. Qualitative content and thematic analysis were used to code the text for themes describing administrator perceptions. RESULTS: NHAs (N = 60) described feeling unprepared, experiencing disruptions of day-to-day operations, and witnessing a decrease in resident well-being. NHAs also expressed a decrease in their own well-being due to COVID-19. Many NHAs expressed wanting to, planning to, or actively working toward leaving their role due to the consequences of COVID-19. CONCLUSION: As nursing homes continue to face staffing shortages, supporting those in the role of administrator becomes of urgent importance, as this role directly impacts staff and resident well-being. [Journal of Gerontological Nursing, 50(6), 17-24.].

Enhancing End-of-Life Care Knowledge Among Older Spanish-Speaking Adults: Results From a Pilot Educational Intervention on Advance Care Planning and Care Options.

BACKGROUND: Disparities in advance care planning (ACP) among older Latinos necessitate targeted interventions to enhance engagement and knowledge in end-of-life care. This study aimed to evaluate the effectiveness of a resource-efficient, culturally tailored educational intervention in improving ACP readiness and knowledge among older Latino adults in the community. METHODS: A quasi-experimental pretest-posttest design was used to assess the impact of the intervention. The study involved community-dwelling older Latinos (aged 61-94) in the U.S. attending community wellness centers. Measures included participants' knowledge of ACP, care options, familiarity with hospice and palliative care, and attitudes toward hospice, assessed using pre- and post-intervention surveys. RESULTS: Statistically significant improvements were observed in ACP knowledge, understanding of care options, and attitudes towards hospice and palliative care post-intervention. Demographic factors influenced knowledge scores, with no significant gender differences in the intervention's efficacy. CONCLUSIONS: The educational intervention effectively enhanced end-of-life care planning readiness and knowledge among older Latinos. The study highlights the potential for sustainable, accessible, and culturally sensitive educational strategies to reduce disparities in ACP knowledge and possibly engagement.

The Impact of Neighborhood-Level Factors on Perceived Quality of Hospice Service Satisfaction: A Geographic Information System Study.

Racial/ethnic minorities are underrepresented in hospice care in the United States, despite this being the standard of care for terminally ill individuals. Research indicates that location of services (e.g., rural vs. urban) plays a role in the differences in quality and quantity of services observed. However, the influences of neighborhood structural characteristics on quality of hospice services have not been explored. The purpose of this study was to explore the relationship between hospice neighborhood characteristics and caregiver-rated satisfaction with services in Florida. Data were derived from the Consumer Assessment of Healthcare Providers and Systems Hospice Survey and American Community Survey; ArcGIS was used to generate heat maps to provide visual representations. Findings showed that higher neighborhood immigrant density predicted lower family satisfaction with timely care, communication, spiritual support, and likelihood to recommend the agency services. The U.S. population is projected to continue to grow in its diversity, and thus understanding neighborhood characteristics associated with racial/ethnic minorities' perception of care quality are important for shaping care improvements.

Suicide Risk Help-Seeking Among Middle- to Old-Age Adults: A Systematic Review.

Background and Objectives: Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these age groups. To address this knowledge gap, a systematic review of existing literature was performed to obtain a refined understanding of help-seeking for suicide risk among middle- to old-age adults. Research Design and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases and key journals with suicide and/or gerontology focuses were searched to identify peer-reviewed publications in English between 2010 and 2020. A total of 4 732 unduplicated publications were screened for relevance based on titles and abstracts, of which 52 were reviewed in full text. Results: Twenty-four articles met inclusion criteria and were included in the qualitative synthesis. These articles discussed a range of topics, including the prevalence of service utilization, service use prior to a suicide death, and correlates of help-seeking. In general, the prevalence of service utilization was low and varied by suicidal history (eg, higher prevalence among individuals with a history of suicide attempts than those with suicide ideation only). Key facilitators (eg, current or history of suicidal thoughts, plans, or attempts) and barriers (eg, stigma) for service use and help-seeking were also identified. Discussion and Implications: Findings highlight the need for future studies and tailored services to improve age-appropriate and culturally responsive suicide prevention and intervention strategies for middle- to old-age adults.

