Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff

Today, family caregivers have options to choose from when they need assistance or respite. And, highly trained and experienced social workers are available to help caregivers sort through the range of available options.  Below is a brief description of some of the caregiving services commonly available. 

Adult Day Care

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

How Do Adult Day Care Centers Operate?

These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.

Assisted Living

Assisted living facilities offer a residential alternative for older adults who may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes.

Assisted living facilities may be part of a retirement community, nursing home, senior housing complex, or may stand-alone. Licensing requirements for assisted living facilities vary by state and can be known by as many as 26 different names including: residential care, board and care, congregate care, and personal care.

Assistive Technology

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
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Note: All names have been changed to protect confidentiality.

By L.B. (LeslieBeth) Wish, Ed.D, MSS

Introduction

Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

Current Issues of Some American Military Families

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.

Fear of Being “Found Out”

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
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Click here to read a Q&A interview about divorce and domestic violence with NASW member Katherine van Wormer, PhD, the author of a number of books including Women and the Criminal Justice System (2007, co-authored with C. Bartollas) and books on addiction and human behavior. Dr. van Wormer teaches Social Work at the University of Northern Iowa.

Dr. van Wormer has published seven articles on www.HelpStartsHere.org http://www.helpstartshere.org/Default.aspx?PageID=1217

By Nella Hahn, LMSW

Introduction

Of all the taboo subjects we encounter there is probably none as dramatic as the topic of incest. Often referred to as the “silent crime,” one out of three girls and one out of six boys will have been abused sexually by their eighteenth birthday, and of those, twenty percent will have experienced an incestuous incident.

Incest is described as sexual activity between family members who are legally and customarily forbidden to marry. This includes blood relatives such as brothers and sisters, parents and children, grandparents and grandchildren, or aunts or uncles with nephews or nieces.

Different cultures ascribe different considerations as to what constitutes incest, such as relation by birth as opposed to adoption or marriage. In some cultures, unrelated individuals who have grown up in the same household and who have engaged in sexual relations are considered to have committed incest.

Incest can occur between same-sex as well as opposite-sex relatives. Incest is a crime in every state in this country. It can occur between people of any age, in any culture, class, religion or gender. Incest is most frequently categorized as a type of abusive behavior since the victim is often a younger relative falling prey to the behavior of an older relative.

Children

Children victimized by incest are generally afraid to disclose what has occurred, sometimes out of fear that they will suffer greater consequences if they tell someone or because they fear that they will not be believed. They may fear that harm will come to the perpetrator if they are believed, or that the perpetrator might retaliate in some other way.

Children are often embarrassed and ashamed about what has occurred. Many children are taught not to tattle, especially on parents, and thus telling exacerbates the guilt that they may feel. Daughters, as they mature, may recognize the triangulation that occurs within their home, and identify with the painful feelings their mothers experience upon disclosure of the crime. The experience can negatively saturate one’s sense of self, one’s relationships, and one’s world view.

A Sense of Loss

It is not possible to experience incest without experiencing a sense of loss, whether loss of youth, loss of self-esteem, or loss of trust. Many incest survivors experience problems in intimacy. They may have trouble expressing how they feel for fear of being devalued. It is not unusual for victims to develop problems with eating such as anorexia, bulimia, or obesity.

An incestuous childhood can destroy an individual’s self-esteem by creating unrealistic views of who they are. Incest victims frequently suffer from depression. They may live with an unrelenting negative self-image regardless of how they are viewed by others. They may feel unworthy and unlovable, in fear that if their story were known they would not be accepted by others. Incest, rather than their deeds and accomplishments, begin to define the individual. Many incest survivors describe feeling that their character is severely blemished and that they must maintain secrecy in order to keep others from discovering how bad they really are.

Empathy

Victims must focus on themselves, attempting to bring normalcy into an otherwise chaotic existence. Yet, it is not unusual to hear victims of incest express strong concerns for the abuser, recognizing the underlying emotional deficits of the perpetrator. Although this is not a typical approach to the incest experience, many victims express concerns about the person who victimized them. For instance, it is not unusual for a sister to speak kindly of a brother who may have tormented her for years, all the while cognizant of the abuse he himself may have received.

Victims may express empathy for the parent/wife/sibling of a person accused and even convicted of this heinous act. Victims of incest frequently worry about the punitive actions imposed upon the abuser; sometimes because they themselves believe they are responsible for what happened, or sometimes because they understand the forces that may compel some individuals to commit crimes against human nature.

Methods of Healing

Healing begins when the silence is broken. Although seemingly a frightening task, especially after years of concealment, it is possible to reach out to others. Some methods of healing include:

• Locating a support group. Sharing your story in a safe environment is a start. The group process is a powerful course of action offering safety and protection. Check with local hospitals or mental health clinics to find a nearby group.
• Exploring reading material offered by national incest survivors groups. There is much free literature online as well as locations of local support groups.
• Tell your story. It is an important step in leading to self-confidence. It will also help others by letting them know that they are not alone, empowering all involved.
• Relearning to trust. Allowing yourself the opportunity to trust is one of the first steps in eliminating isolation and despair.

Conclusion

There are no easy answers or solutions to the crime of incest. But one need not live a life of isolation, resentment and loathing; feelings that only serve to stir up more negativity. It is not necessary to forgive the abuser, but it is necessary to forgive one’s self. The survivor has done nothing wrong. If the survivor chooses to forgive the abuser it does not mean that all negative feelings about the experience are forever banished.

Feelings are cyclical and even years after a victim has “forgiven,” events may occur that stir up feelings of resentment and loss once again. Dealing with incest is a difficult task, but there are ways that enable survivors to begin the process of healing and recovery. The important thing to bear in mind is that even though trust and self-esteem may have been shattered, they can be rebuilt. It takes time and work but the reward is that the process of reclaiming your life will begin.

Nella Hahn is a New York State Licensed Social Worker whose clinical practice is in the Hamptons, New York. In addition to having received her MSW from Hunter College School of Social Work, she received her Bachelors in Psychology from Marymount Manhattan College as well as a Certificate in Bioethics and Medical Humanities from Albert Einstein College of Medicine. While completing her degree in psychology, she worked as a rehabilitation specialist at the Brain Injury Day Treatment Program of Rusk Institute for Rehabilitation Medicine where she assisted individuals who had sustained traumatic head injuries, as well as their families. Nella Hahn is an affiliate member of the New York State Society for Clinical Social Work as well as a member of the National Association for Social Workers.