1

UNIVERSITY OF WISCONSIN-MILWAUKEE

HELEN BADER SCHOOL OF SOCIAL WELFARE

Social Work 945 - FAMILY AND LONG-TERM CARE ACROSS THE LIFE COURSE

Semester: Spring 2013

Instructor: Rhonda Montgomery, PhD

Office: 1157 Enderis Hall

Phone: (414)229-3289

FAX: (414)229-5311

e-mail: rm@uwm.edu

Office Hours: 3 – 5 PM Thursdays

Time/Location: Tuesdays; 2:00 to 4:45 pm

COURSE DESCRIPTION: This course uses the life course perspective to examine the family role

in the provision of long term care within the context of kinship care, and care of persons with chronic

illnesses, developmental and adult disabilities. At the micro level the course will examine the effects

of family structures, cultural beliefs, and family histories on the manner in which care is provided and

the impact of caregiving on family members and family dynamics. The development and assessment

of intervention strategies to support family caregivers will also be critically examined. At the macro

level, the course will examine public policies, institutions, and service programs that affect family

caregiving. Special attention will be given to differential impacts of socioeconomic factors. Through

assigned readings and class discussion, students will learn the demographic and social factors that

have made long-term care an imminent social problem. Students will be encouraged to critically

examine social values and public policies that have been invoked to address the problem in the US

and internationally. Readings from international literature on long-term care will also allow

discussion of comparative cultural attitudes, policies, and interventions. Possible programmatic and

societal solutions to the challenge of long term care will be examined with attention given to the

differential consequences of public policies and social programs for different segments of society.

Prerequisites

Social work/sociology doctoral-student status or permission f instructor.

LEARNING OUTCOMES: By the end of this course, students will be able to:

Apply the life course perspective to current and future issues of family caregiving across the life

course.

1. Analyze the historical and current role of government in public policies relating to dependency

and family caregiving across the life course, including demographic and social factors that have

made long-term care an increasingly urgent social problem.

2. Identify the impact of caregiving on family caregivers, care recipients and the family systems.

3. Demonstrate knowledge of federal, state, and local public policies that affect family caregivers

across the life course. 4. Identify the social values underlying public policies and the differential impact of policies on

different segments of the population, including health disparities related to race, gender and class.

2

5. Use knowledge of established research methods to critically evaluate studies supporting micro

and macro interventions and best practices for supporting family caregivers across the life course.

Student Expectations: It is expected that all readings assignments will be completed prior to the

class that they are listed for discussion on the syllabus. Students should also be prepared for in-

depth class discussions and complete any study activities or study questions that have been

assigned to guide preparation.

Required Readings

Caro, F. G. (2007). Family and Aging Policy. New York: Haworth Press.

Buhler-Wilerson, K. (2001). No Place Like Home: A History of Nursing Home and Care in the

United States. Baltimore, MD: Johns Hopkins University Press.

Olson, L. K. (2003). The Not-So-Golden Years: Caregiving, the Frail Elderly, and the Long Term

Care Establishment. New York: Rowman & Little field Publishers, Inc.

Talley, R. & Montgomery R. (2013) Caregiving Across the Life Span. New York: Springer .

(DRAFT on D2L)

Source Books: Large sections of the following books will be used for the class and students may

choose to purchase these books or obtain them through library reserve.

Haber, C., & Gratton, B. (1994). Old age and the search for security. Bloomington: Indiana

University Press.

Hooyman, N. R., & Gonyea, J. (1995). Feminist Perspectives on Family care: Policies for Gender

Justice. Thousand Oaks: Sage Publications, Inc.

Settersten, R. (2003). Invitation to the Life Course: Toward New Understandings of Later life.

Baywood Publishers.

Students must read one of the following books:

Lustbader, W. (1991). Counting on Kindness: The Dilemmas of Dependence (2nd

Ed.) New York: The

Free Press.

McGowin, D. (1993). Living in the Labyrinth: A Personal Journey Through the Maze of Alzheimer’s

Disease. San Francisco: Elder Books.

Students may choose an alternate book with permission of instructor.

Learning Environment and Resources

Most course materials are accessible online to registered students through D2L at

uwm.courses.wisconsin.edu. In addition, all students have access to the Schools of Enderis computer

lab located on the 10th

floor of Enderis Hall and to computer labs located throughout campus (see

https://www3.uwm.edu/IMT/services/campus/ccls/ for specific locations and hours). Campus policies

regarding participation by students with disabilities, accommodations for religious observances,

academic conduct/misconduct, incomplete grading policies, complaint procedures, grade appeal

procedures, sexual harassment and safety policies, final exam date requirements, and other matters

are available at uwm.edu/Dept/SecU/SyllabusLinks.pdf.