Factors that Contribute to Bereaved Parents' Perceptions of Neonatal Palliative Care: A Systematic Literature Review.

OBJECTIVES: Neonatal palliative care (NPC) is an emerging subset of care in United States (US) neonatal intensive care units (NICUs) that provides relief for both infants and families at the end of life for infants with terminal diagnoses. Families play a integral role in the decision-making process for their infant, but their experiences with and perceptions of the support and care provided to them via NPC is unclear to health professionals. This literature review summarizes the state of knowledge on parents' perspectives of NPC while focusing on the specific factors that influence their experiences and satisfaction with NPC. METHODS: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles published in peer-reviewed journals between January 2010 and January 2021 that investigated parents' perceptions of neonatal palliative care either as their central topic or as a sub-topic as part of a larger focus. RESULTS: A total of 16 articles (N = 16) were included in this review. Three overarching themes encompass the findings of the literature review: parent-clinician interactions, parent-infant interactions, and parent-self interactions. Within these themes, topics such as consistent and clear communication, involvement in care decisions, and social and psychological support were explored. CONCLUSION: Clinicians must focus on these important quality indicators to ensure they provide the best care possible to the patients and families that they serve. Further research must be done to investigate parent satisfaction and needs in relation to NPC more deeply and to develop more supportive interventions and protocols.

The Intersectional Impact of Race/Ethnicity and Sex on Access to Technology Among Older Adults.

BACKGROUND AND OBJECTIVES: Research on technological access and usage has revealed a digital divide based on several sociodemographic factors, including race/ethnicity, sex, income, and education. While several studies have examined these factors separately, few studies have considered how multiple vulnerable identities may combine to influence access to technology. Using the theory of intersectionality, this study assesses the combined impact of race/ethnicity and sex on access to a working cellphone and a working laptop/computer among U.S. older adults. RESEARCH DESIGN AND METHODS: Data were derived from the 2018 National Health and Aging Trends Study. Chi-square tests were used to test group differences, and four multivariable logistic regression models were used to examine the association between the intersection of race/ethnicity and sex, and access to a working cellphone and a working laptop/computer. RESULTS: After accounting for other explanatory variables, White female participants, Black male participants, Black female participants, Hispanic male participants, and Hispanic female participants were all less likely to have a working cellphone or a working laptop/computer compared to White male participants. DISCUSSION AND IMPLICATIONS: The results of this study point to a significant disparity in access to technology based on intersectional identities, with Black and Hispanic female participants having the least access to technology. Interventions aiming to improve access to technology should target these two groups, with a focus on reducing the cost of purchasing technological equipment and the provision of training programs that improve technological skills.

Emerging social workers during COVID-19: Exploring perceived readiness and training needs.

Summary methods and approach: Social workers support clients' psychosocial and resource needs across care settings. Social workers are typically not, however, trained to engage in emergency response practices such as the ones that may be necessary to support needs brought on by the COVID-19 pandemic. This article reports findings from a cross-sectional survey of social work students and recent graduates entering the field of social work during COVID-19, exploring their preparation, perceived readiness, and training needs. Findings: The study sample (N = 94) included 70 students and 24 recent graduates. The sample was 52% White, 22% Hispanic, and 21% Black/African American. Respondents reported training needs in the areas of trauma-informed care (70%), behavioral health (57%), culturally competent practice (49%), telehealth (48%), loss and grief (44%), and emergency management (43%). No significant differences emerged in self-efficacy ratings of students and recent graduates; both groups reported low self-efficacy in their ability to apply advanced practice skills. After controlling for demographics, receiving training specific to the COVID-19 pandemic (ß = .271, p < .05), perceived readiness (ß = .779, p < .001), and satisfaction with training/preparation (ß = .4450, p < .001) significantly contribute to levels of perceived self-efficacy among SW students and recent graduates. Applications: Social work curricular developments, and continuing education, are needed to prepare and support emerging social workers for practice in the context of COVID-19 and its long-term implications. This includes enhancing social workers' readiness to engage in telehealth, trauma-informed practice, emergency management, policy interpretation, self-care, and grief support.

Rising above the Flood: A Systematic Review of Gerontological Social Work in Disaster Preparedness and Response.

