Elderly Chinese and their family caregivers' perceptions of good care: a qualitative study in Shandong, China.

This study aims to understand what older Chinese people with chronic illness and their family caregivers perceive to be good care, and to compare perspectives of those living in rural and urban areas. We conducted semistructured interviews with 24 care recipients and 23 caregivers in Shandong, China. Two major themes were identified: (a) filial piety as the standard, and (b) modifying cultural ideals to meet reality. There was overall consistency in perceptions of study participants. Variations between rural and urban elders' perceptions appear to reflect differences in socioeconomic development and institutional structures.

Does caregiver knowledge matter for hospice enrollment and beyond? Pilot study of minority hospice patients.

We examined the level of hospice knowledge of caregivers of minority elderly hospice patients and determined how it influences the hospice enrollment decision and the decision on the use of hospice services after enrollment. Based on qualitative analysis of medical records and interviews with caregivers of minority elderly hospice patients who received personal care from paid caregivers (eg, other than family caregivers), we found that hospice knowledge increased access to hospice among minority patients who otherwise would not opt for hospice or enroll too late for comprehensive hospice care services. Furthermore, the highest level of knowledge-acquired through caregivers' health care occupations-appears to influence hospice care after hospice enrollment. Caregivers with that level of knowledge made requests for changes in site of care and/or additional services that may enhance the quality of hospice care that their loved ones receive.

Older case management clients with younger family members in need of care: interdependencies and well-being.

This exploratory study investigated caregiving and interdependencies in families of frail older case management clients who coreside with younger individuals in need of care. Analyses were based on interviews with 78 older adults recruited from a large urban case management program. To be eligible for the study, the older adult had to coreside with an individual under age 60 who had disabilities or chronic health problems and/or with minors. Results indicated that the majority of older adults were primary caregivers for at least one younger individual In a substantial number of families, the older adult depended on a younger adult with disabilities for primary care. Older adults who lived with both younger adults with disabilities and minors experienced more negative affect than those who lived with only one of these two kinds of younger individuals. Positive affect among elders living with younger adults with disabilities was positively related to the number of formal services received by the younger adults. The implications of these findings for service delivery to families with complex needs for care are discussed.

Overcoming hopelessness and social isolation: the ENGAGE model for working with neglecting families toward permanence.

The Adoption and Safe Families Act of 1997 (ASFA) mandates policies designed to increase the frequency and speed with which permanency is achieved for children in the child welfare system. ASFA's focus is on child safety, permanency, and well-being. The expectation that parents correct neglectful conditions within specified time frames places an increased ethical responsibility on child welfare staff. Carrying out this responsibility requires vigorous and innovative approaches to engaging and working with neglectful families. Drawing on a well-established conceptual framework for understanding the determinants of effective parenting, the authors derive the ENGAGE (Engagement, Needs assessment, Goal setting, Assessment of progress, Goal achievement, Ending work) model for achieving permanency within the policy structure. The model incorporates creative client engagement, assessment of family needs, mutual goal setting, the goal achievement process, termination, and aftercare.