Promotion Of Personal Autonomy Research Articles

Quality of Life, Physical and Mental Health of Family Caregivers of Dependent People with Complex Chronic Disease: Protocol of a Cohort Study.

Background: informal caregivers have a high risk of suffering from diseases derived from the chronic stress to which they are subjected for their dedication to the care of their relatives. Such stress has a direct influence on the person cared for, mainly affecting the quality of their care. Therefore, the aim of the present study is to assess the association of caregiving on physical and mental perceived health in family caregivers of dependent adults with complex chronic diseases. Methods: a prospective longitudinal cohort study, with a follow-up period of 36 months (HUELLA cohort). The exposed cohort will be formed by family caregivers of dependent patients with complex chronic pathologies. The unexposed cohort will be taken from the general population adjusted for age, sex and health. Outcome variables will include attendance to health services, consumption of psychoactive drugs, dedication to care (only in exposed cohort), concession of the Act on Promotion of Personal Autonomy and Care for dependent persons (exposed only), perceived physical and mental health, depression level, burden level and new diagnosis of chronic pathology of the caregiver during the study. Results: the expected results will be applicable and will incorporate improvements to the usual health system clinical practice, providing feedback to professionals dedicated to the provision, planning and design of services to family caregivers, as well as to groups and organizations of caregivers. Conclusions: investments in preventing low-quality informal care are key, mainly through early identification and interventions to support caregivers who suffer from stress, anxiety or depression.

Aportaciones de los servicios sociales comunitarios a la gestión descentralizada de los cuidados de larga duración. El caso andaluz (España)

El presente artículo pretende poner de manifiesto las ventajas e inconvenientes, de una gestión descentralizada de la Ley de Promoción de la Autonomía Personal y Atención a la Personas en Situación de Dependencia (LAPAD), en las diferentes regiones españolas por medio de los servicios sociales comunitarios de los entes locales. Para ello, se revisan los trabajos que se han elaborado al respecto para validar, posteriormente y a través de una encuesta semiestructurada dirigida a los trabajadores sociales que gestionan la dependencia, estas aportaciones para el caso de la región andaluza, concretamente para los servicios sociales comunitarios de la provincia de Huelva.

The Hybrid Model of Long Term Care to People in Dependency Situation in Spain: a Decade of Legislative Changes and Budget Adjustments

Promotion of Personal Autonomy and Care for People in Dependency Situation Act 39/2006, is one of the most significant advances in social policy in the Welfare State in recent decades in Spain. This legal standard, in line with all European countries in our environment, seeks to respond mainly to the new demands for long-term care as a result of the increase in life expectancy in the population. One of the most novel aspects incorporated by act is the subjective right of citizenship to receive care. In this way, the role of the State in social protection is reinforced within a family model where families, especially women, have traditionally acted as care providers. Ten years after the adoption of the act, it is relevant in the analysis of the policies and public administration, to know the model of social protection of dependency that is being implemented nowadays. For that, we first approach aging of the population in advanced societies. Secondly, the most relevant theoretical contributions in relation to the configuration of the act and its overlap with social welfare regime in Spain. Then, the most important normative changes in the system of attention to dependency from the beginning of its application to the present time. Fourth, it is carry out an analysis of secondary data on act management. Finally, it is exposed what are the characteristics that identify the model of social protection of dependency in Spain.

Program: Functional adaptation at home for dependent and elderly / or disabled people

