Surrogate decision makers' attitudes towards tube feeding in the nursing home.

In the nursing home, a widely accepted medical practice is to recommend the initiation of long term tube feeding in residents with eating difficulties. However, frequently the nursing home resident has dementia, lacks decision-making capacity, and has no advance directives to guide the physician and the family member(s). Therefore, the family member or another surrogate decision maker has to make the difficult decision of whether or not to consent to the placement of a feeding tube. We surveyed 50 English speaking surrogates of nursing home residents who were on a feeding tube for at least 6 months. Each surrogate was contacted by telephone and was administered a 16-item structured questionnaire. Statistical analyses included frequency distributions, and the Wilcoxon signed rank test for two related samples. Most surrogates rated the residents' quality of life as poor or extremely poor. Yet, 78% of the surrogates perceived tube feeding to be beneficial, 62% would repeat their initial decision to initiate tube feeding, and 68% would not consider removal of the feeding tube. Their leading concerns were medical complications, tube feeding's impact on each resident's quality of life, and adequacy of nursing care. The surrogates were satisfied with their initial decision for the placement of a feeding tube despite their perception that there was no improvement in the quality of life of the residents. The surrogates may have viewed tube feeding as a life prolonging measure.

A support group for nursing assistants: caring for nursing home residents at the end of life.

Certified nursing assistants (CNAS) provide the hands-on care to residents in nursing homes, often developing close relationships with those in their care. The current study used a support program model to explore CNAS' feelings, experiences, and needs when caring for the dying. Special attention was given to the experience of caring for residents who opted not to continue life-sustaining treatment. Second, the efficacy of this type of support program for CNAS was examined. Care of the dying elicited complex reactions: most CNAS reported that caring for dying residents can be a very rewarding experience. At the same time, most thought that caring for a dying person is always emotionally draining. Moreover, CNAS said they felt sad and felt stressed at least some of the time when caring for the dying. CNAS participated openly in the discussion and expressed positive feelings about participating in this type of support program.

A center on ethics in long-term care.

Long-term care institutions are beginning to grapple with ethical issues on a regular basis. This has encouraged facilities to develop new mechanisms to deal with these issues. Described is a tripartite program that incorporates direct service, education, and research in ethics.

Home care is where the heart is: the role of interpersonal relationships in paraprofessional home care.

While the provision of an adequate floor of wages and benefits for paraprofessional workers in the home care component of our long-term care system is desirable, efforts to provide it are curtailed by cost constraints. As a result, other factors which encourage the retention of an adequate home care workforce are all-important. Findings from a study of a representative sample of 487 paraprofessional home care workers in New York City indicate that the ability to develop close interpersonal relationships with home care clients and their families is one of the most attractive and rewarding aspects of the work. It is suggested that agencies focus on their roles in providing an optimum environment for the development of such relationships.

The home care industry: strategies for survival in an era of dwindling resources.

The home care component of our long-term care system is increasingly being recognized as the preferred alternative to institutional care for the frail elderly and disabled. Dwindling resources, both human and financial, are likely to have a deleterious effect on home care. Findings from a 1987-88 survey of paraprofessional home care workers of the frail elderly in New York City are used to draw implications for the home care industry. The scope of problems inherent in the industry imply that changes are necessary on both the micro and macro levels; the article concludes with recommendations for both levels.

AIDS, older people, and social work.

The acquired immune deficiency syndrome (AIDS) epidemic is significantly affecting older people. Older people themselves may be HIV positive, or they may be the caregiving spouse, partner, parent, or grandparent of a person with AIDS. In addition, older people may share housing or institutional space with people with AIDS. Concerns about the allocation of long-term care resources may create conflict between the needs of older people and people with AIDS. Social workers are particularly suited to lead the discussion of the impact of AIDS on older people, a role the profession has not yet embraced. Four areas of social work leadership are discussed: education, direct service, research, and advocacy.

Community care for the frail elderly: the case of non-professional home care workers.

With the aging of the population there will be a growing demand for non-professional home care workers to augment family caregivers in the care and support of the frail elderly. Despite the present and future importance of these workers, little is known about their job problems and satisfactions and their relationships with clients and their families. This paper presents an overview of what is known about this vital component of home care and suggests policy and research implications.