Long Term Care Reform in New Hampshire - Research Paper Example

 Long Term Care Reform in New Hampshire    Background:  The word care means concern for another being. When we feel sympathy, empathy, affectionate or anxious towards someone it can be said that we care for that person. Care is a kind of feeling that develops within our minds for somebody intimate to us. Sometimes on the contrary we are forced to express care but that does not mean we feel the same care which we express. Giving on the other hand has different connotations. For example giving can be in the monetary terms and at the same time giving can be out of love and compassion. Giving may arise also under compulsion. Therefore we can say that giving cannot have a particular characteristic. It is multi dimensional. Taking cue from the definition of care as well as giving if we try to combine both the terms we can see that care giving can also have different meanings depending on the context. For example when empathy combines with compassionate giving it develops into informal care giving that is the care giving which we receive from our family and friends. Similarly when care gets combined with monetary giving it takes the form of formal care giving that is the care giving which we get from professionals and it becomes their duty to care for us. Thus we can say that care and giving when combined together can give rise to different types of care giving. Care giving is a term commonly used in all aspects of life whether it is physical or emotional. Individuals need the care of others in times of crisis and the expression of care or concern can either be formal or informal. The main importance of care was to relieve an individual of stress because at times an individual’s capacity may not suffice to bring about improvement of a particular situation. (Hvid, Hasle and Bilfeldt, 2003). Gender plays an important role in the concepts of care giving. It can be said that genders are stereotyped in the task of care giving. Studies have found out that men give less care that is they express less concern as compared to the women. It is the women who invest more energy in providing care to the older relatives of the family and the children. Gender at one point of time has become one of the components of the identity of the caregiver. Moreover the social structure also determines the role of a care giver in the society. (Kramer and Thompson, 2002) Care giving is a part of all social systems. For instance care giving of the employer to the employees in case of organization constitutes an important part of care giving in the society. The goal of the paper is to explore the concept of care giving from all possible angles. Specific Goals: Concept Analysis is a “strategy through which a set of attributes or characteristics essential to the connotative meaning or conceptual definition of a concept is identified”.  ( Pett, Lackey and Sullivan, 2003,22). Thus concept analysis is useful in the sense it helps to find out the attributes related to the concept. Concepts on the other hand can be defined as constituents of mental propositions or thoughts. It can also be said that, “concepts map out the fine structure of beliefs”, (Bos, Read, Thomas and Paulus, 2001, 3). Thus it is very essential to analyze the various concepts in order to develop a clear understanding of the concepts and to be able to use the concepts in the right context. Before conducting analysis on a concept the case may so happen that it seems to be pretty simple but once we analyze the concept it can be found that it has a lot of complexities attached to it. The reason as to why I chose the concept of care giving for analysis was primarily because I wanted to find out the status of care giving in the context of the modern world. In the present age giving of care has declined especially in the family sphere as the members do not have time to provide care to those who need it. Apart from the family the concept of care giving is also receding in the professional front as the employers are more concerned nowadays with gaining profits than in looking after the well being of the employees. Even in the field of medical practice care giving has become very professional in nature. The giving of care or the expression of concern is a more of a profession in the present age and that is the reason I got the interest to explore the concept of care giving. Assumptions: There have been certain assumptions related to the concept of care giving: The incidence of family care giving has declined in the recent times. Care giving is being chosen more in the case of social as well as psychological support. Care giving has taken a very professional approach. Proper care giving has a negative effect on an individual’s existence. Nurses can be important source of care giving to the individuals. Proper care giving enables an individual to function effectively in the society. Care giving poses too much expectation on the women of the society.  