Introduction : In 2006 Spain approves Law 39/2006 of December 14 named _Promotion of Personal Autonomy and Care for people in dependency situations._ This law represents an advance in individuals’ life and families who have a dependent member. “_In 2014 there were, in Spain, 18’1% of dependent people over 65 years old while in Catalonia there was 18,3%_” (Idescat, 2015). Given the large number of people over 65 years old that are dependent in Barcelona City, Barcelona City Council together with Association for Independent Living create a program named Functional adaptation at home for dependent and elderly / or disabled people. This program is being carried out from 2.011 to the present, and it’s a program for people over 65 years without economic resources and it’s a priority that they live alone or with a dependent person. Objectives : The program objectives are: - Improving the quality of life of this collective: providing autonomy maintaining physical and mental activity while the activity is performed in activities of daily living. It also improves accessibility and security at home, while they are promoting more time in their homes and avoid institutionalization. - Provide the discharge of the caregiver in order to avoid the physical and mental impairment. Project overview : Program: Functional adaptation at home for dependent and elderly / or disabled people is done through requests made by Social Workers from Barcelona’s City Council Social Services Centers and Primary Care Centers in the area of Barcelona as well as coordinators of the service of home care services. Independent Living Center (CVI) professionals: physiotherapist, occupational therapist and speech therapist, value the person’s functional limitations at home. All adaptations are done based on this evaluation, usually with support products and, in exceptional cases, arrangements to improve accessibility at home. In arrangements visits also collaborates an expert accessibility engineer. During the assessment, the person also visits CVI, where professionals evaluate which are the best products for the person while learns how to use the prescribed items. Once the functional adaptation is done, the professionals value the person’s satisfaction and his/her caregiver satisfaction. We specifically re-evalue the autonomy’s capacity in those daily tasks that they could not perform: to take a shower, sitting down and standing up from the sofa... by a new scaling. The number of beneficiaries that has been attended during the period taken from 2011 to 2015 is approximately 3,200 people. Project results : Two months after the interventions are finished, CVI professionals track the actions taken to beneficiaries through a satisfaction survey of the products and their use. 86% of users said they feel more independent and 95% of them said they feel safer than before. This program has allowed to CVI to do a study with the University of Barcelona, Econometrics’ Department. The study says that: _For every euro invested in support products annual savings ranging between 2.74 and 3.71 euros_, _taking into account the smaller needs of grants to third parties, and prevention of different types of drops. The repayment of the investment would be lower than 5 months in any case_ _This study also confirmed the efficiency of preventive policies in order to address future situations of dependency aggravations_ Funding : Funding is made through a collaboration agreement that’s been annually signed between Barcelona City Council and Association for Independent Living (AVI), the entity that manages CVI. Improvement proposal : There must be a drawing hand, in order to amend the current care model (more on an assistance and reagent way) to a different system, where social services politics are conceived on a more preventive and active nature. We believe that should be an enhancement interdisciplinary social network (Social Worker, Home Care Service) and healthcare network (physiotherapist, nurse ...) in which could promote comprehensive care person. Barriers of the implementations process : Starting this project back in 2.011 was hard work as we were in the middle of the economic crisis and it was a revolutionary program that had never been done before in Barcelona. We start all work during 2.010 (meetings with different departments from the City Council, meetings with support products suppliers, etc.) in order to get everything ready to be able to start the program in April 2.011.

Calidad de vida de los discapacitados intelectuales valorada por ellos mismos y los profesionales: variables implicadas

Mejorar la calidad de vida de las personas con Discapacidad Intelectual es un objetivo prioritario desde la implantación de la Ley de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia. Los profesionales y los propios usuarios no siempre coinciden en la valoración que tienen acerca de las diferentes dimensiones de que consta el constructo. Es posible que las discrepancias se deban a variables no especialmente atendidas por la investigación como el modo en que viven (vivienda tutelada, residencia o unidad familiar), o el grado de discapacidad que muestran. El objetivo de este estudio ha consistido en analizar las posibles discrepancias existentes entre las valoraciones de unos y otros informantes atendiendo a estas particularidades. Para ello se aplicó la escala INICO-FEAPS a 360 adultos con discapacidad intelectual y a 103 profesionales que trabajan con ellos. Los resultados muestran concordancia en 5 de las dimensiones que evalúa la escala, entre las que destacan derechos, bienestar físico y material; y amplias discrepancias en autodeterminación y bienestar emocional. Se interpretan los resultados a la luz del tipo de necesidades a que responden las diferentes dimensiones de la calidad de vida.Palabras clave: calidad de vida, discapacitados intelectuales, adultos, grado de discapacidad, modo de vida

Predictors of cognitive impairment in population over 64 years institutionalized and non-institutionalized

Describe the factors which can be associated with cognitive impairment in institutionalized and non-institutionalized elderly. Cross-sectional study of 200 people aged over 64 in Huelva (Spain) in 2014. Of these, 100 people were institutionalized in a residential facility and 100 were not. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE-35), basic activities of daily living by Barthel index, general health through the Goldberg GHQ-28 and social, clinical and behavioural variables were contemplated in the study. The association of cognitive impairment with all the variables was analysed using Chi-square test. Finally, a multivariate analysis was performed using logistic regression to identify possible joint influence of variables to study on the cognitive impairment. The prevalence of cognitive impairment in those institutionalized was 47%, higher than that of non-institutionalized group which was only 8% (p<.001). The dependence for basic activities for daily living and learning activities were the only variables in both groups which were associated with the cognitive impairment. Institutionalization (OR=5.368), age (OR=1.066) and dependence for basic activities (OR=5.036) were negatively associated with CI, while learning activities (OR=.227) were associated in a positive way. Conducting learning activities and the promotion of personal autonomy can delay cognitive impairment in older people. It is important to include cognitive stimulation programs aimed at the old population, especially in residential institutions.

