Evaluating the Impact of Elder Cottage Housing on Residents and Their Hosts

Family members who wish to have their older relatives live with them often encounter obstacles that make such an arrangement unworkable. Proponents of the Elder Cottage, and its variant, the Homecare Suite, suggest that many of these obstacles can be avoided with Elder Cottage use. The purpose of this study was to evaluate the impact of Elder Cottages on a variety of resident and host outcomes. A nonequivalent comparison group design was used. Thirty-one treatment group residents and their hosts received Elder Cottages whereas 24 comparison group residents and their hosts remained on a waiting list. Results showed that residents using Elder Cottages reported significantly greater satisfaction with their housing, increased independence, more telephone contacts with friends and family, improved relationships with hosts, more accessible housing, and less formal service use than those in the comparison group. Similarly, hosts in the treatment group reported significantly greater satisfaction with the residents' housing and less stress in their caregiving roles than those in the comparison group. In addition, fewer Elder Cottage hosts than comparison group hosts engaged in caregiver-related driving. Answers to short-answer questions mirrored the quantitative findings. These results provide substantial optimism with respect to the Elder Cottage as a housing option for older adults, although interviews with housing specialists suggested that families will need financial and caregiving assistance for this option to be viable.     

Ethnicity and the ethic of caring in african american families

Abstract

Several important demographic and economic factors have led to the shift in medical caregiving work from health care professionals to family members, primarily women. The growth in family caregiving has spawned numerous studies on how caring for the sick affects unpaid family caregivers. While caregiving work can be gratifying, most studies have focused on the negative effects, such as its adverse impact on the health and employment of caregivers. Only recently have we begun to expand this literature by examining the impact of ethnicity, specifically culture, on family caregiving. This study argues that African American families have retained specific cultural values and developed family systems which may lessen the negative impact of caregiving on families.     

Mothers' representations of caregiving and their adult children's representations of attachment: intergenerational concordance and relations to beliefs about mothering

Mothers (N= 35) and their adult children completed questionnaires and were interviewed in order to examine relationships between mothers' caregiving representations and their adult children's attachment representations, and relationships between attachment/caregiving representations and beliefs about mothering. Mothers' and their children's accounts of and present thinking about their past relationship were highly similar, indicating that the two parts develop concordant states of mind regarding their relationship. In contrast, there was no relationship between mothers' and their adult children's beliefs about mothering, suggesting that such beliefs are not simply passed on from generation to generation within families. Attachment/caregiving classification interacted with generation in influencing a belief that biological facts determine maternal behavior, young adults with preoccupied attachment being particularly prone to reject this idea. Attachment/caregiving classification also had a significant effect on participants' tendency to adhere to an idealized conception of mothering, this tendency being associated with a dismissive attachment/caregiving representation.     

Attachment and spousal caregiving

A community sample of 362 married couples participated in a study of attachment and spousal caregiving, which combined qualitative and quantitative components. The qualitative component focused on actual experiences of caregiving, assessed by participants' semi‐structured accounts of a situation involving their role as caregiver for their spouse. Attachment styles and their underlying dimensions (comfort with closeness, anxiety over relationships) were related to the type of support provided, the coping strategies used in the situation, caregivers' feelings about the quality of their care, perceived effects on the couple bond, and the emotional tone of the accounts. The quantitative component tested a theoretical model of factors predicting willingness to provide care for the spouse if he or she should become dependent in later life. Measures of attachment and caregiving styles, attachment to spouse, and anticipated burden provided reliable prediction of willingness to care. The results support the conceptualization of attachment and caregiving as interrelated features of marital bonds, and they have important implications for patterns of family caregiving.     

Emotional interactions and an ethics of care: Caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.     

Clergy involvement in occupational safety and health

The toll exacted by occupational injuries and illnesses on employed people involves a degree of personal and family suffering of such magnitude that clergy can legitimately consider it a part of their pastoral responsibilities to address the problem. Several cogent reasons for clergy involvement in occupational safety and health are provided, along with approaches clergy can implement to help parishioners reduce their workplace risks. Resources for assistance in engaging in these activities are suggested.This article represents an expansion of a paper that appeared originally inCurrents in Theology and Mission, Fall 1979.     

