Nicole Ruggiano

Person-centeredness in home- and community-based long-term care: current challenges and new directions.

Person-centered care (PCC) has demonstrated to be a viable and preferred model of providing health and institutionalized long-term care services. However, the concept of PCC has not been fully extended to home- and community-based long-term care services (HCBS) for older adults with chronic conditions. This review highlights the need for PCC in HCBS and suggests that social workers may play a role in overcoming cultural and structural barriers to extending PCC to HCBS that include: the fragmentation of the industry, financial structures, regulation of services, and paternalism in policy and practice. Recommendations for practice, policy, and research are provided.

Negative Feelings and Help Seeking Among Older Adults With Chronic Conditions

Older adults with chronic conditions are at greater risk of negative affect, though few studies have focused on older adults’ perspectives on how chronic conditions affect their mental well-being. This study involved in-depth interviews that explored how older adults describe their feelings about chronic conditions, the context within which they experience these feelings, and their experiences with help-seeking for negative feelings. Participants reported that older adults experience a range of negative feelings related to their conditions and are only comfortable talking to people who understand their everyday experiences with managing chronic conditions. The findings have implications for health self-management.

Resource Dependency and Agent Theories: A Framework for Exploring Nonprofit Leaders' Resistance to Lobbying

Despite the widely recognized benefits of nonprofit advocacy, many nonprofits are reluctant to partake in lobbying activities. This qualitative inquiry utilizes resource dependency and agency theories as a framework for exploring the lobbing behaviors of nonprofits in North Carolina. The findings indicate that nonprofit managers do in fact lobby, but use alternative language for their lobbying activities so that they can control external resources available through political action while maintaining positive relationships with organizational stakeholders who hold negative perceptions of lobbying behavior. They also educate stakeholders on lobbying as an organizational necessity. Implications for practice and research are provided.

Need and Potential Use of Information Technology for Case Manager–Physician Communication in Home Care

Case management has become a popular model for providing home care services to nursing home-eligible older adults. To maximize collaborative decision making and patient outcomes, members of the case management team must engage in ongoing, open communication. However, little is known about the quality of communication between home care case managers and their clients’ physicians. This study examined geriatric home care case managers’ perceptions of their communication with their clients’ physicians. Participating case managers were employed at two large home care agencies located in the South Florida region. The findings suggest that communication between home care case managers and physicians is limited and inefficient. Implication for policy and practice are provided. Finally, we propose ways to leverage Information Technology to bridge this communication gap.

Intergenerational Shared Sites An Examination of Socio-Physical Environments and Older Adults’ Behavior

Few studies have examined older adults’ behavior and attitudes within the context of intergenerational shared site (IGSS) environments, where children and older adults receive services at the same facility and typically share space and resources on an ongoing basis. This natural study examined the behaviors of older adults participating in two senior center programs that were co-located with child care facilities. Data collection involved participant observation and in-depth interviews with staff members at each IGSS. The data were systematically coded and analyzed for themes. Although positive informal intergenerational interactions occurred at both centers, many older adults demonstrated negative behaviors and attitudes when their programs shared space and/or relinquished resources to children’s programs. Implications for research and practice are provided.

Networking for Policy Advocacy: Identifying Predictors of Advocacy Success Among Human Service Organizations

In previous studies, nonprofit administrators have reported that networking contributes to achieving their organizations’ policy advocacy goals. However, little is known about the relationship between specific networking activities and policy advocacy success. It is also unclear whether commonly reported problems in interorganizational networking inhibit policy advocacy success. This study examined the association between attributes of networking and policy advocacy outcomes. The findings indicate that networking is more successful when communication indicates higher commitment to a two-way partnership. Also, problems with interorganizational collaborations were not found to negatively affect policy advocacy outcomes. Implications for social workers and research are provided.

Applying Erikson’s Wisdom to Self-Management Practices of Older Adults Findings From Two Field Studies

According to Erik Erikson’s theory on the stages of human development, achieving wisdom later in life involves revisiting previous crises and renewing psychosocial accomplishments. However, few studies have used Erikson’s theory as a framework for examining how older adults self-manage physical and mental health changes that commonly occur later in life. This article presents findings from two qualitative studies that demonstrate how older adults apply wisdom in new domains. Specifically, it was found that older adults (1) reasserted autonomy by initiating creative problem solving and (2) applied skills gained from productive activities earlier in life to new health-related problems that arise later in life. These findings highlight the importance of engaging older adults to repurpose their life skills and thus reapply wisdom to new areas of their lives. Implications for practice are discussed.

Smartphone-Based Health Technologies for Dementia Care: Opportunities, Challenges, and Current Practices:

Most of the 5.4 million people affected by Alzheimer’s disease and other forms of dementia (AD) are noninstitutionalized, receiving care by unpaid family caregivers and medically managed by a primary care provider (PCP). Health Information Technology has been recognized for its potential in improving efficiency and quality of AD care and support for AD caregivers. Simultaneously, smartphone technologies have become an increasingly common way to deliver physical and behavioral health care. However, little is known about how smartphone technologies have been used to support AD caregiving and care. This article highlights the current need for smartphone-based interventions for AD and systematically identified and appraised current smartphone apps targeting and available for AD caregivers. Findings indicate that individual available apps have limited functions (compared with the complex needs of caregivers) and little has been done to extend AD caregiving apps to Hispanic populations. Implications for research, practice, and policy are discussed.

CareHeroes Web and Android™ Apps for Dementia Caregivers: A Feasibility Study

The purpose of the current feasibility study was to examine the use, utility, and areas for refinement of a newly developed web-based and Android™ application (app) (i.e., CareHeroes) with multiple features to support individuals caring for loved ones with Alzheimers disease or other forms of dementia (AD). The study was performed over an 11-week period with triads of AD caregivers, assigned home care case managers, and primary care providers (PCP). The study involved quantitative and qualitative methodologies. Eleven AD caregivers (seven daughters, two sons, and two spouses), six case managers, and five PCPs participated. Data demonstrate participants were mostly satisfied with the multiple features and ability to access and use CareHeroes. Barriers for use include concerns about time constraints and not being familiar with technology. Although the study findings are promising, a longer term study to evaluate the impact of the CareHeroes app is indicated.

“If I Don’t Like the Way I Feel With a Certain Drug, I’ll Tell Them.” Older Adults’ Experiences With Self-Determination and Health Self-Advocacy

Health self-advocacy is associated with positive health outcomes, though existing research indicates that older adults may be at a disadvantage when self-advocating within the health care and disability support systems. This study examined perceptions of older adults’ health self-advocacy behaviors and the context under which they self-advocate for their chronic conditions. The study involved in-depth interviews with 37 older adults with chronic illnesses and disabilities and 9 geriatric case managers in South and Central Florida. Data were systematically analyzed for themes. Thematic findings revealed that concerns over quality of life is the most common motivator for older adults to engage in health self-advocacy and that self-advocacy involves gathering information to prepare for decision-making and confronting providers about the information gathered. The findings suggest that providers may help facilitate self-determination by framing health communication within the context of quality of life.