Adult Foster Care Research Articles

Spatial Analysis of Home and Community-Based Services and Number of Deaths Among Older Adults in Taiwan.

This study examined the geographical distribution of home- and community-based services (HCBS) resources in Taiwan's Long-Term Care 2.0 policy and explored its association with the number of deaths among older adults. The main outcome of the study was determination of the number of deaths among older adults in townships (N = 346) in 2021. The results showed that home-based HCBS had a significant positive association with mortality among older adults; moreover, community-based and complementary services, which are highly clustered within a township and among its neighbors, exert a significant protective effect on mortality among older adults. Stratified analyses showed a significantly lower mortality among older adults using adult foster care and transportation services, but a significantly higher mortality among older adults using home-based professional care and respite care services, after considering the sociodemographic characteristics of older adults, urbanization, and the number of long-term care resources in the spatial analysis.

Outcomes of remote activity monitoring for persons living with dementia over an 18‐month period

Outcomes of remote activity monitoring for persons living with dementia over an 18‐month period

Understanding the Risk of Homelessness for Emerging Adult Foster Care Youth

This publication discusses foster care in the United States, risk of experiencing homelessness among foster care youth, and possible interventions. Written by Francesca Michelini, Randall Cantrell, and Kate Fogarty, and published by the UF/IFAS Department of Family, Youth and Community Sciences, January 2022.

Experiences of black women adult foster care providers for aging adults: negotiating power and care

ABSTRACT This study explored experiences of 23 Black women owners and operators of Adult Foster Care (AFC) homes for midlife and older adults. Semi-structured interview data focusing on multiple dimensions of the care context were analyzed using grounded theory methods. Women leveraged their resources as they invested their expertise, time, and relationships to support their residents and embraced the value of residents for their contribution to the success of AFC settings. The findings underline the critical roles of these AFC providers in maintaining safe and home-like care contexts for aging adults, in the face of systemic challenges.

Adult foster care of older people

The focus of this article is to introduce the community-based adult foster care of older people in Finland. Although adult foster care is a public care service, it is organised in a private home, either in the foster carer’s home or in the older person’s home. The foster carer and the county make a commission agreement. Adult foster care can be full-time long-term care or short-term full-time or part-time care.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Caring in space: the boundaries between public and private spaces in Finnish adult foster care homes

AbstractThe purpose of this article is to explore a hybrid community-based form of care for older people called adult foster care. In the article, the nature of the foster care home as a place of care is explored from the foster carers’ point-of-view. It is based on an interview study of 12 foster carers. In this article, the theoretical frameworks from human geography and work–family research are combined in order to analyse the boundaries between private family-life and public work-life in the particular space of the foster care home. The research questions are: What kinds of public and private spaces exist in adult foster care homes? What kinds of boundaries separate (a) the public and private spaces and (b) the foster care home and the outside world? The findings suggest that foster care homes are very complex socio-spatial places of care, in which the questions of power (who can do what and when in a certain space), the re-organisation of home, and the division of private and public spaces all contest the idea of home as a mere ‘safe haven’ from the pressures of work life. Different boundaries and boundary management strategies enabled the foster carers to regard their place of living and working as their home, even though it had altered to a place of care of ‘strangers’.

Time to care? Temporal variations of agency of the Finnish adult foster carers

This article analyses a hybrid form of housing and care service for older people called adult foster care. In Finnish adult foster care model, an older person moves to a foster care home and is cared for by a semi-professional foster carer who is not related to them. A foster care home is thus simultaneously a personal dwelling and a site of intensive care work which also changes the rhythms and routines of both the foster carer and older person. In the article I ask, how do foster carers express their temporal agency and its variations (identity, pragmatic, life course) through time work? By temporal agency I mean individuals' ability to impact on their experience of time, which is done through time work. The article is based on 12 thematic interviews that were analysed using thematic content analysis. The analysis shows that as a resource, time itself was the most valued aspect of foster care work. Being a foster carer was in fact a way of resisting clock-driven, institutional-like care work. The foster carers were able to exercise their professional identity agency, that is, act like ‘a good carer’ should act, but they found it difficult to allocate time for themselves and to their families. This can.endanger their well-being and the continuity of foster care relationship. In order to develop the adult foster care scheme to a real housing and care option for older people and a tenable work option for potential foster carers, several issues should be carefully considered. To ensure foster carers' well-being, their statutory right to days-off should be increased, and the support and substitute system should be enhanced so that foster carers can allocate more time for themselves and their families, even when this would mean more costs to the municipalities. Also, older people in need of care should be placed to foster care much earlier.

The Resident VIEW in Nursing Homes.

This article presents the Resident VIEW (Voicing Importance, Experience, and Well-Being), a measure designed to learn directly from long-term care residents the extent to which they experience support that matters most to them. The Resident VIEW contains 63 items across eight domains developed through cognitive interviews with residents in different types of residential settings (e.g., nursing homes, assisted living, and adult foster care). Residents rate items on both importance and their experience. In total, 258 nursing home residents living in 32 Oregon nursing homes were selected through a two-stage random sampling design and participated in the study. Results demonstrate that what matters most to residents varies, emphasizing the value of asking residents directly about their preferences. The relationship between importance and experience differed by item. Residents who experienced support rated very important within some domains, reported better quality of life and reported lower levels of depressive symptoms than those who did not experience these things. The interaction between importance and experience, however, did not reach statistical significance, suggesting that positive experiences may provide benefit even in some areas that are not perceived as important by residents. Results underscore the value of incorporating the resident perspective into measure development in long-term care.