Grades will be determined as follows:

3

Seminar participation 20%

Synthesis & Presentation of interventions focused on selected outcome. 20%

Annotated bibliography of interventions for selected Population 10%

Presentation of preliminary final paper and facilitation of class discussion 10%

Presentation of key arguments for class plan to enhance the Affordable Care Act 10%

Final paper on policy/program for selected population 30%

Overview of Graded Assignments

1. Seminar participation – Students are expected to participate in analytical discussions of issues

and assigned reading materials. Class participation will be determined by students’ active

participation in class discussions that reflect thoughtful application of the reading assignments to

class exercises and in-class discussion. With the exception of the first class, attendance at 13 of

the remaining 15 class sessions and active class participation as defined above will result in full

class participation points for class attendance and participation.

2. Synthesis & Presentation of interventions. – Each student will conduct a search of the Applied

Gerontology Data Base and identify and summarize up to 8 papers that report findings about

interventions to address one of the following outcomes:c aregiver health, caregiving skills, uplifts,

mastery(confidence), , interpersohal relationships, or. (Detailed instructions will be posted on D2L)

***This paper is due on Mach 26 on D2L by noon.

3. Annotated bibliography and short summary of key findings (5-6 pages) Students will prepare a

short annotated bibliography (6 to 8 references) regarding interventions for a selected population

and summarize key findings and issues for the class. This information will be presented on March

16. (Detailed instructions will be posted on D2L) ***This paper is due April 2, on D2L by

noon.

4. Presentation of preliminary final paper - Each student will present their paper and facilitate an

analytical discussion among classmates on the issue for a class session on caregiver interventions.

5. Presentation of key elements for the final class project – Each student will contribute to the

development of plan for adapting the Affordable Care Act to better serve family caregivers.

6. Final paper – see appendix

Guidelines for Re-marking Assignments and Exams:

1. If there are individual concerns regarding grading, the entire assignment or exam will be remarked

to ensure fairness.

2. Grades could either increase or decrease depending on remarking.

3. Re-marking can only be requested one week after grades are posted.

4. Students must submit a detailed explanation (1 page) of why their assignment warrants a

reexamination.

4

Late Submissions: Late assignments and/or exams will be “down graded” by 5% per 24 hours past

due date/time. Assignments more than one week late will not be accepted without prior approval for

emergency situations.

Class Schedule & Readings

Session Topic/Readings Tasks & Assignments

Session 1

1/22

Introduction to Course

Who needs care, what kind and why?

Demographics of long-term care Aging populations

Persons with Disabilities

Veterans

Kinship Care (Grandparent Caregivers)

Family Structures

http://www.aarp.org/relationships/grandparenting/info

-

12010/more_grandparents_raising_grandchildr

en.print.html

http://www.aapd.com/resources/publications/disability

-compendium-2011.pdf (disabilities)

http://www.census.gov/prod/2012pubs/p70-131.pdf

(Americans With Disabilities)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27244

54/pdf/1651.pdf (OEF/OIF) PTSD

http://www.va.gov/VETDATA/docs/Demographics/N

ew_Vetpop_Model/VetPop2011_ExSum_Fina

l_123112.pdf (veterans)

http://www.census.gov/newsroom/releases/archives/fa

cts_for_features_special_editions/cb12-

ff17.html (grandparents)

Assignment: Create a one

page summary of family

living arrangements by

historical era and reasons

for these arrangements. due

1/29

Session 2

1/29

Theoretical and Historical Perspectives

Life course perspective

Due: (One page summary

of family living

arrangements by historical

5

Session Topic/Readings Tasks & Assignments

Settersten, R. (2003). Propositions and controversies

in life-course scholarship, In R. A. H.

Settersten (ed.), Invitation to the life course:

Toward new understandings of later life (pp.

15-45). Amityville, NY: Baywood Publishing,

Inc.

Elder, G. H., & Johnson, M. K. (2003). The life course

and aging: Challenges, lessons, and new

directions. In R. A. H. Settersten (ed.),

Invitation to the life course: Toward new

understandings of later life (pp. 46-85).

Amityville, NY: Baywood Publishing, Inc.

Moen, P., Robison, J., & Fields, V. (2000). Women’s work

and caregiving roles: A life course approach. In E. P.