Physical/cognitive limitations associated with the aging process place older adults at disproportionate risk of negative consequences during disasters. Guided by the profession's commitment to supporting vulnerable populations, gerontological social workers have long been on the frontlines supporting older adults during disasters. Yet, disaster social work practice remains an undeveloped and under-researched area. Thus, we asked "what is the current role of gerontological social workers in disaster preparedness with older adults in the United States, and potential areas for improvement?" This paper systematically reviews the literature discussing social work and disaster preparedness/response with older adults in the U.S., to identify needs and inform future directions. PRISMA guidelines were followed to conduct a systematic search across relevant databases for peer-reviewed-publications between January 1, 2009-June 12, 2020. Eleven articles met inclusion criteria. This body of literature is small and covers two broad areas: (1) charging the social work profession to engage in this work, and (2) describing current efforts and unique challenges of older adults during disasters. Only three empirical studies were identified. Future educational efforts should formalize training to prepare social workers for this practice area. Research should detail the roles of social workers in disaster preparedness/response, and factors that predict involvement.

Latino Families' Decisions to Accept Hospice Care.

OBJECTIVES: The underrepresentation of Latinos in hospice care is well-documented. A gap remains, however, in the literature's description of the factors that shape Latino families' decisions to enroll in hospice care. The need for such understanding is dire considering the shifts in population and the research evidence that Latinos experience worse end-of-life outcomes compared to non-Latino whites. This study contributes to such understanding by exploring Latino older adults' experiences with healthcare broadly and reasons for choosing hospice care specifically, including how they learned about hospice and their understanding of the service at the time of enrollment. METHODS: Semi-structured interviews were conducted with 13 hospice-enrolled Latinos 65 or older, or their decision-making proxies. Qualitative data was analyzed using thematic analysis. RESULTS: Findings show that hospice represents a way to access services, and not necessarily a philosophy of care that Latinos understand or seek at end of life. CONCLUSION: Healthcare providers such as hospital and hospice social workers must engage in efforts to enhance advance care planning discussions and hospice education with the Latino community.

Structural Characteristics of Nursing Homes and Social Service Directors that Influence Their Engagement in Disaster Preparedness Processes.

Nursing home residents are an at-risk population during disaster situations, and nursing homes face unique challenges in managing disasters. Nursing home social service departments can support their nursing homes in meeting the needs of residents during disasters, yet there is little research exploring their involvement. To address this gap, we use secondary data from the 2019 National Nursing Home Social Service Directors' study to explore social service directors' and their departments' involvement in disaster preparedness and response, and personal- and nursing home-level characteristics that predict involvement. Results show that nursing home social service directors and their staffs are predominantly involved; 61.9% (n = 562) of respondents stated always participating, and an additional 20.3% (n = 184) usually participating in disaster planning. The age of the director significantly predicted involvement, with older directors being most likely to always be involved. Further research is needed to understand why some nursing homes involve their social service directors in disaster planning and others do not, what roles those directors play, and to identify strategies to increase involvement within this role.

Nursing home social services: A systematic review of the literature from 2010 to 2020.

Nursing home (NH) social workers carry out person-centered care, guided by the 1987 Nursing Home Reform Act. As the projected population of individuals requiring NH care is expected to grow and become more racially and ethnically diverse, the social worker in this setting becomes increasingly important. The aims of this study are to: (1) identify existing research that discusses the role of social work and nursing facilities, (2) synthesize findings to determine what is most often reported in the literature, and (3) present recommendations for practice, research, and policy. This study used the PICO framework and PRISMA guidelines to systematically search for articles published in English between 2010 and 2020 across 11 databases. A final sample of 23 articles discussed social work in the NH organized into three categories: (1) qualifications of the NH social worker (n = 5), (2) social worker responsibilities (n = 11), and (3) policy dictates practice (n = 7). Future research ought to include primary data collection methods with NH social workers, as well as NH residents and family, as residents must be at the center of their care. Considering policy modifications to further enhance the social work role of the interdisciplinary team is warranted.

Caring for Dying Infants: A Systematic Review of Healthcare Providers' Perspectives of Neonatal Palliative Care.