Tensions and resilience: the experiences of adult foster-care workers in Finland

This article examines adult foster care for older people in Finland. This is a semi-formal service in which older people are cared for by foster carers who are remunerated for their work by the local municipality. In the article, the tensions and resources of resilience of foster-care work are analysed. The data consist of 12 thematic interviews with foster carers. The results suggest that foster-care work is emotionally draining and has adverse effects on social relationships. However, foster carers see caring as purposeful, they see themselves as professionals and they have enough social resources.

Deficyty emocjonalne młodych dorosłych wychowanków rodzin zastępczych

The study was aimed to determine the role of attachment bond in emotional functioning in alexithy-mia and emotional processing in foster care alumni. The participants with experience of personal rejection – adult foster care alumni during the transition from foster care to adulthood (N = 29) and persons without such experience (N = 32) took part in the study. The Experiences in Close Relation-ships Scale, Toronto Alexithymia Scale and Emotional Processing Scale were used. Results present that insecure pattern of attachment occurs with alexithymia in ineffective emotional processing. We confront the results with the construct of emotion representations as the key to comprehend observed deficits in emotional functioning.

Implementation of a Community-Based Approach to Dementia Care in England: Understanding the Experiences of Staff

ABSTRACTGiven the increasing numbers of people living with dementia, it is imperative that new, practical solutions are found to the issues faced by this group of people and their families. This article draws on findings from a qualitative study that explored the implementation of a community-based project to support people living with dementia in one local area in England. This approach has different names; in the United Kingdom it is Shared Lives or adult placement, which would be most comparable to family care in Europe and adult foster care in the United States. Interviews were conducted with 14 staff connected to the Shared Lives project. Interview data were coded using the normalization process theory constructs of coherence, cognitive participation, and collective action. Supportive program factors identified were a dedicated staff member and resources, and the availability of specialist knowledge and skills. Detriments to program success included lack of understanding about the service, perceptions it was a poor fit with existing practice, and wider organizational issues that negatively affected normalization of the intervention. Suggestions for future research go beyond staff opinions, stressing the importance of using a wider range of stakeholders and incorporating measurement of outcomes for people using the service.

Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. Descriptive, unmatched study. VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011. Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment. Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs. MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings.

Childhood behavioral disorders and trauma: Predictors of comorbid mental disorders among adult foster care alumni.

This study identifies the prevalence of mental health comorbidity in a large multistate foster care alumni sample as well as early childhood and trauma-related predictors of comorbidity. Secondary analysis of case record and interview data for 1,038 alumni served by Casey Family Programs in 13 states were used to assess pre-foster care, during foster care, and post-foster care predictors of comorbidity, defined as 2 or 3 mental health conditions. Findings indicate that 9.8% of alumni had 2 mental disorders and 10.4% had 3 disorders. Multivariable analyses show that alumni who were female, lived below the poverty line, and who were unmarried were more likely to have comorbid mental disorders. Controlling for these significant factors, alumni who had childhood behavioral disorders or who were maltreated during foster care were more likely to have comorbid mental diagnoses. Alumni who perceived their foster parents as helpful some or a lot compared with a little had less comorbidity. The prevalence of comorbidity in this adult foster care alumni sample is higher than youth still in foster care and adults in the general population. This research highlights the need to prevent trauma-related interpersonal violence within foster families and ensure alumni access to health-care provisions long after they exit foster care. Recommendations focus on the need for comprehensive mental health assessments and quality treatment that addresses multiple conditions. Future research examining the effects of alumni mental health and treatment access on intergenerational outcomes is also recommended.

Adult Foster Care: Relief for those who Despair in Nursing Homes

Adult foster care provides an alternative to nursing home care. Residents are cared for in a private home by a caregiver who provides 24 hour supervision. The caregiver receives payment for room and board and for the care services provided. States vary in their regulatory approach but are increasingly viewing this model of care favorably due to the lower costs and preference for this model of care among frail older adults and their families. Opportunities for nurses in this relatively new care environment are numerous ranging from case managementto direct care provision.

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings

Homelessness prevention for former foster youth: Utilization of transitional housing programs

This article compares two groups of foster care alumni residing in transitional living programs in San Francisco, California. One group of youth was served in programs geared specifically towards youth aging out of foster care who were referred through a transition planning process. A second group of youth was served in similar transitional housing programs that were not exclusively for foster care alumni but instead served homeless youth in general. Comparisons between these two groups reveal that youth in the population-specific programs have less acute initial presentations than foster care alumni in homelessness intervention programs, who had faced more unemployment, school attrition, substance use, and mental health concerns prior to program admission than their peers in the programs specifically for foster care alumni. The research also shows that youth in the homelessness intervention programs had faced more instability during their years in foster care when compared to youth in the population-specific programs for foster care alumni. The research highlights the need for better understanding of the referral process for youth aging out of foster care so that transitional housing programs for young adult foster care alumni can better serve a diversity of youth with different service needs.

Disproportionality in education and employment outcomes of adult foster care alumni

Racial similarities and disparities in the education and employment of 134 African American and 574 White adults placed in foster care as children were examined. Logistic regression was used to compare differences among these young adult alumni who were served by a voluntary foster care agency in 23 U.S. communities. When controlling for demographic background, risk factors, and foster care experiences, race/ethnicity was a significant factor only in the increased odds of White alumni having income at or above poverty level, three times poverty level, and home/apartment ownership compared to African Americans.

Effects of Enhanced Foster Care on the Long-term Physical and Mental Health of Foster Care Alumni

Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Who Recommends Long-Term Care Matters

Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment-but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.