Historical look at family structures & family Care

Haber & Gratton (1994) – Chapter 1 & 4

Hooyman & Gonyea (Chapters 2,3)

era and reasons for these

arrangements)

Assign focus population.

Assign paper to be

presented in session 3.

Session 3

2/5

Patterns & Themes of Family Care Talley &

Montgomery (2013) Caregiving Across the Life Span.

Springer. Chapters 1-7, 9

National for Caregiving, Caregivers of Veterans (2010) –

Serving on the Homefront, Report of Study Findings. , pp

1-38.

http://www.caregiving.org/pdf/research/2010_Caregivers_

of_Veterans_FULLREPORT_WEB_FINAL.pdf

Hayslip, B. & Kaminiski, P. (2005) Grandparents Raising

Their Grandchildren: A review of the Literature and

Suggestions for Practice. The Gerontologist 45(2) pp 262

269.

Suggested:

Fuller-Thomson, E., & Minkler, M. (2000). African

American grandparents raising grandchildren: a national

profile of demographic and health characteristics. Health

and Social Work, 25 (2): 109-118.

TBA: Caring for family members with developmental

disabilities.

Students present &discuss:

Patterns of care for one

population.

Assign: policy to be

presented during Session 5

Assign: International paper

to be presented in Session

5.

Session 4 The state’s role in long term care: Alternative

6

Session Topic/Readings Tasks & Assignments

2/12

views of state, family and individual responsibility.

Major Government Programs

Medicare

Medicaid

Older American’s Act

Friedland, R. (2001). Medicaid. In G. L. Maddox

(Ed.). The Encyclopedia of Aging. New York:

Springer. **

Takamura, J. (1999). Getting ready for the 21st

century: The aging of America and the Older

Americans Act. Health & Social Work, 24(3),

232-238.

Feinberg & Newman: TBA (Paper to be added on

National Family Caregiver Support Program)

Family Beliefs and Expectations

Brody paper: TBA

Guberman et al., Baby Boom Caregivers: Care in the

Age of Individualization . (2012) Gerontologist

52(2) 210-218. Doi.10.1093/geront/gnr 140

Guberman et al., Families’ values and attitudes

regarding responsibility for the frail elderly:

Implications for Aging Policy. . In F. G. Caro

(Ed.), Family and Aging Policy (pp. 59-78).

New York: Haworth Press, Inc.

Gaugler, J. E., & Teaster, P. (2007). The family

caregiving career: Implications for community-

based long-term care practice and policy. In F.

G. Caro (Ed.), Family and Aging Policy

(pp.141-154). New York: Haworth Press, Inc.

Hooyman & Gonyea (1995) Chapters 5; pp 105-119

Montgomery, R.J.V. (1999). The Family Role in the

Assign : book for session 8

Assign: Outcome to be

discussed in session 6

7

Session Topic/Readings Tasks & Assignments

Context of Long-Term Care. Journal of Aging and

Health, 11(3), 401-434.

Session 5

US Public Policies and Programs (Federal) 1. Kinship Policies (welfare reform) 2. Income & Work place (Social Security, Tax an

FMLA) 3. Disability Policy 4. Veterans

Wagner,D (2007) Families, Work and an Aging

Population. Developing a Formula that Works

for the Workers In F. G. Caro (Ed.), Family

and Aging Policy (pp (115-126). New York:

Haworth Press, Inc.

Wisensale (2007). Commentary: What role of the

Family and Medical Leave Act in long-term

care policy? In F. G. Caro (Ed.), Family and

Aging Policy (pp.79-94). New York: Haworth

Press, Inc.

Turnbull III, H. R., Stowe, M. J., Agosta, J., Turnbull,

A. P., Schrandt, M. S., Muller, J. F. (2007).

Federal family and disability policy: Special

relevance for developmental disabilities.

Mental Retardation and Developmental

Disabilities Research Reviews, 13(2), 114-120.

Anderson, S. (2006). The Impact of State TANF

Policy Decisions on Kinship Care Providers.

Child Welfare Journal, 85(4), 715-736.

Copen (2007). Welfare reform: Challenges for

grandparents raising grandchildren. In F. G.

Caro (Ed.), Family and Aging Policy (pp. 193-

210). New York: Haworth Press, Inc.**

International Perspective

Walker, A. (2000) Sharing Long-term Care Between

the Family and the State – European

Perspective Ch. 4 (pp 78-106) in Liu and

Kendig.

Laporte, A., Croxford, R., Coyte P. (2007). Can a

Students: lead discussion

about one type of policy and

its implications for LTC.

