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Tip Sheet for August 2001
Elderly Tend To Hoard
Objects In Household
Objects such as newspapers, containers and other papers fill
homes of predominantly elderly women to the point where living space cannot be
used creating increased functioning and health problems.
In a study in the August issue of Health and Social
Work—a journal from the National Association of Social Workers (NASW)—Gail
Steketee, PhD, from the School of Social Work at Boston University, Randy Frost,
PhD from the Department of Psychology at Smith College, and Hyo-Jin Kim, MA, a
doctoral student at Boston University found that hoarding, a debilitating
disorder characterized by the large accumulation of possessions that clutter
living areas to the degree that those spaces cannot be used for their intended
purpose, occurs in a majority of elderly women’s homes who have never been
married and live alone.
The study interviewed service providers who work with older
people in the Boston area. Many of the elderly hoarders live in urban locations
in apartments and averaged an annual income between $10,000 and $40,000, with
most falling into the lowest income bracket.
According to the authors, the never-married status was
linked to more severe hoarding symptoms—significant clutter in the home,
inability to use parts of the living space for intended purposes, and impairment
in functioning as a result of the hoarding—possibly reflecting greater
attachment to possessions for those who did not have a partner.
The majority of objects collected consisted of old
newspapers, containers, and other miscellaneous paper and was predominantly
found in the living room, dining room, kitchen, bedroom, and sometimes even the
bathroom.
For most of the elderly, the clutter also represented
serious physical threats, including a fire hazard, falling, and unsanitary
conditions.
Many elderly hoarders had some form of mental disorder, such
as affective, personality, psychotic, and anxiety disorders, according to the
authors.
Involuntary cleaning of the homes is not a solution to this
problem. Hoarding is a multi-faceted problem that involves difficulty with
information processing and emotional attachment, erroneous beliefs about
possessions, and behavioral avoidance. Effective treatment is likely to require
modification of faulty beliefs, assistance with organizing and decision making,
and examination of emotional attachment and behaviors that promote hoarding, say
the authors.
They propose intervention likely to alleviate the problems
caused by the hoarding are ultimate goals to enable the elderly to live
effectively and safely in their homes.
DEATH: IS IT A
CHOICE?
The Role of Values in End-Of-Life Decisions
Research reveals the values of competence, integrity,
loyalty, and legacy as the driving values behind decisions at end-of-life. These
values in different life domains; including physical-biological,
social-psychological and societal were also connected by the values of dignity,
quality of life and quality of death.
The authors, Ronit D. Leichtentritt, PhD, a lecturer at Bob
Shapell School of Social Work in Tel Aviv and Kathryn B. Rettig, PhD, a
professor in the Department of Family Social Science at the University of
Minnesota, St. Paul, intended to encourage individuals to talk about end-of-life
decisions as a valuable experience and an opportunity to clarify
intentions.
The study, of elderly Israelis, used four hypotheses for
end-of life—withholding treatment, where life is not prolonged by machines;
withdrawing treatment, taking life-sustaining machines away; active euthanasia,
a physician administering drugs to take a patients life; and physician assisted
suicide, a physician supplying the patient with drugs that when taken will
result in death—and asked the participants and family members how they felt
about each one. The study took place in Israel because of the strong influence
of Orthodox Jewish tradition, the recent recognition of patients’ rights at
end-of-life, and the social norms surrounding care for a dying
patient.
Leichtentritt and Rettig found that participants made a
separation between two forms of non-voluntary end-of-life decisions on the basis
of their role in the decision. In other words, different priority of values
guided the decisions made by self for another family member, compared with the
decision made by another family member made by self.
Participants talked about their biological self when
referring to the value of competence. They also included strength, energy,
endurance, health, appearance, dignity, and qualities of life and death. When
referring to the social-psychological life domain, they highlighted personal
values such as integrity, control, rights, wholeness, dignity, and qualities of
life and death. In the family life domain, loyalty was the main value underlying
end-of-life decisions, regardless of whether the decision was made by members of
the family for self, or made by self. When participants took the perspective of
citizens in society, they emphasized terminal social values, including legacy,
heritage, and community.
Ecological theory acknowledges that an end-of-life decision
is an individual, relational, and social-cultural phenomenon. Participants in
the decision-making process took into consideration social, community and family
contexts, giving attention to past (heritage) and future (legacy) time
perspectives, say the authors.
Reduced Home Health Care Services Cause
Ethical Dilemmas for Social Workers
In a study published in the August issue of Health and
Social Work—a journal from the National Association of Social Workers
(NASW)—home health care workers, including social workers, report ethical
conflicts when a patients safety is in question due to decreased mental and
physical capacity and, also important, lack of access to services.
The study’s authors, Goldie Kadushin, MSW, PhD, an associate
professor at the School of Social Welfare at the University of
Wisconsin—Milwaukee, and Marcia Egan, MSW, PhD, an associate professor at the
University of Tennessee, Memphis, found that social workers in home health care
settings felt that assessing patients’ mental competence, patient access to
services, and patient self-determination were the most frequent ethical
conflicts and the most difficult to solve in the home health care
setting.
In 1997, as part of the Balanced Budget Act, the Interim
Payment System (IPS) was implemented. According the Department of Health and
Human Services, the IPS attempts to control the cost and amount of services
provided to beneficiaries through the application of payment limits.
In response to this legislation, agencies refused to provide
care for the sickest and frailest beneficiaries who require more services or a
longer duration of services, while targeting care to relatively health
beneficiaries.
This causes an ethical dilemma for the social worker who is
pressured by the employer to restrict access to services or prematurely
terminate service, despite what might be in the best interest for the patient.
The social worker in this situation is ethically obligated
to advocate for patients in their agencies and also on a social level, for
health care regulatory reform through the political process.
The National Association of Social Workers (NASW), in
Washington, DC, is the largest membership organization of professional social
workers with 153,000 members. It promotes, develops and protects the practice of
social work and social workers. NASW also seeks to enhance the well being of
individuals, families and communities through its work and through its
advocacy.
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