Analysis: Concept analysis is fruitfully carried out by looking at all the definitions of the concept. It also includes examination of all the characteristics of the concepts and all the antecedents present. All the consequences present and the importance of all those consequences also fall under the purview of concept analysis. Carrying out a thorough literature review assists in carrying out the analysis of concept in an effective manner. Definitions: A number of definitions are found for the concept of care giving under the scope of our study. Care giving may be defined as a process in which a doctor, a nurse or a social worker helps in the treatment of a disease or disability. It can also be defined as means by which the parents or the family members attend to other dependant members of the family. Care giving is also a process which helps to sustain life and care giving is a way of life. Caring at the same time is fundamental for the human society. (Goddon, Benner and Noddings, 1996). Merriam Webster Collegiate Dictionary ninth edition says that caring means feeling concerned and troubled. Caring on the other hand also includes feelings of affection, care, responsibility and attending to the need of the person. The working definition of care giving includes affection and responsibility in combination of actions which is able to bring about well being of an individual. Giving of care on the other hand means portrayal of concern towards a living being. Care giving involves physical care like feeding a person and emotional care at the same time which includes a tender touch, supportive talk, empathy and affection. It also includes other activities like driving someone to the store or arranging for a person’s medication in the hospital. (Cancian and Oliker, 2000). Thus we can see that care giving has a wide range of definitions. As per as care giving is concerned there are certain contexts of care giving like the socio cultural, socio political and familial context. That means care giving is present in all aspects of our lives. Giving of care generally begins in the family, when a member is emotionally or physically unfit. In that case the primary care begins in the family and when the family is unable to provide further care the task of care giving is transferred to a formal method of care giving. With the term care giving the term care giver is closely associated. A care giver is a person who undertakes the physical or emotional care of an individual. The role of a care giver also varies with different situations for example at one point of time the mother may be the care giver for an individual but after some time the situation may be such that the wife becomes the care giver. A very important thing that we should keep in mind is that a care giver while caring for an individual should not become dependent on that person and also in the process should not forget to care for oneself. Thus we can say that care giving incorporates in it basically the two broad aspects those are physical care and emotional care and the term care giver is of utmost prominence in the concept analysis of care giving.  Theoretical Framework:  The concept of care giving has some theoretical framework. For instance the socio biological theory states that an adult is naturally likely to care and protect for it’s off springs and that is the reason as to why mothers tend to care a lot for their children and in fact parents of a child carry out the primary responsibility of care givers in the lives of the children. Thus it can be said that the close the familial tie the more is the scope or desire for providing care. (Theoretical definition). Such a statement about the incidence of family care can be seconded by a fact sheet published by the Public Policy Institute which has said that in the US almost 80 percent of the care is provided by the family members. To judge the intensity of family care it can be said that the value of family care was around 196 billion dollar in the year 1997 if family care was replaced with paid care. Surveys carried out by various organizations found that around 45 to 52 million individuals were related to family care giving. (empirical referents) (Coleman and Pandya, 2002). But this at the same time do not mean that the family is always best equipped to provide care, the professional care givers are rather more equipped in terms of care giving. Hence it is not always wise to depend on familial care giving. (Bornstein, 2002)   Defining Characteristics: An attempt to talk about the defining characteristics of care giving is actually an attempt to understand the individual process related to care giving and the particular situations which rise in care giving or it also talks about the particular behavioral elements and characteristics element of the individual care givers.  Care giving is a concept which includes both physical and emotional care of an individual. The need of clinical care arises in case when the family of a person fails to provide for the emotional need of the person and the person has to turn to a professional care giver to fulfill all his or her needs. Secondly in a situation when change takes place in a family; a family member may need the assistance of a care giver to be able to adjust to the changed condition. Thirdly in case of familial conflict it may be absolutely necessary for some persons to approach a care giver because he or she is not able to adjust to the stress that the familial conflict provides. There are several factors which create a dysfunctional family like cases of job loss, trauma, serious surgeries and bereavement. In all of these cases an individual may seek the help of a care giver. (Craven and Hirnle, 2008) The best possible outcome of care giving is when it enhances the quality of life of all those individuals who seek the assistance of care givers. At the same time providing care can have both positive and negative consequences. This is because care giving is too personal a domain and it becomes very difficult to predict how a care giver will react to a particular individual who is in need of the care giving. The positive consequences which are brought about by family care giving are improving the quality and meaning of life, increasing the autonomy of the self and last but