Students present one paper

on ltc policy and the family

role in a different country.

8

Session Topic/Readings Tasks & Assignments

publicly funded home care system successfully

allocate service based on perceived need rather

than socioeconomic status? A Canadian

experience. Health Social Care in the

Community, 15(2): 108-119.**

Johansson, L., & Sundstrom, G. (2007). Policies and

practices in support of family caregivers –

Filial obligations redefined in Sweden. In F. G.

Caro (Ed.), Family and Aging Policy (pp.7-

26). New York: Haworth Press, Inc.

Stuart, M., & Boll Hansen, E. (2007). Danish home

care policy and the family: Implications for the

United States. In F. G. Caro (Ed.), Family and

Aging Policy (pp.27-42). New York: Haworth

Press, Inc.

Mehta, K. K. (2007). A critical review of Singapore’s

policies aimed at supporting families caring for

older members. In F. G. Caro (Ed.), Family

and Aging Policy (pp.43-58). New York:

Haworth Press, Inc.

Zhan (TBA)

Session 6

2/26

Impacts of Family Caregiving & Causal Paths

1. Caregiver burden and stress

2. Caregiver Health

3. Economic

4. Work and family costs

TBA

Students lead discussion

relevant to one outcome

drawing on assigned paper

and selected population.

Assign: meta-analysis &

outcome variables session

9)

Session 7

3/5

Costs of Dependency

Olson (2003) – Chapter 5**

Baltes, M. M. (1996). What is dependency? In M. M.

Baltes, The many faces of dependency (pp.1-

24). New York: Cambridge University

Press.**

Each student selects one of the following to read

and present to the class.

Students. Give book report and lead discussion about the experience of dependency.

9

Session Topic/Readings Tasks & Assignments

Lustbader: Counting on Kindness

McGowin: Living in the Labrynth Taylor, R. My Story: Alzheimer's From the Inside

Out

Discussion of Equity of Costs (Public Vs Private)

TBA

Session 8

3/12

Interventions for Family Caregivers I – Linking

Research to Practice

Rahman, Annie, R. Applebaum, What’s all this about

Evidenced –based practice? The roots, the

controversies and why it matters. Generations.

34(1) 7-12.

Prohaska, Thomas R. & Caryn Etkin (2010) External

validity and translation from research to

implementation. Generations 34(1) 59-65.

McCallion, Philip, L. A. Feretti (2010) Social Work

& Aging: The challenges for Evidence-based

practice. Generations 34(1) 67- 71.

Whitelaw, Nancy (2010). System Change and

Organizations Capacity. Generations. 34(1)

43-50.**

Belle, S. H., Czaja, S. J., Schulz, R., Zhang, S.,

Burgio, L., Gitlin, L., Jones, R., Mendelsohn,

A. B., & Ory, M. (2003). Using a new

taxonomy to combine the uncombinable:

Integrating results across diverse caregiving

interventions. Psychology and Aging. 18(3),

396-405.

Theory

Pearlin: TBA

Montgomery and Kosloski: Chapter 8 in Talley &

Montgomery

.

10

Session Topic/Readings Tasks & Assignments

3/19 Spring Break

Session 9

3/26

Interventions for Family Caregivers I I– Linking

Research to Practice

Meta-analyses

Sorensen, S., Pinquart, M., & Duberstein, P. (2002).

How effective are interventions with

caregivers? An updated meta-analysis.

Gerontologist. 42(3):356-7. **

Zarit, S. H., & Femia, E. E. (2008). Behavioral and

psychosocial interventions for family caregivers.

American Journal of Nursing, 108 (9, supp), 47-53.

Singer H.S.. (2007) Primary and secondary effects of

parenting and stress management interventions

for parents of children with developmental

disabilities: A meta-analysis. Mental

Retardation and Developmental Disabilities

Research Reviews, 13(4) 357-369.

Students present paper:

Use intervention database

to identify and summarize

findings related to one type

of caregiver outcome (e.g.

Caregiver health,

caregiving skills, uplifts,

mastery(confidence), ,

interpersohal relationships,

or depression,)

DUE: Paper summarizing

Interventions studies due

on D2L noon of class day,

Session

10

4/2

Interventions for Family Caregivers III: Linking

Research to Practice

.

Reading to be determined by student projects

Student presentation of :e:

Annotated bibliography of

interventions for selected

population

Due: Annotated

bibliography (5-6 pages)

due on D2L a noon day of

class.

