Brief report #3: building a rural community caregiver network: student learning in small town America.

The Rural Caregiver Network Project in Eastern Maine is a prime example of indigenous coalition-building in a region struggling to ensure that vulnerable older adults can age-in-place and manage with scarce resources. Through this innovative initiative, a range of elder caregiver interventions were mobilized, coordinated, and sustained in a rural two-county region in Maine, including navigator services, adult day care, information and referral, caregiver support groups, a caregiver resource center, and caregiver skills-building workshops. The endorsement of participatory research, evaluation, and programming principles enabled undergraduate and graduate social work students to assume major roles in all aspects of project planning, implementation, and assessment while remaining grounded in the realities of rural life. Competence in such a generalist gerontological social work practice perspective is critical in small towns and nonmetropolitan communities.

Engaging students in gerontological work through innovative caregiving programming: introduction to three brief reports.

The number of Americans aged 65 and older is projected to increase from 35 million to 88.5 million in the first half of the 21st century. However, there is a serious gap between the number of health care and social service practitioners needed to work with the aging and the number available and trained to do so. The authors review current research on what works in engaging students in geriatric and gerontological work. The authors then present three projects from the Weinberg Caregiver Initiative as illustrations of innovative caregiver programming building on community-based partnerships which successfully incorporate aspects of best practices in gerontological education to increase student interest in work with the aging populations, while serving older adults and their caregivers.

Racial/ethnic disparities in access to medicare home health care: the disparate impact of policy.

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and "other" users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.

Intervention with abused older males: conceptual and clinical perspectives.

Men and women experience abuse in different ways and older men have particular treatment needs that must be addressed by clinicians. The current design and configuration of clinical services may create barriers to abused older men receiving treatment fully suited to their needs. In this article, the unique experiential dynamics and help seeking behaviors of older men who experience abuse are delineated and recommendations are given for structuring services to better meet their needs. Gender-sensitive clinical techniques and modalities are described and suggestions for interventions that could prove particularly efficacious in the treatment of older men are offered.

Depression and caregiver burden among rural elder caregivers.

Family caregivers of older adults frequently experience feelings of burden and depression though they may not come to the attention to health and service providers until they are at a point of crisis. Through a simple screening tool, the Maine Primary Partners in Caring (MPPC) project identified individuals providing care to older adults through rural primary care practices, in order to provide upstream interventions before caregivers were in crisis. This paper describes a sample (n=62) of rural family caregivers identified through their physicians' offices. High levels of caregiver burden and depression were reported. Family support and knowledge of caregiver tasks predicted decreased caregiver burden and depression, while isolation predicted increased caregiver burden. Implications of these results for gerontological social workers are outlined.

Early intervention screening for family caregivers of older relatives in primary care practices: establishing a community health service alliance in rural America.

The Maine Primary Partners in Caregiving project provides a prime example of how disparate community health, social service, and higher education institutions can build a successful rural service alliance for the purposes of screening for family members experiencing stress during the provision of care to impaired older relatives. Community primary care practices are featured as prime sites for the early identification of elder caregivers experiencing stress and burden. Initial project results and implementation challenges as well as recommended strategies for nurturing such community partnerships are presented.