not the least is reducing the amount of family stress and increase the capacity to deal with the stress. ( Lubkin and Larsen, 2002). There are certain factors that influence care giving and the care givers. Care giving at times may cause a lot of stress for the care giver. Factors that generally effect care giving are the intensity of care that has been provided, the pattern of care giving tasks that are being performed. It also depends on the individual characteristics of the care giver, the gender of the care giver, the relationship that develops between the care giver and the person who is being offered care, the extent of support received from the family members and the obligations that the care givers have. Various studies conducted have found out that the stress which the care giver undergoes can easily be termed as strain or a kind of burden. A care giver is strained when the patient is illogical, manipulative and does not bother to appreciate the care giver and instead demands more and more from him or her. Burden takes place when the patient is more disabled because in that case the care giver needs to produce more care and hence is burdened. It has been found that persons who care for dementia patients report more depression than those of the non-dementia care givers. They report to be more emotionally stressed and burdened and not only that they are found to develop more of depressive disorders. A study carried out by the members of AARP in Maryland has found out that 58 percent of the care givers report to be extremely stressed due to care giving. Not only that but also 67 percent of the care givers said that care giving has forced them to lose their social life to a large extent. And around 70 percent of them said that care giving leaves them with almost no time for family and friends. (empirical referents) (AARP members, 2008). Gender plays an important role in determining care giving responsibilities. Studies have revealed that women care givers report more of emotional stress than their male counterparts but on the contrary it has also been found that female care givers continue to be attached with the care giving profession than the male care givers. Researchers have also found that it is unlikely for the female care givers to engage in preventive health care measures and as a result they remain more stressed than the male care givers. “Burnt out” is a term in close association with the profession of care giving. It means a kind of physical, emotional and mental exhaustion that the care giver experiences in the profession of care giving. Prolonged exposure to the sufferer causes immense stress for the care giver and at times in a family one care giver may be replaced by another family member or a professional care giver because the initial care giver is unable to carry out his or her duties due to the excessive physical or mental stress that he undergoes. In some cases it has been found that the women care givers in a family who depend on the care recipient or the family members of the recipient for all important decisions of the family may be subject to neglect and abuse. In such a case the service of the care giver is not given due appreciation which in turn leads to emotional stress of the care giver. Care giving may sometimes be in excess that is an impaired adult may be provided too much of care at times. Excessive care may bring the physical and emotional health of the care giver under risk. Excessive care when provided by a spouse may affect his or her behavior negatively. It has also been seen that those care givers who experience negative or antisocial behaviors from the care recipient is more likely to develop unhealthiness both physically and mentally. Another case of an excessive care is when the care giver tries to provide for all those activities which the care recipients are able to perform by themselves. Too much of care can actually cause an erosion of the autonomy of the care recipient and the loosing of autonomy is not beneficial to the emotional and physical health of the care recipient. A proper care giving regime should incorporate a perfect balance between providing for the need of the care recipient and at the same time maintaining his or her feeling of autonomy. Thus we can say that the concept of care giving is a vast one by itself and the terminologies or the variables which are closely associated with the concept of care giving is certainly caregivers, emotional and physical care giving, familial and professional care giving, emotional stress and burden and excessive care giving (specify variables) and we are very likely to come across all these terms as we go on with our concept analysis of care giving. ( Lubkin and Larsen, 2002). Antecedents: The concept of care giving has several antecedents related to it. First of all care giving originates from affection and anxiety for the close relatives. That is concern is the main key word that gives rise to care giving. Secondly care giving also originates as need for a profession that is care givers in many cases engage in care giving because through care giving they are able to earn their living which at times support their family. Thirdly care giving is also practiced as a social service that is out of humanity. Some people engage in care giving because they love serving people who are in need. Fourthly care giving may be a part of responsibility that the individual is not able to deny and hence has to carry on the task of care giving. For example a mother caring for a mentally retarded child to some extent is part of her responsibility and she cannot deny it. Care giving may also take place in case of compulsion when a family care giver is forced to take care of a sufferer. For example a case of compulsion happens when a woman is forced to take care of an ailing relative by her in laws. It may also be the case that as the profession of care giving is comparatively easy to enter many men and women prefer it in comparison to other professions.  