Session 11

4/9

Development, Testing and Dissemination of Tailored

Caregiver Assessment and Referral

Montgomery, R.J.V., Kwak, J., Kosloski, K., &

O’Connell Valuch, K. (2011). Effects of TCARE ®

Intervention on Caregiver Burden and Depressive

Symptoms: Preliminary Findings From a Randomized

Controlled Study. Journal of Gerontology:

Psychological Sciences, 66(5), 640-647.

On-Line Discussions

In-class presentation

11

Session Topic/Readings Tasks & Assignments

Kwak, J., Montgomery, R.J.V., Kosloski, K., & Lang, J.

(2011). The Impact of TCARE ® on Service

Recommendation, Use, and Caregiver Well-being. The

Gerontologist, doi: 10.1093/geron/gnr047.

Savundranayagam, M.Y., Montgomery, R.J.V., &

Kosloski, K. (2011). A Dimensional Analysis of

Caregiver Burden Among Spouses and Adult Children.

The Gerontologist, 51(3), 321-331.

Session

12

4/16

On-line

Affordable Care Act : Implications and Challenges

for LTC

Miller, E. (ed.) (2012) Critical Essays on Health Care

Reform: The Affordable Care Act, Long-Term Care,

and Elders, Journal of Aging & Social Policy ,

Special Issue, 24(2) .

Group meeting to plan final class project.

On-Line Discussions &

Group meeting

Session 13

On-line

Alternative Care Settings

Group homes

Nursing home care

Assisted living and continuing care communities

Quality care issues

TBA

On-Line Discussions

Session 14

4/30

Student presentations on chosen policy or program

recommendations.

Class time for preparation for final discussion

Students present on topic of

final paper. Prepare

PowerPoint presentation and

lead discussion

Session 15

5/7

Adapting the Affordable Care Act to Support Family

Caregivers

See Attachment for description of activity.

Class presents integrated

plan

5/14

EXAM

DAY

FINAL PAPER DUE by 5:00 PM

12

APPENDIX

Class Project: Adapting the Affordable Care Act

Due date: May 7

Where: in class

Learning Outcomes: 1, 2, 3, 4, 5, 6

Each student will contribute to the development and presentation of a viable proposal to amend the

Affordable Care Act (ACA) to support adults needing long term care and their family caregivers in an

effective and equitable manner.

The proposed plan should include the following information:

Summary of key of elements the current legislation that address long term care needs.

Limitations of the current ACA for various population groups and family members

Inequities that result from the current ACA

Detailed description of proposed changes and expected benefits (i.e. how will the proposed

changes address limitations of the current ASA?)

Answer the question: what expectations does the proposed adaptation place on family

caregivers?

Likely barriers (political, economic, logistical) to adoption and/or implementation.

Strategies for overcoming barriers.

The proposed plan need not address all of the limitations of the current legislation, but it should

include elements that are likely to improve long term care for some or all segments of the population

and support efforts of family members to provide are.

Presentation Format

Students should prepare a single integrated presentation (and PowerPoint) that addresses each of the

points above.

Each class member should present one or more segments of the presentation

13

Final Paper

Due date: May 15 (final exam day)

Length: 4500-5500 words (approximately 10 pages) excluding references (must include word count)

Where: Due on D2L at 6:00 p.m.

Learning Outcomes: 1, 2, 3, 4, 5, 6

Your task is to design a policy or program(s) that will improve long term care and support family

members caring for a selected population individuals in need of long term care (veterans,

grandchildren, LGBT partners, adults with developmental disabilities, persons with mental health

issues (not Alzheimer’s disease,)foster children). To do this, you may borrow ideas from other

countries, build upon or expand current demonstration programs or simply advance your own ideas.

As you design this policy or program be certain to address the following issues:

(1) Describe the policy/ program in some detail noting major components including when and how it

would be implemented.

(2) Identify key limitations of current long term care system that the proposed policy or program

would address.

(3) Identify the way in which the program would support family members and the role(s) they would

play in providing care. Be sure to define who you mean by “family members”.

(4) Discuss the merits and limitations of the program/policy with regard to

Affordability of the program to individuals and society

Equity of the program for different segments of society

Choice that the program/policy would give to individuals and families.

(5) Discuss the barriers that would need to be overcome to implement your program or policy.

(6) Summarize the primary costs and benefits of the policy/program.

Be sure to use original data sources to support your ideas and statements.

All sources must be cited using American Psychological Association (APA) format. Please refer to

the handout on D2L or access the following link for more information on properly citing sources:

http://www.wisc.edu/writing/Handbook/American_Psychological_Association_(APA)_Documentatio

n_M.pdf