African American, White and Latino Fathers’ Activities with their Sons and Daughters in Early Childhood

We examined the activities that low-income, ethnically diverse fathers of sons versus daughters engage in with their children in the preschool years. African American, Latino, and White fathers (N?=?426) from research sites across the United States, were interviewed about their caregiving, play, literacy, and visiting activities when their children were 2?years, 3?years, and preschool age. Fathers of boys engaged more frequently in physical play than fathers of girls, whereas fathers of girls engaged more frequently in literacy activities. Moreover, gendered patterns of father engagement were already evident at the 2-year assessment, suggesting that fathers channel their children toward gender-typed activities well before their children have a clear understanding of gender roles. Ethnic differences were also found in fathers’ activities with children, and child gender moderated ethnic patterns of behavior. For example, Black fathers of sons reported the highest levels of engagement in caregiving, play and visiting activities, and both Latino and African American fathers of sons engaged in more visiting activities compared to White fathers of sons. Fathers’ education and marital status were also associated with fathers’ activities. Married fathers and those with a high school diploma more frequently engaged in literacy activities than unmarried fathers without a diploma; moreover, although Latino fathers engaged less in caregiving activities than African American and White fathers, this difference attenuated after controlling for differences in fathers’ education. The activities children share with their fathers vary by child gender, race/ethnicity, and family circumstances and offer insight into early gendered experiences in the family.     

Caregiver behavior in center and family day care

In an effort to examine relationships between variations within day care settings and adult caregiving behaviors the social experiences of 40 toddlers and their caregivers in family and center care were systematically observed. Caregivers were interviewed and conditions of caregiving recorded. Caregivers in both settings with fewer children in their care, who worked shorter hours, with less housework responsibilities engaged in more facilitative social stimulation, expressed more positive affect, were more responsive, and less restrictive and negative. Family day care caregivers who worked in spaces specifically designed to be safe and appropriate for children were less restrictive of toddler activity. Adult-child ratio and caregiver training appeared to be the best indicators of quality care in center day care, while a safe and appropriate caregiving environment and small groups appeared as quality indicators in family day care.     

Stressful situations in caregiving: relations between caregiver coping and well-being

We examined ways in which caregivers cope with stressful caregiving situations and the relations between coping strategies and caregivers' psychosocial well-being. Respondents were 58 family caregivers to patients discharged from a rehabilitation hospital. Caregivers identified a recent stressful event in caregiving and indicated strategies used to cope with this event. After controlling for patients' impairment level, analyses indicated that caregivers engaging in more escape-avoidance coping reported greater depression and more conflict in their personal relationships. Those using more positive reappraisal demonstrated greater positive affect. Younger caregivers, many of whom were women, used more avoidance strategies. Results have implications for therapeutic interventions with family caregivers.     

Fetal Risks,Relative Risks,and Relatives' Risks

Several factors related to fetal risk render it more or less acceptable in justifying constraints on the behavior of pregnant women. Risk is an unavoidable part of pregnancy and childbirth, one that women must balance against other vital personal and family interests. Two particular issues relate to the fairness of claims that pregnant women are never entitled to put their fetuses at risk: relative risks and relatives' risks. The former have been used—often spuriously—to advance arguments against activities, such as home birth, that may incur risk; the latter implicate the nature of relationships in determining the acceptability of coercing or precluding activities. Motivated reasoning by clinicians and judges leads to inaccurate risk assessments, and judgments based on false claims to objectivity. Such judgments undermine the moral and legal standing of pregnant women and do not advance the interests of fetuses, pregnant women, families, or states.     

Stress Reduction for Family Caregivers in Chronic Mental Illness: Implications of a Work Stress Management Perspective

In several studies involving a total of 291 family caregivers for schizophrenia sufferers, the stressors that arise from caregiving were identified. Also identified were the outcomes for caregivers, which often include psychological distress. Caregivers develop various stress-reduction techniques, but this article explores the utility of applying the principles of work stress management to caregiver well-being. An organizational psychology perspective suggests that a comprehensive focus must include not only how individuals can learn to manage the emotional demands of their work, but also how the work of caregiving can be made less stressful for them. Suggestions from a work stress management perspective highlight the possible contributions of worker participation in policy formulation and a collaborative relationship between family and professional caregivers. Potentially fruitful research directions are noted.     