OBJECTIVES: The palliative and hospice care movement has expanded significantly in the United States since the 1960s. Neonatal end of life care, in particular, is a developing area of practice requiring healthcare providers to support terminally ill newborns and their families, to minimize suffering at the end of the neonate's life. This paper seeks to systematically summarize healthcare providers' perspectives related to end of life, in order to identify needs and inform future directions. METHODS: Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically reviewed the literature discussing healthcare provider perspectives of neonatal end of life care ranging from year 2009 to 2020. To be included in the review, articles had to explicitly focus on perspectives of healthcare providers toward neonatal end of life care, be published in academic peer-reviewed sources, and focus on care in the United States. RESULTS: Thirty-three articles were identified meeting all inclusion criteria. The literature covers, broadly, provider personal attitudes, experiences delivering care, practice approaches and barriers, and education and training needs. The experiences of physicians, physician assistants, nurse practitioners, and nurses are highlighted, while less is discussed of other providers involved with this work (e.g., social work, physical therapy). CONCLUSION: Future research should focus on developing and testing interventions aimed at training and supporting healthcare providers working with neonates at end of life, as well as addressing barriers to the development and implementation of neonatal palliative teams and guidelines across institutions.

Prescription opioid availability and opioid overdose-related mortality rates in Medicaid expansion and non-expansion states.

AIMS: To determine whether, in the United States, higher opioid overdose-related mortality rates (OOMR) in Affordable Care Act (ACA) Medicaid expansion states relative to mortality rates in non-expansion states have been mediated by increased prescription opioid availability. DESIGN: Separate mixed-effect regression models examined difference-in-difference effects of time and expansion status on Medicaid-reimbursed opioids measured in morphine milligram (mg) equivalents on all OOMR and on prescription OOMR. We used generalized structural equation models to test whether increases in Medicaid-reimbursed prescription opioid availability mediated OOMR post-Medicaid expansion. SETTING AND PARTICIPANTS: This study used national, serial, cross-sectional data for Medicaid-reimbursed prescription opioids, Medicaid enrollment information and annual OOMR for any opioids and for prescription opioids from 49 states and the DC pre- (2008-13) and post-ACA Medicaid expansion (2014-16). MEASUREMENTS: The outcome measures were OOOMR and Medicaid-reimbursed prescription opioid availability. The main input variables were time and ACA Medicaid expansion status. FINDINGS: Medicaid expansion states had larger increases in prescription opioid availability (b = 480, 357.8, P = 0.001) compared with non-expansion states. However, the largest increases in prescription opioid availability in expansion states were between 2009 and 2011, well before the ACA Medicaid expansion. Whereas expansion states also had higher any OOMR compared with non-expansion states (b = 3.6, P = 0.011), significant differences in prescription OOMR between expansion and non-expansion states did not emerge until 2015 (b = 1.4, P = 0.014) and 2016 (b = 4.0, P = 0.004), and Medicaid-reimbursed prescription opioid availability was not a significant mediator. CONCLUSIONS: Increases in Medicaid-reimbursed prescription opioid availability in Affordable Care Act Medicaid expansion states in the United States do not appear to have mediated post-Affordable Care Act Medicaid expansion mortality rate differences, but there is still a possibility of lagged effects.

Hispanic Hospice Patients' Experiences of End-Stage Restlessness.

End-stage restlessness, or terminal agitation, is experienced by some patients during their final days and is characterized by physical, emotional, or spiritual distress, agitation or anxiety. End-stage restlessness negatively affects the patient's death experience and can be distressing to the family and care team. Using the 2007 National Home and Hospice Care survey, this study examined factors associated with experiencing end-stage restlessness among non-Hispanic white and Hispanic hospice patients deceased at time of discharge. Results showed that being Hispanic/Latino, experiencing dyspnea, pain, and receiving palliative sedation treatment were risk factors for experiencing end-stage restlessness. The association between pain and restlessness was stronger for Hispanics compared with non-Hispanic whites. The Hispanic population remains underrepresented and little is known about the patient-centered experiences of Hispanic hospice users. Findings indicated that dying Hispanic patients continue to experience pain and other negative symptoms, even when hospice care is in place. Thus, it is important that social workers provide education to interdisciplinary team members about culturally competent practices, and advocate for a patient-centered approach to care.