Garantías en el ejercicio de un derecho social en el marco de una difuminada relación entre público y privado: no da lo mismo

La implementación de la Ley de Promoción de la Autonomía personal y Atención a situaciones de Dependencia (LAPAD), en la Comunidad Valenciana ha sido un escenario privilegiado para la observación y el análisis del impacto de la relación entre público y privado en un derecho social reconocido. Este artículo condensa algunas de las conclusiones que derivan del estudio de caso sobre el ciclo de vida de esta Ley en la Comunidad Valenciana durante el periodo 2006-2012. El objetivo de esta investigación es identificar las razones que contribuyen a incrementar la brecha entre la formulación legal y su efectiva implementación. Los resultados obtenidos fijan la atención en aquellas dimensiones que remiten al modelo institucional que acoge el derecho social y aquellas condiciones que posibilitan o dificultan su pleno ejercicio, siendo uno de los obstáculos identificados en el reconocimiento y ejercicio del derecho la relación público-privada en la política social valenciana.

Los modelos territoriales de organización social del cuidado a personas mayores en los hogares

La mercantilización de los cuidados familiares a través del serviciodoméstico y la incorporación de prestaciones económicas desde laentrada en vigor de la «Ley de Promoción de la Autonomía Personal yAtención a las Personas en Situación de Dependencia» (LAPAD) han sidolos cambios más relevantes que en la última década ha experimentado laprovisión del cuidado doméstico dirigido a las personas mayores. Dada ladiferenciación interna existente en España en cuanto a la extensión de losservicios sociales, los subsidios dirigidos a la asistencia y la privatización,el artículo se centra en indagar sobre la emergencia de variados modelosde organización social de los cuidados entre las ComunidadesAutónomas y determinar el carácter regional de los mismos. Mediante laaplicación de un análisis de correspondencias se presenta unaclasifi cación de la distribución territorial de los cuidados familiares,públicos y privados en cada una de las regiones.

Cuidados, género y transformación de identidades

Nowadays social care crisis facilitates the emergence of different institutional measures that try to reformulate the unequal distribution of care responsibilities between the market, the state, the family and the civil society, as it is, in the Spanish case, the development of the Law of the Promotion of Personal Autonomy and the Attention to dependent people. In this article, we analyze the frames of sense promoted by this law, as well as the current context in which the social organization of care is being transformed, to understand their contribution to a reformulation of the identities of the care givers and the gender’s social order. Also, the understanding of public policies as a result of the symbolic fights between different social actors, allows us to analyze the main interactions and the hegemonic discourses that influence the definition of social reality, related to social care recognition and its distribution.

Why Nudges Matter: A Reply to Goodwin

This article argues that, contrary to Goodwin's recent arguments, nudges are compatible with the coalition government's stated aspiration to further self-empowerment. This is because, despite its libertarian roots, nudging is compatible with the promotion of personal autonomy and thus can be used to promote self-empowerment in a non-paternalistic fashion. Further, I argue that nudging may play a valid role in tackling large-scale social problems in tandem with other traditional policy measures. Consequently, Goodwin is wrong to reject choice architecture for these reasons.

On the Right of Dependent People to the Promotion of Personal Autonomy and Care

It can thus be seen that human rights try to protect autonomy, favor the exercise of independent acts and the disappearance of dependency not consented to. Autonomy and independence, to a greater or letter extent, form part of the content of these rights. However, it is also possible to construct an individual human right to autonomy of a general character. The recognition of such a general right to autonomy or independence must clear the obstacle of the confusion between the field of justification and that of legal technicality. Such a right must not be enunciated with such a high degree of indeterminacy and abstraction as to make practically impossible the guaranteeing or establishing of its essential content.