Involving caregiving grandmothers in family interventions when mothers with substance use problems are incarcerated

The alarming rate of incarceration of women disproportionately affects women of color, frequently intersects with the women's substance use problems, and often results in grandmothers providing care for their grandchildren during their daughters' incarceration. Numerous factors complicate the grandmothers' caregiving experiences and contribute to strains that exceed those typically associated with grandparent caregiving. Such complicating factors include the stresses associated with their daughters' substance use problems and incarceration; the complex biopsychosocial needs of many of their grandchildren; the challenging relational issues they must address; and often, the long-term, multifaceted effects of poverty. Despite the critical roles they play, the multiple vulnerabilities they face, and the potential for multigenerational, culturally relevant family interventions to yield gains for all three generations, grandmothers have received little attention in intervention research with this group of families. This paper provides a theoretical and empirical rationale for the inclusion of caregiving grandmothers in interventions and research with families affected by maternal incarceration and substance use problems, in general, and for the promise of multifamily groups, in particular. Strategies for tailoring multifamily groups with this population of families are also included.     

“I Didn’t Expect to Learn as Much as I Did”: Rewards of Caregiving in Young Adulthood

While much attention is given to unpaid caregivers in midlife, there is a notable gap in the literature regarding young adults in family caregiving roles. Although two out of 5 family caregivers are between the ages of 18 and 40, we know relatively little about these younger relatives providing support to ill and disabled family members. Understanding the experiences of this under-researched population is critical to effective social service provision for this new wave of caregivers. In addition, the challenges associated with caregiving are well documented, yet examining the positive aspects of caregiving is necessary to provide a balanced picture of caregiving. The purpose of this qualitative study was to explore the gains experienced by family caregivers in young adulthood. In-depth telephone interviews were conducted with a diverse sample of 22 individuals who were (or had previously been) caregivers while in young adulthood. Analysis of the data resulted in identification of four themes concerning gains experienced by young adult caregivers: a strengthening of family relationships, character growth, personal satisfaction in the care provided, and material benefit. This study sheds some understanding on rewards experienced by a subgroup of family caregivers who has received little attention—young adult caregivers.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

Parents of Adults with Intellectual and Developmental Disabilities (IDD) and Compound Caregiving Responsibilities

In some cases, parents caring for an adult child with an intellectual and/or developmental disability (IDD) must balance this with caregiving for another family member. This dual responsibility, referred to as “compound caregiving”, may contribute to increased feelings of distress, or change their perceived ability to care for their child. The current study examined how compound caregivers differ from other parents of adults with IDD, and whether compound caregiving is significantly associated with family distress. Data was available for 199 parents aged 38 to 91 years who were seeking adult services for their son or daughter with IDD. Parents completed a mailed questionnaire and telephone interview in which they indicated compound caregiver responsibilities. Parents identified as compound caregivers were then compared to those who were not in terms of family characteristics, as well as parental perceptions of burden and mastery, and family distress as measured by the Revised Caregiver Appraisal Scale and the Brief Family Distress Scale, respectively. Nearly half of the parents reported being compound caregivers. The demographic profile of these parents was no different from that of the other parents but their children were slightly younger. Compound caregiving was significantly associated with parental perceptions of burden and mastery and family distress. Demands outside of caring for an adult child with IDD can negatively influence family functioning and must be included as part of caregiving assessments.     

Aging family caregivers: policies and practices

This review examines later life family support for adults with developmental disabilities from a life course perspective that takes into account social trends and changes in service patterns and in attitudes of families. Key issues addressed include: (1) trends affecting family caregiving, (2) health and social outcomes of life-long caregiving, (3) support needs of families, (4) family support policies and practices, and (5) recommendations for a research and policy agenda. Research examining outcomes of life-long caregiving has shown that most families adapt well to having a family member with disabilities. However, some families are at risk for poorer physical and mental health outcomes. These include cultural minorities and families of adults with behavioral challenges. Caregiving does seem to have a negative impact on maternal employment and family income as mothers often give up or cut back on employment to care for a child with developmental disabilities, who is more likely to continue living in the family home throughout adulthood than other adult children. Federal and state initiatives are addressing issues of family support through both the developmental disabilities and aging service systems.     