Consequences: Care giving bears consequences for the care giver as well as the care recipient. In case of the care recipient the major consequences are enhancement in the quality of life, increased ability to cope with the stress of life, easing of physical pains and an availability of a support system through the care giver. In most of the cases it is seen that the care recipient benefits from the process of care giving. Excessive care on the other hand robs the care recipients of some essential qualities like autonomy and control. In case of care givers the consequences are far reaching in the sense that it has both positive and negative consequences in equal proportion. The positive consequences that are related to the profession of care giving are enhanced self concept, developmental improvement, and a scope to be exposed to more of learning experience, a way to achieve financial profits and improved attitude towards the old and the sick. Sometimes the care givers report that they are gifted with money and gifts from the care recipients which are of great value to the care givers. Children care givers especially had mentioned that through their involvement in care giving they are able to achieve a sense of self gratification and an enhanced system of self esteem. They have said that care giving makes them feel worthwhile in the society. The income earned by care givers sometimes helps the family finance to a great extent. (Szinovácz and Davey, 2007) Another important criterion related to care giving is that the cost it incurs. In most of the cases the cost of professional care giving goes beyond the capacity of the care recipients. Especially in the case of long term care, the cost goes beyond the capacity of individuals. In  a study conducted by the AARP it was found that most of the Americans were facing challenges in the issue of long term care and seven out of ten respondents preferred to avail care at home because they were not able to manage the finances which long term care in nursing home involved. (Bridges, 2009) A study in North Carolina by the AARP members has found out that many employees in the US have to carry on the roles as care givers to their families. Such care giver roles affect the productivity of the employees in the manner of late arrival to work, early departure from work, personal phone calls and emotional distraction. The estimated cost related to employee productivity and attrition is high in the US companies. It amounts to as high as 11.4 billion dollars per year. And the cost of unpaid care giving also does shot up to 257 billion dollars per year. (empirical referents) (Dinger, 2004). A prolonged exposure to care giving may impair the emotional as well as physical health of the care giver. The care giver may undergo a lot of emotional stress being unable to cope with the ever increasing demand of the care recipients. In the process of care giving it becomes obvious that the care giver has to undergo a number of situations and at times it becomes difficult for the care giver to deal with all kinds of situation and sometimes they even have to deal with reluctant behavior from the care recipient. In such a case the care giver faces a more serious hindrance to carry out his or her duty. It can be said that a care giving practice becomes effective only when it is able to fulfill the needs of the care recipient and at the same time does not bring about any kind of impairment to the care giver. Model Case: Jan is a lady of 83 years of age and she is the primary care giver of her 87 years old husband who has dementia, sleep disorders and other chronic problems. Although Janet is the primary care giver of her husband and has to assist her husband in all the daily activities yet she continues to work three days a week. Jan reported that she had been working for 25 long years. Her work not only helps to look after the financial needs of the family but also she loves her work a lot. Jan is full of positive attitude. Only at times she has a little problem with her arthritis. And when she is away for her work she arranges for another care giver for her husband. Jan also feels fortunate because she has been able to save enough finances which help her to carry on her husband’s treatment. Thus we can see that Jan has no complaints as a care giver and her act of care giving does not interfere in her life in any way. She is able to deal with all kinds of situations effectively. (Case study of a Working Care Giver, 2007) Thus this case can be termed as a model case because it has all the requisites of proper care giving in the sense, this case of care giving serves the need of the care recipient as well as the care giver. Related Case: Harry has moved into his mother’s apartment so that he can be of some help to his mother. His mother Susan is an old lady and suffers from serious health problems. But as Harry moved in he did not take up the role of the primary care giver but he arranged for a full time care giver who would look after his mother. Harry only communicated with the care giver once a week to learn about the problems and accordingly took actions. Harry’s only duty was to pay for the care giver. Thus we can say that it is a case of related care giving because here Harry does not participate