Factors associated with perceived effectiveness of local long-term care ombudsman programs in New York and California.

OBJECTIVE: Long-term care (LTC) ombudsman advocate for the health, safety, welfare, and rights of residents in LTC facilities. This article examines factors associated with self-rated effectiveness of local LTC Ombudsman Programs (LTCOPs) in California and New York across the five statutorily mandated activities under the Older Americans Act: complaint investigation, resident/family education, community education, monitoring laws, and policy advocacy. METHOD: Data were collected from telephone interviews with coordinators of local LTCOPs in California and New York and from the National Ombudsman Reporting System. Analyses examined factors associated with effectiveness: program size, resource adequacy, organizational autonomy, interorganizational relationships, and program outputs. RESULTS: Resource and autonomy measures are significantly associated with different effectiveness measures in each state. Staff full-time equivalencies and coordinator hours per week in New York and the quality of training in California are significantly associated with effectiveness in most mandated activities. DISCUSSION: Findings highlight variability within and between the local LTCOPs in California and New York.

Economic expenditures associated with instrumental caregiving roles of adult siblings of persons with severe mental illness.

Siblings of persons with mental illness who assume primary caregiving roles experience substantial and tangible economic impacts associated with this responsibility. This study investigated mailed survey responses collected from 156 adult siblings of persons with mental illness from New York State to examine instrumental costs associated with providing support to siblings with illness. Genders of both siblings, severity of the relatives' mental illness, and number of surviving parents in the family distinguished those occupying primary caregiving responsibility from those not in primary roles. Current caregivers incurred greater instrumental costs in the form of financial expenses, time spent in care activities, and crisis involvement than did those who were not primary care providers. Additional demographic and behavioral factors related to siblings with and without illness were associated with specific dimensions of instrumental expenditure. As siblings become increasingly engaged in caregiving, social service professionals must assume leadership in promoting programs and policies that meaningfully support family involvement for relatives with mental illness.

How siblings of those with severe mental illness perceive services and support.

This study examines the complex and varied effects associated with having a brother or sister with a severe and persistent mental illness (SPMI) on the lives of adult siblings without chronic disability. Through five focus group interviews, 19 participants were asked to describe the impact that having a brother or sister with mental illness had on their lives. Codes and categories derived from the text of the transcribed interviews were grouped into broad themes. The respondents described the manifestations and challenges of contending with the SPMI of an adult sibling. They focused on gaps in services and communication with mental health providers, particularly with regard to timing of interventions and identifying readiness for treatment, as well as their own mental health needs. The article concludes with a discussion of the increased need for exchange of information and clarity of communication among family members and providers, following best practice guidelines that are well documented but not well implemented.

Evaluating awareness of New York's Assisted Outpatient Treatment Law among adult siblings of persons with mental illness.

This study examined knowledge of New York's Assisted Outpatient Treatment law, enacted November 1999, among adult siblings of persons with mental illness. Mailed survey responses collected between April, 2000 and September, 2001 from 100 siblings residing in New York State were reviewed. Only 48% acknowledged familiarity with the law. Possessing higher education, reading about mental illness more often, planning to occupy future caregiving roles, maintaining membership in a support group, and reporting that their siblings experienced more difficulties with treatment compliance were associated with a familiarity with the law. Among those aware of the law, two thirds incorrectly believed eligibility for a court order was contingent on a history of violent behavior. Low rates of general awareness and knowledge of the law highlight the need for further community education.