Conceiving a child to save a child: reproductive and filial ethics

I conclude that Mary and Abe's decision to conceive a child to save a child does not impose harm on persons or on relationships in the family. Nor does it evince a lack of respect for the child they have conceived. The ethical guidelines that support this conclusion can now be summarized. First, actions should not depersonalize or otherwise endanger personal relationships. Second, although ideally personal relationships are initiated and continued for their own sake, after a personal relationship has been established and sustained the motives for establishing it recede in importance. Third, the requirement of honesty looms especially large in the context of personal relationships. Fourth, privacy protects personal relationships in the family from intrusion by the state. Fifth, even if those with whom we stand in personal relationships are not fully rational or self-conscious, we should treat them with respect. Finally, persons often are called upon to make greater sacrifices in personal relationships. These principles represent only the barest beginnings of an ethics for filial relationships. Nonetheless, they mark progress in the direction of developing a more complete account. We should not suppose that ethics in the family always will be spontaneous or "natural". Over a century ago, Mill warned that nature and natural are "one of the most copious sources of false taste, false philosophy, false morality, and even bad law". Especially in the wake of medical advances, such as recombinant DNA and new reproductive technologies, the complexity of filial ethics will only increase. The demographics of an aging society will add further complexity to filial contexts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Promoting Recovery Identities Among Mothers with Histories of Addiction: Strategies of Family Engagement

Changes in identity are critical to managing transitions to recovery from substance and alcohol addictions. Identity change is particularly important for mothers, whose recovery processes are often in the context of critical but complex family relationships and societal expectations. But research and practice often underestimate the relational dimensions that promote or inhibit changes in one's identity during recovery. Here we analyze data from a study that involved interviews with 30 formerly incarcerated women participating in a community-based substance use treatment program in the Midwest. Drawing from Constructivist Grounded Theory Methods, our analysis identified three factors shaping levels of engagement with family members: (1) the relational consequences of a shared past; (2) ascribing permanence to the old identity of “addict” versus the ability to see women's capacity to change; and (3) the current provision of caregiving support to participants’ children. Our analysis supports and extends existing research by highlighting how family can both promote and inhibit a recovery identity process. We discuss potential implications for theorizing “recovery” and “identity” as relational and identify key elements to support practices more attuned to the hidden complexity of family support.     

Introduction: Reflections on mothering and on reexperiencing the early relationship experience

As President of the World Association for Infant Psychiatry and Allied Disciplines the Editor has invited me to introduce this issue, which continues with papers from the Stockholm Congress. Advances in developmental biology and medical genetics make it clear that the future of psychiatric and mental health research will be centered in preventive intervention. This prospect highlights the need for more knowledge about environmental/individual interactions. The caregiving relationship experience is a crucial aspect of these interactions and frames the later development of strength or disorder. Several papers in this issue focus on the caregiving experience and provide me an opportunity to offer some reflections on the nature of experiencing and reexperiencing. Propositions that seem important include the following: The experience of caregiving involves a reexperiencing of earlier represented relationships; reexperiencing in this sense involves other past relationships that had a similar role relationship context; reexperiencing involves a dynamic interplay on both sides of a represented role relationship (that is, self and other interacting); early formative relationships are apt to be represented as affective prototypes such that reexperiencing occurs mainly without conscious awareness. Understanding such affective representations can guide infant psychiatry as it opens new opportunities for brief interventions. These can benefit infants and caregivers through the medium of the infant-caregiver relationship experience. Activating formative aspects of that experience can promote health and the strengths of individuality and provide a buffer against illness and self-defeating attitudes.     

A Closer Look at Religiosity Among Family Caregivers

This article addresses the relationships between the dimensions of religiosity and positive appraisal of caregiving among African American, Hispanic, and non-Hispanic Caucasian family caregivers for older adults. Data analysis of 69 subjects revealed a negative correlation between non-organizational religiosity and positive appraisal of care among African American caregivers and a positive correlation between organizational religiosity and positive appraisal of care among Hispanic caregivers. Findings from this analysis challenges the overall assumption that religiosity increases positive appraisal of caregiving. Rather, the nature and outcomes of family caregiving are different for various ethnic groups.