in direct care giving but initiates the process of care giving for his mother through somebody else. Borderline Case: Sam’s parents have come to visit him in his new home for some days. As they leave both Sam and his wife asks Mr. and Mrs. Taylor to visit the doctor to treat their arthritis. This can be treated as a borderline case because it involves the basic concept of care giving that revolves around concern. This is so because Sam and his wife are concerned about the well being of his parents. Contrary Case: Dorothy is a nurse involved in a private hospital. She is fed up with her profession because she feels that it does not pay her adequately and she expresses her anguish on her patients. An old lady had come into the hospital seeking help for Alzheimer’s. Dorothy could not cope with her demands and started abusing her verbally and also stressed her mentally. This particular case can be an instance of case which is contrary to the case of care giving because it violates the basic principle of care giving which is providing of support. Invented Case: Sullivan was a young man of 28. He had married at the age of 26. Few months after the marriage had taken place his wife Sarah became paralyzed after meeting with an accident. Right from then Sullivan has been performing the role of a care giver both in emotional and physical terms. After almost a period of one and a half years Sullivan feels stressed and frustrated. He feels that unlike his colleagues he is not able to enjoy with his wife. He feels overburdened with the task of care giving. This case of care giving brings into light a very important aspect to light that is the emotional stress which the care giver undergoes. Illegitimate Case: Nancy was a member of a social help group and her duty was to provide care to those persons who were mentally not very sound. Accordingly she was assigned the task of care giving for Marc a man of 55. At times Marc exhibited funny behaviors and he used to feel very embarrassed when all those acts were expressed in public. But Nancy gave all the details of Marc’s behavior to all his neighbors. As a result Marc became a laughing stock for the neighbors and even people started calling him names. Hence this is an apt instance of illegitimate case of care giving because an essential principle of effective care giving is maintaining the confidentiality of the patient. But in this case Nancy did not keep up to the norms and hence it was illegitimate. Measurement:  As per as measurement is concerned there is no adequate method available to measure the extent of given care. There are some indicators which are commonly used to measure care giving. The indicators are physical abuse, physical neglect, psychological abuse, and psychological neglect. All these may be assessed based on self reports. (Observable indicator) Self reports are not always proper means to measure care giving because in most cases care recipients are not in a position to report the inadequacies of the care giving offered to them in a proper manner. So an alternative to self reporting have been used which includes an observational checklist which looks for overt signs of abuse and neglect. (Observable indicator) Thus it can be said that the measures of care giving needs a lot of upgradation and alteration to give out more acute results. (Schulz, 2000) Conclusion: The aim of the paper had been to look at the concept of care as well as the giving of care to others from all the possible angles. In our study we have seen that how the giving of care easily became gender stereotyped. Through our study we have been successful in analyzing the concept of care giving extensively. We have realized that the origin of care giving is certainly concern for our fellow beings and in the consequent expression of our concern. Through our concept analysis we have been successful in exploring the fact that most of the care giving originates from the family settings. As we have progressed with our study we have also found that the most essential effect of care giving is obviously an enhancement of the quality of life. At the same time negative connotations related to care giving like too much of care has also been discussed in the paper. Moreover we have also learnt that giving of care may sometimes prove disadvantageous to the care giver in the sense that the care giver may undergo immense strain and stress under the process of care giving. The discussion of various cases of giving of care taking different situations under consideration has also assisted in our understanding of the concept. We have also seen that how the measurement of care giving is still inadequate. On the whole we can say that our goal to analyze the concept of care as well as giving has been well accomplished in the entire study. References 1. AARP Members, (2008). “2008 Survey of AARP Members in Maryland on Care giving” New York: Knowledge Management, available athttp://assets.aarp.org/rgcenter/il/md_caregiving_08.pdf, (accessed on 07/07/2009). 2. Bornstein M, (2002). Handbook of Parenting: Being and Becoming a Parent. Philadelphia: Lawrence Erlbaum Associates. 3. Bos E, Read S, Thomas and Paulus, (2001). Concepts: the treatises of Thomas of Cleves and Paul of Gelria : an edition of the texts with a systematic introduction. Belgium: Peeters Publishers. 4. Bridges K, (February, 2009). “A Balancing Act: AARP Survey on Long Term Care Reform in New Hampshire”. New York: Knowledge Management, available at http://assets.aarp.org/rgcenter/health/nh_hcbs_09.pdf (accessed on 07/07/2009). 5. “Case study of a Working Care Giver”. 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