Home Care in Spain

The progressive aging of the population in Spain, as in other developed countries, has caused a series of health and social problems for which existing infrastructures have been found wanting. Increased life expectancy is a major root cause of this situation. In Spain's aged population (one of the oldest in Europe), women live an average of 82 years, whereas men live around 74 years. This aging trend will continue to the point that at the end of the first quarter of this century, the current approximate figure of 17% of the population being older than 65 years will reach 33%. These figures were provided by the government agency Instituto de Mayores y Servicios Sociales IMSERSO (Institute for the Elderly and Social Services). As the 21st century began, care services for older person and dependent persons were skewered and myriad and spread out over the public sector through social security, government health services, and different social health agencies. On the other hand, a large part of the care of this dependent population followed a tradition and was in the hands of families and relatives. Most of these caregivers were, and are today, women. In 2004, the Ministerio de Trabajo y Servicios Sociales (Ministry of Labor and Social Services) published a study on dependent persons in Spain. This concluded that 6.44% of the Spanish population (2,782,590 persons) needed support of some kind to carry out activities of daily living. All this support by the public services outlined previously did not meet demand. According to Alzheimer Europe (www.alzheimer-europe.org), in Spain, 1% (at the turn of the current century) of the elderly was receiving government home care services and that the vast majority of elderly dependent people had to rely on informal carers, that is family members. The report also adds that the main aim of the social service networks at the time was to keep the elderly in their homes for as long as possible. Yet with all its problems, home care for the elderly and the attempt to keep elderly dependent patients at home with the best quality of life had evolved in Spain as in other countries as one answer to the gaps in social and medical care. This obviously was not a radical concept at the beginning of the 21st century as home care was, and is, a common situation in Spain where care of the elderly traditionally has been seen as a family obligation. Alzheimer Europe quoting Larizgoitia Jauregui, 2004, states that a 2001 survey found, however, that only 24% of the population believe that children will continue to bear the responsibility for caring for their elderly parents in the future and the number of elderly people living alone is steadily increasing (p. 1). It should be noted that the Spanish Civil Code (Book1), again quoted by Alzheimer Europe, states that all citizens are entitled to health protection and that the spouse and children of elderly dependent people are responsible for their maintenance, which covers everything that is essential for sustenance, shelter, clothing and medical assistance. The extent of the maintenance to be provided depends on the means of the providers and the needs of the dependent person. . . . The main criterion of the social service network is to keep the elderly in their own environment for as long as possible. (p. 2) In this context of a dependent population covered by a series of laws and regulations at different levels-among them the central government (i.e., Social Security), regional Autonomous Communities (the 17 administrative areas into which Spain is divided), and local services-the of Dependency was passed on December 14, 2006, and came into effect on January 1, 2007. Commonly known as La de la Dependencia (Law of Dependency), its full title in Spanish is Ley de Promocion de la Autonomia Personal y Atencion a las personas en situacion de dependencia. Its official English translation used by Spain's government agencies such as the Ministerio de Trabajo y Asuntos Sociales (Ministry of Labor and Social Services) is Law on the Promotion of Personal Autonomy and Care for Dependent Persons. …

A League of Their Own? Evaluating Justifications for The Division of Sport into ‘Enhanced’ and ‘Unenhanced’ Leagues

Cheating through the use of illegal performance enhancements (such as doping) is a persistent problem in sport. It has been suggested that one response to this problem is to separate sport into two parallel leagues. One league would resemble sport as it is currently practised – i.e. with restrictions on use of particular enhancements – and the other would not possess these restrictions, allowing those that wish to use currently illegal enhancements to do so. In this paper I articulate the ‘two leagues’ proposal further and subject it to critical scrutiny. The proposal fails. It does so by failing to address conceptual confusion regarding enhancement use in sport; by replicating in the new league the current problems associated with enhancement-based cheating; and by creating new problems. In an attempt to revive it I describe other possible justifications for the proposal, based on its promotion of personal autonomy, and rights-based justifications. These fail, with the exception of a group right claiming provision of the enhanced league as a participatory good. I conclude that this latter use of the proposal is the only sensible one, but it nevertheless faces significant obstacles.

Implementation of the Dependency Law in Spain. The activities-based cost systems as tools that can facilitate decision-making for the implementation of the Law

The coming into force in 2007 of Law 39/2006 about promotion of personal autonomy and care for people in a situation of dependency has created the right of everyone in these circumstances to be served by public services. This law involves an expansion and complement of the protective action of the State and Social Security System. To date these people have been treated by state, regional and local services by Plans of Action for People with Disabilities or Plans for Older People, and also by the Social Security System through some benefits of it. Social Services Area of the city councils has also been rendering a service in the basic benefits in terms of available resources. The Spanish Federation of Municipalities and Provinces (FEMP) has supported the execution of a project to implement a cost system in the municipalities. Some municipalities have joined this project in partnership with several universities. We have studied different areas of the municipalities, including Social Services, where we have identified: assistance, required activities, consumed resources and a set of activity, cost, environment and budget indicators. The analysis by the people in charge of Dependency Law of the information in the Social Service Area that this project can provide could help them to make efficient and effective decisions on the allocation of limited resources.

La atención a las personas en situación de dependencia: valoración, servicios y prevención

El cambio de la concepción de la discapacidad hacia una visión centrada en la interacción entre la persona, el entorno y la actividad como factores determinantes en el funcionamiento de la persona, constituye la base de la atención a las personas en situación de dependencia. La atención a la dependencia, dentro de la cual se incluyen tanto la valoración como los recursos para la promoción de la autonomía personal y prevención de la dependencia, debe abordarse desde una concepción holística e integral de la persona, considerando en la misma todos los factores intervinientes en el funcionamiento de la persona. El presente artículo presenta los fundamentos sobre los cuales se basa el Sistema para la Autonomía y Atención a la Dependencia, y desarrolla la cartera de servicios existente para ello, prestando especial atención a las medidas de prevención de las situaciones de dependencia. The change in the concept of disability towards a view focused on interaction between the person, the setting and activity as determining factors in the person's functioning is the basis of care to dependent persons. Care for dependent persons, within which both evaluation and resources for the promotion of personal autonomy and prevention of dependency are included, should be approached from a holistic and integral concept of the person, considering all the intervening factors in the person's functioning in it. The present article presents the foundation on which the System for Autonomy and Care to the Dependent Person are based and it develops the existing service portfolio for it, paying special attention to the prevention measures of the dependency situation.

Personal autonomy and informed consent

Two ways of understanding the notion of autonomy are outlined and discussed in this article, in order to clarify how and if informed consent requirements in biotechnological research are to be justified by the promotion of personal autonomy: A proceduralist conception linking autonomy with authenticity, and a substantivist conception linking autonomy with control. The importance of distinguishing autonomy from liberty is emphasised, which opens for a possible conflict between respecting the freedom and the autonomy of research participants. It is argued that this has implications for how consent requirements based on different criteria of specificity and understanding should be viewed and justified.

Autonomy and the Rule of Law

Abstract. In this paper I am concerned with the belief that the moral value of the rule of law is based upon some kind of connection between the rule of law and the respect and promotion of personal autonomy. I identify and analyse two possible connections: the rule of law as a sufficient condition for the respect and promotion of personal autonomy, and the rule of law as a necessary condition for personal autonomy. My conclusion is that neither of these two connections grants the moral value of the rule of law.

Tolerating uncertainty: the exploration of a 10-week stress management course which supports a process of recovery, personal change and educational development for people experiencing stress and anxiety

An exploration of a 10-week stress management and relaxation course which aims to support stressed and anxious learners. As students develop physical relaxation skills for the reduction in symptoms of stress and anxiety, they gain knowledge of stress management theory in relation to their own difficult life experiences and go on to self-select strategies for the management of personal stress and anxiety. The course itself encourages students to explore the notion of uncertainty and discontinuity in relation to their own lives and weaves in a variety of education learning theories, along with Hutton’s model for ‘Learning in Action’. Within this structured, yet experiential learning environment, the underlying aim of the curriculum is the promotion of personal autonomy and the development of metacognition.

Domestic work count! Characteristics and transformations of the domestic service in Spain

This paper explores the characteristics of and transformations that Spanish domestic service has undergone in the since 2000. The paper also analyzes the domestic service’s contribution to the Spanish economy since the beginning of the country’s economic crisis. Relying on quantitative analysis of the domestic work data from the Active Population Survey, the most relevant changes identified are the increase of its demand and the consolidation of migrants workers in it. The paper also looks at the tasks carried out in the households of employers. The recent conversion of the domestic services in a nonprofessional care sector seems to mitigate the burden of personal care work that Spanish families aim to provide to their older relatives. This transformation of domestic work into care work has changed some traditional features of this occupation: the outcomes of qualitative data show changes in the intensification of the tasks carried out, a tendency to higher male workers, a reappearance of live-in workers, and key modifications in the relationship between employer families and employees. Finally, this paper incorporates a short assessment of Real Royal Decree 1620/2011 (which regulates domestic service) and Law 39/2006 (Law on the Promotion of Personal Autonomy and Care for Dependent Persons) to analyze which is the legal space delegate to the labor category related with the non-professional caregivers in private homes.